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#33436Topic: Post-Dual Lumbar Foraminotomy Symptoms in forum BACK PAIN |
Dr. Corenman:
First off, thank you for being such a great resource to those of us suffering from some of these awful conditions.
To provide some context, I am 25 and have had sciatic pain (more-so irritation) since about 20 or 21. As a former multi-sport athlete in HS and powerlifter, my symptoms progressed which interfered with my workouts. I was diagnosed with a herniated disc at L4/L5 in 2016 and proceeded with conservative treatment. For the next 3-4 years, I tried to train as best I could and do core strengthening, my symptoms improved but I was never able to fully return to lifting without flaring up the nerve. Keep in mind, I was never bedridden with my sciatica and very seldomly had a shooting pain (maybe 7 or 8 times total). I essentially figured I would be stuck with minor nerve irritation on/ off and would never get back to 100%.
Whilst doing light deadlifts in March, I noticed I began developing S1 nerve root numbness in my outermost toes, the same side as the glute/ hip inflammation that I’d be dealing with for years. I scheduled an appointment with a new nuero with the following update MRI and x-ray:
IMPRESSION:
Increasing size to L4-5 disc herniation compared to previous. No significant spinal canal or foraminal stenosis.Spondylolysis and stable grade 1 anterolisthesis L5-S1. Disc bulge
Narrative
INDICATION:
Low back pain, lumbar radiculopathy.COMPARISON:
2016TECHNIQUE:
Sagittal, axial, T1 and T2 sequences were performed without contrast. The exam was performed on 1.5 tesla closed high field MRIFINDINGS:
The lumbar vertebrae show no evidence of acute fracture. The conus terminates at L1. Reporting assumes 5 lumbar vertebra.L1-2 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding.
L2-3 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding.
L3-4 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding.
L4-5 disc space shows disc space narrowing disc bulge and central disc herniation more prominent compared to prior study. It abuts the thecal sac but does not cause any significant canal stenosis.
L5-S1 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding. There is mild disc bulge. Grade 1 anterolisthesis is stable at L5-S1. Findings of bilateral spondylolysis are again noted.
XRAY:
Impression
IMPRESSION:
L5 spondylolysis with L5/S1 spondylolisthesis.1.4 mm increase in spondylolisthesis with lumbar extension.
Narrative
INDICATION:
Low back pain, lumbar radiculopathyCOMPARISON:
MRI lumbar spine 07/13/2016TECHNIQUE:
Four views lumbar spineFINDINGS:
On the lateral neutral view, L5/S1 spondylolisthesis measures 4.6 mm. L5 spondylolysis. With flexion, the spondylolisthesis measures 5.2 mm and with extension 6.1 mm. The intervertebral disc heights are otherwise normal. No compression fractures.Also worth noting, I was making the best progress in years by fixing my deadlift form with almost a complete resolution of symptoms (I deadlifted 2 days before surgery). However, symptoms were still intermittent and I figured I wouldn’t be able to get back to 100% since there was clearly something impinging so I went ahead with surgery. Also of note, I’ve almost never had backpain and any discomfort was fixed by strengthening my core/ deadlifts.
On September 28th, I had surgery for the doc to look at the disc and see what the best course of decompression would be. He did dual left-side foraminotomies at L4/L5 and L5/S1, noting that the disc was ‘calloused over’ and he didn’t think it should be messed with since it was clear that two bone spurs were causing my issues.
I’ve had a somewhat slow recovery so far, but have noticed days of solid improvement. I’ve been taking ibuprofen on and off with flare ups (currently dealing with somewhat significant inflammation 9.5 weeks post-op.
Are these flare-ups typical? Should I run an oral steroid cycle as I continue to increase my activity?
It seems as though the spondylolisthesis was an incidental finding. If the flare ups stop happening and I return to 100%, would you recommended that it’s safe enough to return to lifting/ athletic lifestyle?
Please let me know if you need me to clarify anything. I want to thank you in advance for any insight that you may have into my condition.
#33428Topic: Continued Pain 3+ months post microdiscectomy in forum BACK PAIN |Dear Dr. Corenman,
I herniated my L5/S1 disc in February 2020. It was a 6 mm left lateral disc herniation that displaced the S1 nerve posterior laterally. Due to Covid, I didn’t start PT until early May. In June I saw a surgeon because I continued to experience buttock, back of leg and foot pain. Surgeon recommended surgery but I wanted to avoid it. I agreed to another MRI to see if there was improvement which occurred in July. The MRI results showed I still had a 6mm disc herniation but this time it was classified as an extrusion. On August, I finally had a microdiscectomy, after my pain symptoms intensified.
Recovery went well initially. I never had to take any narcotics post surgery. I suppose I have a high tolerance for pain. By three weeks I was walking 2+ miles a day. I started PT at 6 weeks and have been diligent in doing my exercises. I’m also walking 4+ miles a day now. Around the 5th week, I started to get some radicular pain on my buttock, thigh, leg and foot. However, instead of it being in a straight line, like pre-surgery, it was more a patchwork. I also started to experience pain in parts of my leg and foot that are not associated with L5/S1.
I got another MRI this past Monday and this is what it reads:
L3-L4: There is a 1.7 X .4 X 3mm left foraminal and paracentral disc extrusion which displaces the left L3 nerve root within the neural foramina. The left L4 nerve root is displaced within the lateral recess.
L4-L5: There is a 1.2 X .03 X 3.6 mm disc extrusion with spondylosis which displaces the L5 nerve roots within the lateral recesses. Central canal and neural foramina are patent.
L5-S1: Operative changes of left laminotomy are noted. There is a recurrence/residual left foraminal 1.3 X .4 X 2 mm disc extrusion which displaces the left L5 nerve root wihtin the neural foramina. The left S1 nerve root is displaced within the lateral recess.My MRI from July 2020 reads:
L3-L4: At the L3-L4 disc space, there is a 3 mm far left lateral bulging annulus with minimal distal foraminal stenosis. Disc is seen contiguous without displacing the sensory root ganglion. There is a minute Schmorl’s node of the superior endplate.
L4-L5: At the L4-L5 disc space which is desiccated, there is a minute Schmorl’s node of the superior endplate and a 2 mm bulging annulus without central or foraminal stenosis.
L5-S1: At the L5-S1 disc space, there is a 6 mm left lateral extruded disc herniation displacing the left S1 nerve root posterior laterally. There is no central canal stenosis. There is a quite capacious spinal canal. There is no foraminal stenosis.What would you recommend as a next course of action? I’m meeting with my surgeon on Friday to go over my MRI results so I’m curious as to your recommendations. I am a 44 year old female who was extremely active prior to this injury. I did sprint triathlons, ran and did boot camp style workouts 4 days a week. I can’t help but feel those days are behind me now.
#33379 In reply to: Thigh Pain after discectomy |You had a disc herniation at L5-S1 that was surgically removed. You then note; “But ever since the surgery the back of my thigh has had pain. Its not the same level as pre-surgery. In weeks 1-6, it would come about with no provocation. An aching pain in the back of my thigh that would eventually go away in about 30min or more”
You then note; “Since weeks 6, the pain in my thigh would come & go like before. But it will now happen if I sit down for any length of time”
Finally:”its been 18 weeks now. I have the same pain in the back of my thigh & tailbone whenever I sit in a chair for more than 15 minutes. The pains will gradually go away if I lay down or walk around”. Nerve tension when sitting that gets better with standing or lying down is consistent with a recurrent disc herniation. A new MRI is a good idea.
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.#33376Topic: Thigh Pain after discectomy in forum BACK PAIN |Hello, I had a question about pain Ive had ever since my discectomy surgery.
Some background to my situation, I had a torn meniscus in my left knee & a herniated disc L5/S1, which was giving me sciatica pain on my right side.
My primary doctor got a referral to a orthopedic clinic & ordered a MRI. MRI showed that I had a moderate herniation at L5/S1. At this time, the MRI session also showed that I had a meniscus tear in my left knee as I mentioned. The surgeons wanted to take care of the knee first. I got the surgery for my knee & then I had to wait 6 weeks later to have the surgery for my disc herniation. The knee healed up very quickly. But the 6 weeks waiting time for the discectomy was hard to handle.
The sciatica pain I had pre-surgery was so intense that I couldn’t go to work, stand up, walk, use the bathroom, etc. It was the worst pain I have ever had in my life. The pain was on my right side. Stabbing pain in the buttock, back of thigh & the outside part of my foot was numb. I only felt relief if I laid down. I could sleep fine. But sneezing & coughing would send zingers of pain.
I had the discectomy surgery on July 2 for the herniated disc at L5/S1. The first week was ok. I did get up & walk for the first time in 2 months. I took everything very very slow. No bending or anything. Log roll out of bed, etc. I had my wife tape my back up with strapping tape to keep me from doing any bad movements. This helped a lot.
But ever since the surgery the back of my thigh has had pain. Its not the same level as pre-surgery. In weeks 1-6, it would come about with no provocation. An aching pain in the back of my thigh that would eventually go away in about 30min or more. Really had no pain in my back at all. Just some zingers in my buttock ever now & then.
Since weeks 6, the pain in my thigh would come & go like before. But it will now happen if I sit down for any length of time. At week 6 after my surgery, I went back to work. I got an expensive ergonomic chair hoping that it would help with anything related to my situation.
I also get pain in my tailbone. Or at least it feels like it is my tailbone. I can squeeze the muscles around the tailbone and it will hurt as well. But lying down or walking around will help relieve it.
Its been 18 weeks now. I have the same pain in the back of my thigh & tailbone whenever I sit in a chair for more than 15 minutes. The pains will gradually go away if I lay down or walk around. As since surgery, I can walk with no problems. Just when I sit in a chair for any length of time.
A heating pad seems to help some.I just called my surgeon today & asked about getting another MRI just to rule out another herniation. Again, I can walk, stand up, etc. Just sitting causes the pain in my thigh.
They informed me that they are in the process of getting the MRI approved.
I hate being so worrisome about all this.
I didnt know if I am being too overly dramatic about all this.thanks for reading my story
jeff#33374Topic: Abdominal distension and pain after post-laminectomy surgery in forum BACK PAIN |On July 24, 2020, I had post-laminectomy surgery. I also had a broken back which was repaired at the same time. My surgeon went through my back. The surgery was to be 6 hours, it lasted 13 hours and I had 7 blood transfusions and 2 platelet transfusions. I was in the hospital for 2 weeks, 6 of those days being in ICU. My surgeon never gave me a straight answer as to why it took 13 hours and I had so many transfusions When pressed it only said that “it is a complicated surgery and the amount I received was normal.” EVERY doctor I spoke to said that this is not the case. My left thigh was numb when I woke up from surgery and remains so to this day. A week after I was released I noticed my belly button was 2 inches off-center and the left side of my abdomen was quite distended. I was also tachycardia and was on blood pressure meds for 6 weeks to ensure that my BP was normal. Since being released the pain and distended abdomen remain. The pain got so bad I went to the ER twice, they ran tests, took 2 MRIs, with and without contrast – both came back normal. I had a colonoscopy, which showed no abnormalities. The gastro doctor and my general surgeon both said that the surgeon could have nicked a nerve during surgery. I went back to my neurologist today who did a nerve test. The results showed a pinched nerve on my left side. I am scheduled for another MRI on December 14 and then it is back to the neurologist to review the results.
I am at a loss of what to do. I am both physically and mentally exhausted. Any idea what may be causing these problems?
#33354 In reply to: Lumbar facet pain? |The key to the diagnostic block is relief for the first 3 hours after repeating the actions (extension) that created the pain in the first place. Just like going to the dentist, the anesthesia lasts for about 3 hours then abates. It is not unexpected to hurt 10 hours later as the anesthetic agent has worn off and the steroid is yet to take effect.
Just to be sure, your fusion at L5-S1 has been proven to be solid based upon a CT scan and flexion/extension X-rays. Correct?
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. -
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