I thought I would throw out a question that has been nagging me for some time now. For the past 2 years, I have been trying several conservative measures to try and fend off a fusion surgery...which several doctors that I have spoken to feel is in my future. I have DDD in my L4/L5 disc and in my L5/S1, and have had a microdisectomy and lamenactomy on that L4/L5 disc over the past 7 years.
Currenlty, I am dealing with both back and nerve pain, and the nerve pain is happening on both the right and the left...more on the right. Of course, I experience those fun sensations of numbness and tingling in both feet as well.
I am in physical therapy and just tried another bout of prednisone, which are slowly moving me into a positive direction, but my question concerns the nerves. I am all for dedicating myself to live with the pain for awhile longer in the hopes of a conservative method making a difference, but am I causing damage at this point that even a surgery cannot fix. Based on others' experience, how long should one wait or when did you decide enough was enough?
Location: San Francisco, California, United States
Re: Am I doing permanent damage?
It's hard to tell, but I can share a little of what I learned today. I spent two years with epidurals, PT, chiro, prednisone, etc., before having an L4-L5 fusion in December 2011. At my most recent follow-up appointment, my surgeon told me that while the fusion looks good, the nerve damage is likely not to recover fully. So, referral to pain management and we'll see where it goes.
Looking back, I have had symptoms of nerve damage since I was about 12, but they were minor and no one would think that a 12-year-old with no significant history of trauma would have nerve damage. If you are still getting some relief from the nerve pain through conservative treatments, then they might be worth pursuing. But, your concern is valid and when to pursue a more aggressive surgery is going to have to be a decision you and your doctor make together.
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I don't believe you will find a spine specialist who will give you a direct answer to this question, mainly because they do not know the answer. Damage to nerves and their recovery seem to be one of the areas of medicine that continues to be unknown in some ways. A doctor can quote you some statistics, but cannot say if you are doing damage by waiting.
In general, the worse the compression, the better the chances for permanent damage. Doctors have recently changed the recommendation for how long to wait before performing discectomy. It used to be six months and now they say if the pain isn't improving in six weeks, surgery can be considered at this point.
Anecdotally, I know of people who have had a nerve compressed for a matter of a week and ended up with permanent damage. I know others who waited at least a year, if not longer, and were just fine.
Having been through three lumbar surgeries, my suggestion would be to try to figure out if surgery is inevitable...if it is, don't wait. On the other hand, having a little residual numbness in the toes isn't the worst thing that could happen.
Anytime you are considering elective surgery, it is a balancing act...trying to weigh all your options and measure them against the risks and the benefits....there are NO clear answers, as far as I can see, anyway.
I cannot tell from your description if most of your pain is in your back or legs.
Last edited by teteri66; 04-02-2012 at 07:56 PM.
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Thanks so much for replying. Actually, last night, I had a pretty decent flair up that has laid me up for the day, so my question is even heavier on my mind. To answer your question Tere...I have both. Currently because of the Prednisone, I think I have more leg related symptoms, and certainly that was the case last night with this flair up.
I spoke with the nurse this morning, and she scheduled an appointment for me with the doctor in mid April (his is booked solid), and said that if the pain became unbearable I should get to the hospital: ) Next step will most likely be injections...I would imagine.
I asked the nurse my question, and she said that it is hard to say at this point, but that they still felt we are still looking for a conservative solution to my pain (which is my preference as well) before the surgery becomes an option, and that she couldn't say what the nerves might do in the meantime: )