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Old 01-09-2011, 07:10 PM   #1
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L5-S1 with minimal leg pain, but major back pain, should I have surgery?

I know that is a loaded question. I am scheduled for an hemi-laminectomy at L5-S1 on Feb 25th. I always told myself that surgery is the last option for me since I am relatively young (37). However, over the past couple of years, my back has really taken a turn for the worst. My back hurts the most, and only when it gets really bad is my left leg, groin area and hip really involved. It is not so much the pain in my leg and groin as much as it is the just overall discomfort, like I have to move it alot, stretch it out, punch my left butt, etc. I would say about 95% of my pain is in my low back, at the S1 itself, I think at least. My typical day starts out with getting out of bed. For the first half hour, I don't feel too bad, but then the pain and stiffness start to kick in. My core feels unstable after this point and and bending over, even if just to tie my shoes hurts greatly. Work can be difficult due to the fact that I am an IT Helpdesk tech, which involves alot of sitting. I have received a new chair, supposed to be a 24 hour chair from our facilities department. This still really doesn't help. If I sit for more than say 15 - 20 minutes, when I go to stand is the hard part. It takes me about 10-15 seconds after I stand before I really can stand straight up and start moving. I walk with a limp, probably due to the fact that my left leg is about 8mm shorter than my right. Sitting is the worst part for me. Laying down is ok till I have to roll over or sit up to get out of bed. The pain in my back feels like someone is just squeezing my S1, but still not much pain down my leg. I have seen the MRI, and the L5-S1 root is being squashed by herniated disk, but my last MRI was in May of 2010. I am wondering if I should have another MRI, one of my entire back, before the surgery, just to make sure there are no further problems above the known defective L5-S1? Any of you have it like this? Should I really go for surgery that is designed to alleviate leg pain, more so than back pain, especially since my pain is mostly in my low back? I also have arthritis in my low back. What do you all think?

 
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Old 01-09-2011, 07:55 PM   #2
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

If you don't mind, could you elaborate about one leg being 8mm shorter than the other? Are you sure it is a leg length discrepancy rather than a rotation in your pelvis that causes one hip to be higher than the other? Second, if it is your leg, what do you do about it?

 
Old 01-11-2011, 06:45 PM   #3
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

[QUOTE=tetonteri66;4657952]If you don't mind, could you elaborate about one leg being 8mm shorter than the other? Are you sure it is a leg length discrepancy rather than a rotation in your pelvis that causes one hip to be higher than the other? Second, if it is your leg, what do you do about it?[/QUOTE]

I was told about the leg being shorter by a Chiro that I went to. I can also feel it when I stand straight up because when I do, and if I plant both heals and share an equal amount of weight on both feet, I lean to the left. They told me it was due to the muscles rotating my pelvis because of the pain in my back. I was compensating for the pain, which I do believe. It does cause pain in other parts of my body as well. So I don't think my leg itself is actually 8mm shorter though. It has not always been like that though, of this I am sure.

 
Old 01-11-2011, 09:02 PM   #4
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

I can't really advise you about whether you should have surgery or not. It is not a good idea to leave a nerve compressed for too long. It is possible for a disc herniation to heal without surgery, but current thinking is to not let it go on too long when there is nerve compression.

I would encourage you to find someone who does bodywork and can get you in better alignment, either before or after your surgery. It can take awhile as the muscles and soft tissue go through a period of adjustment. Perhaps the chiropractor could help you with alignment, or a good physical therapist or one of the alternate medicine types who does this sort of thing.

When you have major imbalances it probably won't be enough to just try to "fix" your back. Something as simple as a pad in your shoe or an orthotic might help to realign the pelvic area and prevent the rotation. It's too complicated to go into here, but someone trained in body mechanics will be able to look at how you stand and walk and tell you, beginning with your feet, what is causing the rotation in the pelvis.

Sometimes the SI joint will slip, which causes a pelvic rotation and for one hip to be carried higher than the other, which makes one leg appear longer....Since everything is inter-connected, one thing being out of balance can create a bit of chaos all along from the feet to the ankles, on to the knees, hips, pelvis and into the spine....One thing I've found very helpful in this regard is to lie on my back on the floor, knees bent with feet flat on the floor, arms to the side with palms facing up toward the ceiling. I just lay quietly and breathe deeply from the belly for about 5 minutes. It gets you out from under the weight of gravity and lets the discs unload. The spine settles into its own natural position and can relax, even for a bit. I always feel better aligned when I return to my feet. It's a simple and safe position that many PTs etc. have their clients do. If you can get down to the floor, you might give it a try to see if it helps.

 
Old 01-12-2011, 01:52 PM   #5
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

I can't tell you what to do either, but I have always been told that surgery is more successful when it's done to treat leg pain and less so to treat low back pain. I do think I know how you feel, though. I do get a lot of nerve pains, but even when they're not too bad, I get terrible pain in what feels like certain parts of my spine. It's very deep, localized pain, and feels almost like a very severe painful bruise is inside. I also get parts of my spine that just feel "inflamed". I'm not sure how else to describe it. I also have severe OA in my right ankle and have had many bouts of severe inflammation in there. The feelings I get inside my spine sometimes kind of feel like that. Very pressurized, like I wish I could pop it and release the pain & pressure. Sometimes in my sacral and SI areas, I get the same thing. It feels like I've been kicked by a horse or a fastball a few times in the same area and all of it comes and goes. Well, it's always there, just there are days that's it worse and less worse.

Also, before my spine surgery, I had multi-level spinal stenosis, partly due to some disc herniations, among other things. All of this caused me neurogenic claudication. Not saying you have this, but if I tried to straighten in the least bit, the pain inside the low back and even down my legs was unbearable. It felt like there was a permanent vice grip around my around everything inside, with terrible squeezing pains. So when you mentioned your S1 area feels like it's being squeezed, it reminded me of the claudication I had from stenosis.

Does that squeezing pain get even worse if you try to bend backwards? Does it feel any better if you lean forwards?

 
Old 01-13-2011, 09:54 AM   #6
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

[QUOTE=Baybreeze;4659990]I can't tell you what to do either, but I have always been told that surgery is more successful when it's done to treat leg pain and less so to treat low back pain. I do think I know how you feel, though. I do get a lot of nerve pains, but even when they're not too bad, I get terrible pain in what feels like certain parts of my spine. It's very deep, localized pain, and feels almost like a very severe painful bruise is inside. I also get parts of my spine that just feel "inflamed". I'm not sure how else to describe it. I also have severe OA in my right ankle and have had many bouts of severe inflammation in there. The feelings I get inside my spine sometimes kind of feel like that. Very pressurized, like I wish I could pop it and release the pain & pressure. Sometimes in my sacral and SI areas, I get the same thing. It feels like I've been kicked by a horse or a fastball a few times in the same area and all of it comes and goes. Well, it's always there, just there are days that's it worse and less
Also, before my spine surgery, I had multi-level spinal stenosis, partly due to some disc herniations, among other things. All of this caused me neurogenic claudication. Not saying you have this, but if I tried to straighten in the least bit, the pain inside the low back and even down my legs was unbearable. It felt like there was a permanent vice grip around my around everything inside, with terrible squeezing pains. So when you mentioned your S1 area feels like it's being squeezed, it reminded me of the claudication I had from stenosis.

Does that squeezing pain get even worse if you try to bend backwards? Does it feel any better if you lean forwards?[/QUOTE]

It does hurt in my low back to bend backwards, and my whole spine feels like if I could just crack it in the right direction, I would be good to go, but this never happens. The pain in my low back is very deep and tends to be on the left side. I think the thing I can do that bothers it the most is to lay on my belly for any length of time. When I try to stand up from the, or like roll over in bed, roll my hips, etc, the pain in my low back is horrible. Sometimes it will feel like a sharp stab if I hit just the wrong spot. Really sucks. I do remember from past MRI's reading the results and seeing that I had stenosis, will have to look again for the exact description again. I do get the cramping type feeling and a little pain down my leg, but mostly just an uncomfortable feeling like it is tight or something. It is very hard to describe the way it feels. I also get this general feeling of instability in my back which makes me avoid anything that can cause it to hurt. I am sure this inactivity doesn't help and I am overweight (300 pounds @ 6' 2"). I don't think I feel weakness in my left leg, just feels weird. Kinda feels like a phantom limb sometimes :-).

On and on...just not sure if I should do the surgery or if I should make a very concerted effort to drop about 90 pounds and see how I feel at that point. Losing weight can't hurt!

 
Old 01-13-2011, 10:16 AM   #7
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

[QUOTE=phils95cobra;4660618]It does hurt in my low back to bend backwards, and my whole spine feels like if I could just crack it in the right direction, I would be good to go, but this never happens. The pain in my low back is very deep and tends to be on the left side. I think the thing I can do that bothers it the most is to lay on my belly for any length of time. When I try to stand up from the, or like roll over in bed, roll my hips, etc, the pain in my low back is horrible. Sometimes it will feel like a sharp stab if I hit just the wrong spot. Really sucks. I do remember from past MRI's reading the results and seeing that I had stenosis, will have to look again for the exact description again. I do get the cramping type feeling and a little pain down my leg, but mostly just an uncomfortable feeling like it is tight or something. It is very hard to describe the way it feels. I also get this general feeling of instability in my back which makes me avoid anything that can cause it to hurt. I am sure this inactivity doesn't help and I am overweight (300 pounds @ 6' 2"). I don't think I feel weakness in my left leg, just feels weird. Kinda feels like a phantom limb sometimes :-).

On and on...just not sure if I should do the surgery or if I should make a very concerted effort to drop about 90 pounds and see how I feel at that point. Losing weight can't hurt![/QUOTE]

Something I forgot, kind of a recent development, is my tail bone. After sitting for 20 mins or more, it will just ache when I go to stand up! I have tried several different chairs with no help. The pain does go away not too long after standing, but until then... Thanks for listening.

 
Old 01-13-2011, 11:05 AM   #8
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

Did we cover whether you have more than one spinal specialist saying that this particular surgery is recommended? It seems like if you are this undecided that you might want to gather a couple more opinions, if possible, or perhaps postpone it until you are convinced it is the right thing to do at this time.

The fact that the majority of your problems are in your back makes me a little uneasy. I think when the issue is kind of a general, non-localized lower back pain, these patients often are not pleased with the results of surgery.

Of course losing weight might very well help with the pain, but how realistic is that? It is very difficult to exercise when there is lower back pain, and it is hard to lose weight without exercising.

I wanted to mention that if you have stenosis, any activity that arches the back generally results in pain...whether it is swimming on the stomach, or trying to sleep on the stomach. You often see older adults bending over while walking, or pushing a shopping cart....this position naturally opens up the disc space just enough to provide a modicum of pain relief. If the surgeon has located the correct segment, surgery should provide some relief.

I'm kind of just "thinking aloud" as I type this....you have a hard decision to make.

 
Old 01-13-2011, 06:08 PM   #9
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

I was not able to lay on my stomach, though thankfully I have never preferred that position. However, I wasn't able to lay on my back either due to the stenosis, I could only lay down in the fetal position on either side. Since my surgery, though, and after getting lumbar ESI's, I'm able to pretty comfortably lay on my back. After surgery, it sure felt wonderful to be able to do that again since Ihadn't in years. Just to stretch out a bit. Right now I have stenosis again, though it's not as severe as before. I don't lay totally flat, so I can lay on my back a bit, though I still have to fall asleep curled up on either side.

Actually the not being able to bend back is a classic sign of stenosis. So is when you feel somewhat better by bending forward. That was the only way I could before surgery, bending far forward at almost a 90 degree angle.

Like I said, only you can decide if/when to have surgery and I think it'll be one of those things where you'll just know. A time might come after dealing with it for so long that you feel surgery might be worth the risk. That's what happened to me, anyway. Since you mentioned you could lose some weight, you might want to really try to do that and see IF it helps you any. Then again, it all depends on what's causing the stenosis & Pain. Especially if it's bone overgrowth and/or tissue thickening and buckling, there is nothing that can help that but surgery. Sometimes disc herniations resolve on their own, but that's no guarantee either. Unfortunately, none of what we have to deal with is guaranteed. It's a matter of accepting your condition/limitations and dealing with it the best you can. I do believe, though, that a lot of these types of surgeries have like a 75 to 80% percent success rate, which if you think about it, is pretty good as compared to the failure rate. I wish I could help you more, but all I can do is offer my thoughts and support. I do wish you the best in whatever decision you make.

 
Old 01-13-2011, 11:18 PM   #10
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

phils95cobra,

You have my sympathies for the pains you are experiencing, as well as the rollercoaster of emotions and frustrations of trying to figure out your options and best moves.

Most surgeons want to have an MRI that is within 6 months of your surgery date, so it might be worth asking your surgeon about whether it would make sense to get a new one. A lot can change (better or worse) in 6 month's time, and if there are any new problems you would want to make sure you have the right surgery at the right levels done.

I agree with the other poster that it would be good to make sure you have a 2nd opinion on this surgery by another surgeon - different surgeons can have very different opinions about the same condition.

You need to be comfortable with having the surgery done. If you aren't comfortable, get additional surgeon opinions or talk to your surgeon and have him address your concerns. Having any spine surgery is very serious, and you don't want to go through it and be sorry afterwards. Also, there are many conditions that can only be addressed by having surgery, so you may be in a situation where only surgery can improve your situation. Your surgeon would be better able to talk to you about this than we can.

Regarding your weight, it's easy for us to blame ourselves for being overweight - don't punish yourself and think you need to live in pain because you didn't control your weight. You don't deserve to be in pain any more than anyone else. The chances of you successfully losing weight on your own while having such significant back pain is quite minimal. For sure it would be in your best interest to lose weight if you are able to prior to your surgery, but I don't think you should try to postpone your surgery to lose weight first.

Carrying around extra weight is really bad on our backs as well as many of our other joints, so anyone who has back or joint problems should have a plan to bring their weight under control or at least keep themselves from gaining weight after a surgery. Many medical centers have nutritionists and doctors who focus on weight control, and most insurance plans cover these services. Find out if your insurance and medical center can offer you help in weight control and take advantage of it if you can. We can fully control most of the factors that make us healthy or not, and controlling our weight is one of the most important areas we can control. I have around 40 pounds I need to lose as well, and I do understand how very difficult this is when you are in chronic pain.

Best wishes in making your decisions, and I hope what we have shared helps you figure out your best options!

 
Old 01-16-2011, 03:07 PM   #11
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

Just so everyone knows, here is the reading from my MRI from May, 2010.

"Impression,

Left paracentral disc protrusion with associated osteophytic spurring at the L5-S1 posteriorly displacing the ipsilateral lef S1 nerve root. Narrowing of the neural foramen bilaterally at this level, predominately the inferior aspect of the neural foramen. Mild degenerative disc disease at L2-3 and L4-5 as above. "

When they mention narrowing of the neural foramen, is that also called stenosis? and is it referring to the left or both canals or the central canal?

Thanks

 
Old 01-16-2011, 03:30 PM   #12
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

Osteophytic spurring mean bony overgrowth, which means less space for the nerves. Narrowing of the neural foramen bilaterally - the neural foramen are small bony areas that come off the sides of each vertebrae (kiind of like a short tube of bone) and inside of that space, the nerves at that level come off the spinal cord and run through that space. IN this case, those "tubes" have narrowed on both sides (bilateral), probably due to bone overgrowth. Hence, this would be referrred to a foraminal stenosis. Looks like the herniation is also compressing the nerve root on the left at the S1 level.

 
Old 01-16-2011, 03:43 PM   #13
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

If you cannot live a normal life, then you should the op. If the pain isn't so bad that you can work, get around, etc., maybe should buck up and use painkillers.

 
Old 01-16-2011, 04:33 PM   #14
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

[QUOTE=Baybreeze;4662730]Osteophytic spurring mean bony overgrowth, which means less space for the nerves. Narrowing of the neural foramen bilaterally - the neural foramen are small bony areas that come off the sides of each vertebrae (kiind of like a short tube of bone) and inside of that space, the nerves at that level come off the spinal cord and run through that space. IN this case, those "tubes" have narrowed on both sides (bilateral), probably due to bone overgrowth. Hence, this would be referrred to a foraminal stenosis. Looks like the herniation is also compressing the nerve root on the left at the S1 level.[/QUOTE]

So this is saying that I have narrowing of those canals on both the left and right side?

 
Old 01-16-2011, 04:47 PM   #15
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Re: L5-S1 with minimal leg pain, but major back pain, should I have surgery?

[QUOTE=phils95cobra;4662754]So this is saying that I have narrowing of those canals on both the left and right side?[/QUOTE]

Yes, I can say that for certain since bilateral means two-sided, or two sides

 
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