L4-5 herniation. I am 20 years old and considering surgery.
Hello! I am a 20 year old student with a L4-5 disc herniation. I have had mysterious periodic back pain since I was 14 years old. However, since July 2011 I have been experiencing chronic lower back pain on my right side and pain in my right lower leg, accompanied with tingling from my knee to my toes. I finally got an appointment with an orthopedist and had x-rays, an MRI that showed a recent l4-5 herniation, and a steroid injection that had no effect on my symptoms whatsoever. The injection was given in October, and my doctor has me scheduled for another one in a couple weeks in hopes that it will be better than the first. At this point, it has been 6 months since the herniation occurred. I was in much worse shape for the first month or two, I think because my muscles were having spasms. Since about September, however, I've felt almost exactly the same. My pain is by no means unbearable. I can get through my daily activities, I can shave my legs, get my shoes on, etc. This is injury has been very hard on me though, because it has changed my entire lifestyle. I used to be very athletic; a runner, an equestrian, dancer, majorette, stable hand, and a landscaper. I need a large amount of exercise, as I have found it does wonders for my mental health. Right now there isn't much more than walking that I can do. I foolishly played twister with my friends last night, and I am regretting it.
I'd like anyone with experience with this kind of injury to tell me about their experiences, and whether or not they chose to get surgery and how much of a difference it has made. I'm only 20 years old and I can't imagine feeling like this forever. I'm desperate to get back to my old life, but I'm not sure if my pain right now is bad enough to warrant surgery. My doctor has mentioned permanent nerve damage if the herniation exists for too long, and also permanent nerve damage from the surgery itself. I don't know which would be worse. My doctor explained the surgery as the removal of the herniation. He'd have to cut through a small amount of bone and sweep my nerves to the side. Should I be seriously considering this surgery? I feel like I'm too young for this kind of thing. Like I said, my injury is not unbearable but it has significantly decreased my quality of life. I've done physical therapy and it hasn't helped. Occasionally they'll do something to me that makes it worse for a day or two, so that's no good. I don't really want to wait any longer to see if it will heal on it's own, but I'm not crazy about getting cut open either. Any advice?
Re: L4-5 herniation. I am 20 years old and considering surgery.
I was in dance and was a majorette, but only for a couple years. I did a lot of running and horseback riding (since I was 4 years old), which is high impact I guess. I've also done lots of heavy lifting and bending (stable hand and landscaping). I had an xray in 2006 which showed nothing, one this past October and another just last week. I'm not sure if that's how you diagnose spondylolisthesis, but my doctor has never mentioned it.
Re: L4-5 herniation. I am 20 years old and considering surgery.
Spondylolisthesis is fairly common in young athletes. It is fairly easy to see on a flexion/extension x-ray. It is a condition where one vertebra slips over the adjacent vertebra...almost always at L4-L5 or L5-S1. In many cases it doesn't cause problems, but it can create instability and it can result in nerve compression...with all the resulting pain.
Next time you see your doctor, be sure to ask about it. When it is not very obvious, it can be missed on MRI or plain X-ray. The reason I asked was because you mentioned having "mysterious" back pain since you were 14 -- which is a common age for it to begin. If there is a small instability, the pain can come and go. You might not be bothered for months, and then, without really doing anything to aggravate the back, the pain returns. It can also cause pain to switch sides...sometimes on left, sometimes on right....
I would not rush into surgery unless you have pain that you cannot deal with. I would recommend you get a copy of a book by Robin McKenzie, who is a very well known physical therapist from New Zealand who devised a series of exercises that strengthen the spine and can heal ruptured discs. "Heal Your Back Pain" is the name and it is in its 9th printing. Do not do the program if you have spondylolisthesis. Otherwise, give it a try for a few weeks and see if you don't get better.
Surgery is not an easy cure-all even though it seems it should be. Many people are left with pain and sometimes even unintended consequences....
Re: L4-5 herniation. I am 20 years old and considering surgery.
I have tried physical therapy recently, but only for a couple weeks. It did not help, and occasionally made it worse. I could try it again.
tetonteri66 -
I am interested in your spondylolisthesis suspicions. When I was younger the pain was episodic and only hurt my back, not my leg. It switched sides and occasionally disappeared. Months of physical therapy in 2006 had no effect, however. I would be surprised that after 3 xrays that no one has caught it - but I will definitely ask about it. I'm wondering if it is possible for that to cause a herniation like i have? I also have an old collapsed disc and a dark spot on my xray that looks like it could be an old fracture, and my doctor has attributed my previous back pain to those two injuries.
I think it's pretty obvious that my current pain is coming from the l4-5 herniation because of my symptoms and when they started. If I am a good girl and don't do anything strenuous, the pain is definitely manageable. After playing twister two nights ago, I'm still feeling it - it is now painful to walk, stand, twist my neck too far to the right etc. This is pain that I can't deal with for long. I know that this is just because it's inflamed and if I wait it will improve. My fear is that if I put off surgery too long I'll end up with nerve damage.
Re: L4-5 herniation. I am 20 years old and considering surgery.
Hi there - sorry to hear you're going through this. I went through a very similar thing at the age of 23 (8 years ago). I didn't have much back pain though - almost all leg pain. I let it linger for a year until it got so bad that I couldn't stand for longer than a minute or two without having to sit down. I had no idea it was a back problem, but turns out I had a HUGE herniated L4-L5 disc. Like you, my doc told me that I was facing (and probably already had) permanent nerve damage if something wasn't done soon. I sought a few other opinions and all agreed that surgery was the only option, so I went through with the microdiscectomy/laminectomy.
The surgery was a success for me and I woke up with virtually no leg pain. The recovery wasn't terrible and I was back to a "normal" life in about 8 weeks. So, I was VERY glad I went through with it! That being said, everyone is different, so I was just one of the lucky ones.
You're being smart in exploring all options first. However, I have heard that if a disc herniation doesn't respond to conservative measures within 6-9 months, then surgery might be the only thing that will help. But, that should most definitely be a final resort and only after exhausting everything else first.
Also, if you do go through with the surgery, be very careful with your recovery. (I was very cautious during the initial recovery period, but then resumed a normal life and pretended I didn't have a "bad back." Since then, I had the same surgery on L5-S1 and then recently re-herniated both discs and ended up having a 2-level ALIF fusion just a few months ago.)
Re: L4-5 herniation. I am 20 years old and considering surgery.
ddp11 - it's good to hear from someone who had similar problems at an age close to mine. My fears are exactly what happened to you - I'll feel better after surgery and think I can do everything I used to do, and then hurt myself again. It's especially difficult because sitting down for long periods of time is very uncomfortable for me, and I am a full time student. When I'm not sitting in class, I'm sitting to study. I'm seeing my doctor next month to really discuss whether or not the surgery is a good idea so that if I decide to, I can get it done right before spring break and have a break from classes. It's frustrating because I'm still very far from making a decision.
Re: L4-5 herniation. I am 20 years old and considering surgery.
Sitting puts 30% stress on the spine than standing/walking or lying down. After surgery especially, it is really important to not sit for more than about 20 minutes at a time
If you have surgery, you'll need to figure out some strategies so you don't have to sit all the time...a standing desk, taking frequent breaks, etc.
Re: L4-5 herniation. I am 20 years old and considering surgery.
I feel your pain I am also 20 years old and a student but I cant go to school now because I hurt too bad. Im getting a Discogram on May 9th. My L4/5 might be torn and leaking I will most likley need a fusion. I have had back problems since I was 17...
Re: L4-5 herniation. I am 20 years old and considering surgery.
I just had a discectomy & laminectomy of my S1 & L5 because of a ruptured disc with nerve pain and damage that I let go on and my nerve was disinegrating and I also had the injection in an effort to avoid surgery. Had the surgery nerve pain is gone now just revcovery. It is amazing. You are much younger than I so I am sure you will bounce back quicker but I would do it. I am glad I did now!
Location: San Francisco, California, United States
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Re: L4-5 herniation. I am 20 years old and considering surgery.
Hi lilsister -- welcome.
For those who receive relief from a discectomy, or in your case, also a laminectomy, I would caution you to be very careful during recovery. "Let pain be your guide" seems like a silly instruction, because you've usually overdone something by the time the pain kicks in. Just take things slowly, and when are ready to try out something new, start with ten-fifteen minutes per day, then build up your time by ten percent per week.
If you are fortunate enough to recover fully, I would encourage you to get back to life and your full range of safe activities. However, you may have to change some of your body mechanics, knowing that you had an underlying weakness, a traumatic injury, or a body mechanics issue that caused the back injury. So, roller coasters and bungee jumping may be out, but knowing that you have the opportunity to live pain-free should make giving up a few activities totally worthwhile,
Re: L4-5 herniation. I am 20 years old and considering surgery.
i am in similar situation, had discectomy nov 2010 , herniated disc 11mm, did another MRI august of 2011 shows herniation still 4mm...did discogram 2 weeks ago, show positive results, and do believe after seeing spine surgeon will suggest a fusion as did the pain management dr has already said that she believes that a fusion will in fact do good in my situation. From onset of accident had left leg pain and numbness if foot, numbness still present but the constant back pain is number on concern, hopeful nerves will regenerate, not giving up and keeping positive attitude is key...good luck....if want to talk am usually here
