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Dear Dr Corenman,
I’m writing to share that two years later, with ongoing physical therapy, my large herniated cervical disc resorbed without surgery and my sciatic pain is largely gone though I do have lingering back pain. Overall, though I’m still on a journey to higher levels of activity, I’ve hiked in the desert, ridden my bicycle, danced at weddings and overall experienced life with no or managable pain. My injury was quite traumatic and I thank you for the peace of mind that a second opinion gave while I navigated it. I hope I will not be back with questions, but I appreciate knowing your site is here should I have any. Thanks for this resource!
Dear Dr Corenman,
Happy new year and thank you for this response.
The cervical pain is slowly subsiding and centralizing, though arm and hand pain is not gone from my life it has become manageable. My back pain, too, still has me disabled but I am able to walk 2-4 miles a day and sit for longer periods. I still get nerve aggravation and have residual numbness and causalgia in my foot that experienced near total foot drop, but the strength is back except for my big toe.
My surgeon has cleared me for physical therapy and I finally have my first appointment next week. It will be exactly 4 months since my revision L4/5 discectomy, and 6 months since my original procedure. I was advised by both my surgeon and physiatrist that I should not do therapy except for walking until now due to the extent of my injuries. The C6/7 herniation and holidays only further slowed things.
Do you have any advice for making the most of therapy? I understand that it is crucial element of rehabilitation, and I’m afraid that the hesitation in getting me moving will actually be detrimental to my making a full recovery in the long-term. Could that be the case? Prior to this, I traveled every month, rode my bike around NYC weekly and enjoyed spinning, practiced yoga, hiked avidly, worked long days and went to events or concerts after without tiring, etc. I’m fearful that I’ll never get back to my normal level of activity after this ordeal, and though I can’t turn back time, appreciate any advice that will help me advance more in my recovery.
Dear Dr Corenman,
Thank you. This is reassuring and I appreciate it. Things have improved from where they were, so hopefully they will continue to do so even if slowly.
Separately, I hoped to gain insight on one final issue that has accompanied my injuries and recovery process. My C6-C7 herniation seems to have been caused by the multi-month period of lying with my head propped up on a pillow to cope with my low back pain, or standing looking down at my laptop and phone. I have since made multiple ergonomic adjustments and am wearing a soft collar, and things seem to be improving well.
Before the cervical herniation, I was treating cubital tunnel in both arms that I believed to be from my supine positioning and iphone use. Ulnar nerve pain in both arms came on in October, two months after surgery, but I had warning signs prior with my pinky/ring finger falling asleep in flexed positions. My physiatrist and surgeon provided ulnar nerve stretches which helped, but I wake up nearly daily with my hands “asleep.” Since the herniation has shifted from just part of my hand to include either my entire hands or today my index and thumb. It can happen in both arms but moreso has been in the left; my cervical herniation also caused left-sided arm pain (now mostly diminished). This resolves within about a minute or two of waking.
Is there a chance that the two are linked? My surgeon thinks it is just the cubital tunnel, but after recovering from severe foot drop I am afraid of the same happening to my hands. I am doing gentle ulnar arm stretches (minus the neck components) twice daily but want to be sure I’m not neglecting any preventative mess as it’s. It feels as my injuries are competing for my attention, and I just want to be as careful as possible moving forward.
Appreciate any further guidance you have, thanks so much again for your time over these past several months of posting. That should be my last question for now :)
Best,
LCThank you, this is helpful to consider.
The low back symptoms seemed to come on gradually over a few days. In addition to general pain certain movements do trigger specific sharp pain, so perhaps there is a tear. It does also seem possible that different positioning could have also aggravated pain, as with my neck pain I increased sitting and lying down than normal. I’ve been walking more which seems to be helping the pain slowly subside.
Either way it seems that the solution is to be cautious for now? thanks again, it’s so helpful to have a second opinion as I navigate this long recovery.
LC
Thank you for this helpful explanation; it is appreciated. I am hopeful that strength building and time will help once I am cleared for therapy. It has been 5 months since my original herniation, and 5 months since I have been to my office or had a normal life, so I am beginning to feel concerned that things are not more improved by now.
With respect to the sudden onset of more low back symptoms nearly 3 months, is this common? Prior to three weeks ago, I was not experiencing severe low back pain. I was improving, and able to stand for fairly long periods. Sitting was also improving, and I never woke up with back pain apart from the immediate post-herniation and post-op periods — it always set in end of day following activity. This increase seems to have followed the neck herniation, which is why I was concerned that it might warrant further imaging to rule out further injury or instability?
Dear Dr Corenman,
Thank you for your feedback above and please pardon my delayed reply. I write with an update and request for further guidance, as I’ve so appreciated your insight throughout my recovery. It has been quite helpful when informing dialogue with my surgeon and care team.
First, the sciatica caused by the disc re/herniation at L4-L5 seems to be on the path to being mostly gone. Since my October post the nerve pain has become much less frequent, though the it is still aggravated mildly from overactivity or in certain positions.
That said, at nearly 3 months since my second microdiscectomy (the first was July 2019; second was September 2019), I am experiencing a concerning onset of low back pain. My low back pain had largely diminished until now, and was never as much of an issue as the sciatica, but it is now increasing daily when standing or sitting making even remote work with a sit-to-stand desk difficult. The increase in pain followed a new herniation at the C6-C7 level three weeks ago, which caused mild pain in my left arm but seems to be improving conservatively with rest and a soft collar. The neck injury means I can no longer work well lying down, making me pretty useless.
The new onset of pain also coincided with an increase in time spent sitting, which at first was going great. Finally, I have a bulging disc at L5-S1 with degeneration at L3-L4, so I am unsure if there is one obvious cause of my new symptoms or if this is a confluence or things? I’m also nervous about epidural fibrosis given the timing. The pain feels like pure inflammation throughout my low back, with occasional sharp pain and tenderness near or above the surgery site. For reference, I had almost no low back pain before the second microdiscectomy and walked 6 miles the day prior, but the radiculopathy when standing still and herniation was so severe that I had to move forward with the surgery. It’s quite disappointing to now come out of this with a great deal of back pain but little sciatica.
My surgeon is monitoring these details and believes that there is a chance I will improve over the next few months with conservative therapy. I walk about 2.5 miles per day but have not been cleared for any other PT out of caution. When I am, I will be working with a highly respected specialist in spinal rehabilitation.
While I understand my back is going through traumas, and I clearly have DDD, I am confused as to the origin of this new low back pain and what I can do to improve my quality of life. I am 31, have a career that I am passionate about returning to, and am feeling a bit lost despite the many resources at my disposal. Is time really all that is needed here, or can I be doing more? I absolutely do not want further surgery but wonder if my PT timeline is off, or if I should be requesting injections, more tests, etc.
I appreciate your guidance. Thank you!
Happy holidays,
LC -
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