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Old 01-20-2012, 04:38 PM   #1
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Unhappy Told I need an L4-L5 diskectomy. What can I expect?

Hi,

I hurt my lower back on September 2011. I had an MRI that showed a pretty big disc herniation. My orthopedic surgeon sent me to a pain management doctor who gave me two ESIs that didn't help. At first my surgeon said that he didn't recommend surgery because of my age (I'm 27) but I just had a follow up with the doctor again and was told that my only option now is surgery.

I would think that there are other things that we could try before going down the surgery road. Am I wrong? This was a work related injury and I can't help but feel paranoid and thinking that some how this is the insurance company wanting to rush things along so they can get rid of me. Really hope that just silly paranoia.

If I decide to do the surgery, what can I expect? Obviously the positive side is that the surgery fixes all my issues and I live happy and pain free for the rest of my life, assuming I don't do something stupid and re-hurt myself. But what are some of the bad side effects/possible complications that come along with having a procedure like this done - both short term and long term?

Also, I was told that the diskectomy would be on the right side but now looking and the handouts that the doctor gave me, as well as looking things up online; I see that they perform a laminotomy.. is that a different procedure, is it the same? Can a diskectomy be done with out a laminotomy? My doctor didn't mention that during my appointment.

 
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Old 01-22-2012, 02:59 PM   #2
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Re: Told I need an L4-L5 diskectomy. What can I expect?

This will probably be a bit longwinded, but bare with me.

I was only a few years older than you when I had my L5-S1 discectomy and ALIF (Anterior Lumbar Interspinal Fusion) (29 to be exact, going on 32 now).

Most doctors would like you to have something called a discogram to ensure that the disc that shows as problematic is indeed the source of the pain. The discogram involves injecting dye into the "problem" disk and the disks around it to attempt to replicate the pain. The pain you feel if you do have an issue is different for everyone, the two that I had were completely different experiences as well. The first discogram they had to literally knock me out because I tried to come off the table when the L5-S1 was injected. The second fusion was quite painful on all three disks they tested, but no where near as bad as that.

As far as what to expect from the surgery itself (if thats the route you go), you will learn how to roll out of bed instead of flopping out like most people do. Going to the bathroom will be pretty difficult for the first week or so. If you have the same type of surgery as I did, the scar will be along your stomach, and at times for me it felt like my incision was going to open right back up...trust me it won't. I felt useless for the first month or so, I literally could NOT do anything. Thankfully my wife and my mother were the best support system I could ask for during that trying time.

Most fusions, according to my neuro, have a 50/50 chance at alleiving the pain. In my case, I fell in the negative 50%, however, I do not wish the pain that I have on a daily basis upon anyone and wish you all the best in whatever you decide!

 
Old 01-22-2012, 11:06 PM   #3
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Re: Told I need an L4-L5 diskectomy. What can I expect?

Are you able to get a "second opinion" from another surgeon? The skill of the surgeon and necessity of the operation can make all the difference between resolving your problems or ending up with a lifetime of back problems. That sounds a bit melodramatic, but I hope you get my point.

It is always a good idea to get more than one opinion when faced with a surgery on the spine. You want to look for a fellowship-trained orthopedic spine surgeon or neurosurgeon who limit the practice to issues of the neck and back.

I imagine since it has been six months, and you have tried some conservative treatments, the surgeon is now recommending surgery because your disc is still herniated. Generally conservative treatments would consist of a course of physical therapy, a series of epidural steroid injections and oral medications. If you have a nerve that is being compressed, doctors don't like to wait too long for fear that there will be permanent nerve damage.

You don't mention how much this problem is affecting your life, how the pain affects you, whether you have nerve compression, etc. Does the pain radiate down your leg? Do you have any numbness? If you don't have severe nerve compression, there is no reason to have surgery, unless you can't deal with the pain.

If you do have surgery, a discectomy can be done as an "open" surgery or it can now be done minimally invasively (in most cases). The other poster described a type of fusion surgery, which is NOT what you were told you needed.

You can find lots of information online about discectomy including some animated videos that do a good job of explaining the procedure. You can start at the sister site to Healthboards:

[url]http://www.*****.com/back-pain/discectomy-or-microdiscectomy-for-a-herniated-disc[/url]

Good luck, and please feel free to post again with questions or comments.

 
Old 01-25-2012, 11:22 AM   #4
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Re: Told I need an L4-L5 diskectomy. What can I expect?

[QUOTE=sadie83;4914387]Hi,

I hurt my lower back on September 2011. I had an MRI that showed a pretty big disc herniation. My orthopedic surgeon sent me to a pain management doctor who gave me two ESIs that didn't help. At first my surgeon said that he didn't recommend surgery because of my age (I'm 27) but I just had a follow up with the doctor again and was told that my only option now is surgery.

I would think that there are other things that we could try before going down the surgery road. Am I wrong? This was a work related injury and I can't help but feel paranoid and thinking that some how this is the insurance company wanting to rush things along so they can get rid of me. Really hope that just silly paranoia.

If I decide to do the surgery, what can I expect? Obviously the positive side is that the surgery fixes all my issues and I live happy and pain free for the rest of my life, assuming I don't do something stupid and re-hurt myself. But what are some of the bad side effects/possible complications that come along with having a procedure like this done - both short term and long term?

Also, I was told that the diskectomy would be on the right side but now looking and the handouts that the doctor gave me, as well as looking things up online; I see that they perform a laminotomy.. is that a different procedure, is it the same? [B]Can a diskectomy be done with out a laminotomy?[/B] My doctor didn't mention that during my appointment.[/QUOTE]
Bolding is mine....

Hi,
First to answer the part that I have bolded, to the very best of my knowledge, No, they cannot. I have been told that consistently by the surgeons I have been working with. They will only take out what they need to access the disc material but they will need to remove a portion.
I have had two microdiscectomies at L4-5 so trust me I feel your pain. Literally! I ruptured my disc in Sept '10 and am still in search of relief.

My circumstances were very different. My advice if you do the surgery... and I don't regret doing the first surgery (I had relief in the recovery room!) take it easy!!!! Don't bend, lift, twist, for 4 to 6 weeks until your back has had plenty of time to heal. Even though you think you feel great, don't do it!! You have your whole life ahead of you! I wish you the best. I know it is a tough decision. I was scared to death trying to figure out what to do and I didn't HAVE a choice on the first go round, there wasn't an option but surgery. I hope everything works out for you!!!

 
Old 02-02-2012, 05:25 PM   #5
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Re: Told I need an L4-L5 diskectomy. What can I expect?

Hi,
I had my L5-S1 micro-diskectomy in August 2011. It was a day Surgery, I was on the table at 9am and home by 2pm. The scar is an inch long. Pain was controlled with a T3 every 4-6hrs. I was able to walk, slowly, out of the hospital. Everything for the first few days was done cautiously. I needed to sit to put on my shoes/socks but that wasn't new for me. Stepping in and out of the shower was the hardest, but do-able on my own. Just don't rush anything!
As for "the surgery fixes all my issues and I live happy and pain free for the rest of my life, assuming I don't do something stupid and re-hurt myself." Not so much.
I woke up with continued numbness saddle to toes on the outside of my leg. This has subsided to calf and foot. Back pain was tolerable a week out and stopped the T3s. Radiating pain hasn't changed and does it when it feels like it, and with flexion. Still going to Physio 3x/wk, started back at work in December. Back pain returned. Didn't do anything stupid. Repeat MRI in October showed nothing abnormal. ESI did nothing for radicular pain. The nerves may have been 'pinched' for as long as 5months before surgery so its hard to tell if my leg weakness is Neurogenic or just regular de-conditioning. I can barely work a 6hr shift. (Normally work 12s) Had to start on Nucynta for the pain. Quite a jump from T3s. Surgery may not fix all. However you never know until you try it. Found out today my vertebrae is slipping anteriorly. The muscles are still weak and 'not holding things where they should be, I am told this is a normal part of having a disk removed. I still don't regret surgery. Btw, I was 26.
It'll be a long road but it can be done. GL!

 
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