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#8055 In reply to: Four month post microdiscectomy complications? |
Hi Dr. Corenman,
I’m back and here to tell you that you were right on the money when you said it was inflammation. The last time I was on here I guess was November of 2012 and felt like the world was ending for me especially after the extra pain down the leg.
Well, I decided not to sit around and do nothing. From spending countless hours reading all the doom and gloom on line, one thing I noticed was the folks who had good results after surgery were the ones that moved and moved. I purchased a electric heat pad, got my ice gel packs, and hit the thread mill twice daily along with doing my PT stretches. Surely enough, the first week of this, the pain was intense but I noticed as the weeks went by, the pain down my leg was getting less and less. I manage to be completely off the Ibuprofen by the end of December and Lyrica by early January. My back does have the occasional “ache” but is nothing compare to the previous pain. I’m doing my PT stretches to help strengthen the area.
I forgot to mention in my other posts but before December, I could not sit more then 30-45 minutes but it has improve to 2 hours now. I could probably sit more but I’m not pushing it. I do use a small ice gel pack in my lower back when I’m sitting for more then a hour, probably don’t need it but hey, it helps and works.
Anyway, I would like to send out a heart warm THANK YOU, especially for interpreting my MRI and telling me I had inflamed nerves. Crossing my fingers the relief will be a long time but if it doesn’t, I”m be back asking for your expert advice.
#8051 In reply to: L5S1 Revision Discectomy |The numbness that you find present might have been present prior to surgery but “covered over” by pain in the same area. When the pain abates, the numbness is noted. Manipulation of the nerve during surgery can also create numbness that was not present prior to surgery. Normally, this numbness will disappear over time.
Pain that was not present immediately after surgery can recur in some patients but not normally to the same intensity as prior to surgery. This can occur from the inflammatory cascade (it takes some time for inflammation and swelling to occur), from hematoma (a small amount of blood in the canal can cause inflammation or compression) or from a recurrent herniation (rare but known to happen in the immediate post-operative period).
There is a very small change of the presence of chronic radiculopathy (a preexisting injury to the nerve from the herniation-see website) but that is unlikely.
Return to work depends upon the patient and occupation. If you were one of my professional athletes, you might not go back to competition for 8 weeks. If you were an attorney or CEO, you might go back to work in one week (part time-light duty). Some patients walk out of the hospital without any symptoms and some are uncomfortable for two weeks. Sitting is always the most symptomatic of the prolonged positions in the immediate post-operative period.
You normally want to start nerve glides in about 10 days after surgery. The root should be free of adhesions immediately after surgery and the normal response of the body is to form scar tissue. The nerve root should move about one centimeter with leg or back motion. This is why physical therapy is helpful for prevention of adhesions. The technique is called nerve flossing and is self-descriptive.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.#8050Topic: L5S1 Revision Discectomy in forum BACK PAIN |Hello Doctor Corenman,
Your website is an excellent source of information, and the time you take respond to concerns of people is quite remarkable.
I am a generally fit 46 year old man 5’9” 185 lbs. Two weeks ago I had a revision micro/discectomy/foraminotomy performed on the L5S1 level. I had been suffering some relapses for the last 3 years, but 2.5 months ago, I ended up with severe 10 out of 10 pains from sciatica, with very little relief over that duration and a huge downgrade to quality of life. The MRI report stated “small amount of enhancing scar around the left S1 nerve, disc thinning and degenerative changes in disc, moderate left Para central disc herniation/protrusion impinging the left S1 nerve root”
The original discectomy was performed in 2001 for left leg pain and some foot weakness. It was an open procedure. It was discovered during the revision surgery that the ligamentum flavum was laid back down and left in place after it had been dissected during the original procedure. This resulted in an excess of scarring around the thecal sac and nerve. The Surgeon firs had to decompress this left over ligament first then proceeded to remove the offending disc (about the size of the tip of a pinkie finger). The nerve was not as mobile due to scarring in, and therefore, the Surgeon had to push the herniation down in order to visualize and remove it due to the nerve’s limited mobility.
My main questions are:
1. I awoke with numbness on the left side of my left foot, my left calve, and back of left thigh. I did not have this prior to the surgery at any time. I have read this can occur more frequently in revision surgery, what are your thoughts?
2. My sciatica was gone after the procedure for the first 2 days, then crept back about 20% just in the left butt and slightly down the left back of leg to mid thigh. It was much more intense and far reaching before the surgery. However, I can intensify the sciatica by just palpating my back in the area of the surgery (push and feel more sciatica). This has me very concerned. I had this issue prior to the surgery and it was much worse then. Is this lingering inflammation, is this normal?
3. I was told I could return to work after about 1.5 weeks. It’s been two weeks. I am a Project Manager am required to drive 45-60 minutes each way to work, then sit in meetings that can last anywhere from 1 to 2 hours or longer. This seems aggressive and I don’t feel I could handle the discomfort at this time, nor would I want to compromise my recovery. What are your thoughts on returning to work with for my type of work?
4. Where can I find the best advice and exercise to mitigate scarring during the healing process?Thank you.
Regarding central disc herniations, the bulge can cause a number of symptoms and it is the type and intensity of symptoms that need to be addressed.
If the symptoms are mild as many central disc herniations are, nothing needs to be done or a conservative rehabilitation program needs to be started. If the symptoms are more problematic, an epidural injection can be considered.
If the disc herniation is larger and causes central stenosis, the symptoms of neurogenic claudication can occur (see website). In this case a microdiscectomy will address the symptoms.
If the symptoms are lower back pain only (without the presence of the degenerative spondylolisthesis), a microdisectomy can be considered with a success rate of about 50-60 %. With the degenerative spondylolisthesis, a fusion needs to be considered for lower back pain.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.#8015Topic: Sciatica, lower lumbar DDD AND Cervical DDD w/cord 'flattening in forum GENERAL |Dear Dr. Corenman,
Stats: 49 year old female. Car accident, major whiplash 1990. Two more rear end collisions (like the first), minor, but more jarring of neck, five years later, then one year after that.
Chiropractor after first accident ‘cracked’ neck several times leading to terrible pain. Never saw a real doc after accident. Pain on/off through the years, never thought much about it.
FF to 2010: New symptoms: facial numbness. increased neck pain, range of motion diminished. Intermittent pain in legs, occasional numbness and tingling. Neck pain increasing. Lots of popping/cracking noises. Deep pain from shoulder into back. Lightning like pain down shins, into left arm, outside of arm, into all fingers on both hands and a feeling of fullness and pressure in all ten fingers with numbness,left foot pins and needles, legs numbing doing nothing to create numbness. Pain at site of cervical stenosis increasing. Headaches that are frequent from back of skull to top of head. I cannot now turn my head to look out my back window in reverse in my car. Lower back begins to bother me. DX’d with sciatica. Take low dose pain med, alternating ibuprofen, stretching, mile walks in effort to strengthen. Increased my activities due to concern about weakness and alarming increase in pain in legs, tingling. numbness. Dropping things more. Cannot pick up small items like change, without concentration, cannot grip them. Stumbling when walking, all intermittent. range of motion decrease continues. Pain in legs has massively increased the last two months. Pain at the site of cervical stenosis increasing, and deep pain in left arm. Because all of these symptoms have developed over two years, it was a little like a crazy making abusive boyfriend…is it me, or is it HIM? Is it my neck,lower back or just me…until a week ago. I picked up a laundry basket tub (very large) full of wet towels to take to laundry mat. I felt a sudden lightning like pain and then a dull thud like feeling in my back. I had the clothes almost to the ground, so I stayed bent over until I was sure that was not coming back. Got up resumed my day, nagging pain in back. Next day..I could barely get out of bed. Pain increased throughout the day. I was also scheduled for an EMG and I could not bear it, so had to reschedule I’ve been waiting to see a neurosurgeon for a year. They would not see me unless I had an EMG first. I went immediately home and rested on heating pad. pain continued to increase from lower back, through buttocks down legs and a horrible pain shooting into my foot. I awaken each day and have for several months with a lightning like shooting pain from my feet straight to my back. walking has begun to really become painful. Most days my leg pain is deep and my legs feel heavy and weak when standing too long. Anyway, wound up in ER with an unbearable pain I’ve never experienced before in my life. I tried to hold off, telling myself it was just me but I could no longer tolerate the pain. MRI was done, no significant change from last MRI this last June, but there are neurological changes that suggest something wrong with my reflexes although I was not told what. Ironically, the doctor seeing me in the ER, called the neuro who reviewed my case and wanted the EMG first. After he heard about the MRI and physical and pain level with the back issue, we are bypassing EMG for now and he wants e to call Monday morning for appt with him. Finally..Okay, so brief descriptive of my MRI from June:
C 4-5 There is a mild central disc osteophyte complex which minimally effaces the ventral thecal sac but causes no significant canal stenosis or cord flattening. No significant foraminal narrowing.C- 5-6- There is a central disc osteophyte complex which effeaces the ventral thecal sac and flattens the cord with moderate canal stenosis. Unconvertebral hypertrophy results in mild foraminal narrowing. The left foramen is patent.
C6-7- There is a central/right paracentral broad based disc protrusion which effaces the ventral thecal sac and results in moderately severe canal stenosis. There is moderate right foraminal narrowing.Oddly enough, the cord flattening is not mentioned in the “impression’ part of the read. The cord has normal signal intensity. There is mild straightening of the normal cervical lordosis.
Lumbar:
L2-L4 There is mild circumferential disc bulging and mild facet changes. No foraminal narrowing
L4-L5- There is a mild circumferential disc bulging and mild facet changes. No canal stenosis or foraminal narrowing
L5-S1-There is a small central disc protrusion with an associated annular tear. No stenosis, no foraminal narrowing and no impingment.Questions: Since my cervical spine is not showing signal changes, but cord flattening, is it insignificant? While my symptoms have gradually increased, is it even enough for a spinal surgeon to consider it surgically worthy? These symptoms, collectively, are taking a toll now, on my activity levels, which are slowing down. Also I have had significant weight loss of ten pounds over the last three weeks and continued muscle weakness on the left side. Could these be associated?
Can an steroidal injection be done on a cervical spine where the cord is compressed? Can myelopathy be present without signal changes to the cord?
I was dx’d in the ER with lumbarsacrol radiculopathy. I assume this to be a fancy medical term for ‘sciatica’. Why is my lower back more painful then my neck? My neck pain has subsided with extremity symptom increase and now my lower back has symptom increase with pain and most especially in my legs. My skin is sensitive to the touch in these areas as well.I am in good health otherwise. I do not wish to wait for symptom increase, disability and age to put off the inevitable. It is very frustrating to have BOTH cervical and lumbar. I’m sure you have seen people with both in your practice.
OTher than the questions asked above, is it even worth pursuing a neurosurgeon for potential surgery upon my neck? It’s the cord compression that most concerns me and the extremity symptom increase. I trust you will give me a totally straight answer on this one.
Thank you so much for reading.
#7998Topic: Post ACDF did great, played volleyball, now not great. in forum NECK PAIN |Dr. Corenman-
I had ACDF 12/17/12, C4-C5, C5-C6 (C5-C6 was taken out), allograft with titanium plate and 6 screws. Did wonderfully, upper arm weakness resolved practically immediately, no post op complications. Flexion extension x-rays at 2 wks and 6 wks post op did not reveal any problems with hardware not being in place/other issues. Played 20-30 minutes of volleyball this past Saturday with neighbors. Served the volleyball 3 times (not on 3 different rotations–3 times in a row) and jumped up in air 3 to 4 times to hit (return) ball back to other side of play. I made no contact with any players (physical contact, colliding, etc) at any point during the time I played. Did not have/feel any problems during or after limited playing time, however, Sunday, my left pinkie went intermittently numb/tingly. Monday & today continuous numb/tingly pinky,ring finger tingly on same hand, headaches, pressure low mid cervical spine (guess around c6-T1 area), some burning. I think I need to call my surgeon. Could I have messed up the fine work he did and caused the plate to shift, crack or something else.
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