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Old 07-03-2013, 09:52 PM   #1
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Can a large ruptured disc heal itself?

Just happened to stumble onto this site looking for some answers about what to expect the next few months with regard to my ailing back. After reading several threads, I decided to see if I could get some advice on what to do. So, I'll give a little background info:

I'm 45 and have lived with back pain most of my adult life. About 15 years ago I was first diagnosed with degenerative disc disease. I had several physical therapy sessions before my left calf muscle became virtually useless. MRI at that time showed a bulge on S1-L5. My physiologist insisted that surgery was a last resort, so I took Naproxen for about 6 months until the pain finally subsided and eventually I regained function of my calf muscle. After that, I would have an occasional back blowout that a couple days rest and muscle relaxants would get me back on my feet. The pain was always in the muscles in the lower back.

On 6-19, I felt my lower back give out with two distinct "pops" while attempting to lift something I had no business lifting. I had never experienced the kind of debilitating pain as what I felt that evening. So, after a miserable 120 mile drive home, it was Flexeril and hydrocodone for the night and next day. My back really did not feel horribly bad the next day and I thought that I was going to bounce back like before. During the night on 6-21, I woke at about 1:00 am with excruciating pain in my left thigh extending to the top of my knee.

So, on Monday, 6-23, I went to see a spinal surgeon who performed a microdiscectomy on my 21 year old daughter the year before. He prescribed an MRI and the report is as follows:

[I]The L1-L2 is negative

At L2-L3 a large soft tissue density is present which appears to communicate with a left paracentral disc protrusion. The large soft tissue density extends from the left side of the L2-L3 disc space inferiorly along the left side of the L3 vertebral body. The soft tissue density has a superior to inferior diameter of 26 mm, an AP diameter of 9 mm, and a transverse diameter of 16 mm. The findings are consistent with a large extruded disc fragment. This is not believed to represent a mass, although no significant disc space narrowing is present at L2-L3 as would often be present with a large extruded disc fragment.

At L3-L4, moderate disc desiccation, mild disc bulging. Small annular rent. Small central disc protrusion.

At L4-L5 disc desiccation, right sided annular rent and mild to moderate disc bulging. Mild facet disease bilaterally foraminal narrowing.

At L5-S1, moderate to severe osteoarthritis with disc space narrowing, disc desiccation and degenerative endplate changes. Mild facet disease bilaterally. Approximately 2 mm of retrolisthesis is present. A small to moderate left posterolateral disc osteophyte complex is present which results in mild displacement of the descending left S1 nerve root. [/I]

So, I was scheduled for surgery on 7-9 for an L2-L3 discectomy followed by fusion of L2-L3. After I expressed some apprehension about having surgery so soon after the injury, the surgeon recommended waiting for a month to see how things progress. He said it all may heal itself??

After having some ups and downs, I now have about 70% strength loss in the left thigh, and at times pain that allows me about 3-4 hours sleep. I am now thinking I should have kept the 7-9 surgery date. I hate the way the meds make me feel and I refuse to risk meningitis for some pain relief.

So, can a disc rupture heal on its own, or is surgery going to be necessary eventually? The surgeon said that I would not see any nerve damage for the first few months, but the way my left leg feels scares me. I would appreciate any personal experiences with ruptured discs healing on their own. I need some hope.

mizkt

 
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Old 07-04-2013, 08:04 PM   #2
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Re: Can a large ruptured disc heal itself?

Welcome to the board.

To answer the question of your thread's title: in a word, yes. A large rupture can heal...but I'm sure it is dependent on a number of things.

First let me say that we are not medical physicians...just fellow spine sufferers who share experiences. So take what I am about to say with that in mind. I may be way off base...but I would not proceed with surgery without getting at least one more opinion...and personally, I would get more than one "second opinion."

It looks to me like fixing L2-L3 will be a temporary fix because there are issues at other levels that very well could cause problems and pain in the near future...and I imagine they may be causing you pain right now. The popping you felt after lifting was probably this disc rupturing. And this level shows signs of injury whereas the problems lower down are more the degenerative/arthritic type issues that get worse with time and more wear-and-tear.

I'm not quite sure why he wanted to fuse L2-L3. The extruded matter probably needs to be moved off the spinal nerves at this point. The report indicates that the disc space has not narrowed...so I'm not sure why he would immediately do a fusion at this point.

I'm curious if you are located in Canada or England? The language of the findings is different from your usual US radiology report.

At the next two levels, L3-L4 and L4-L5 both discs have small bulges, included small annular tears...which can be painful.

L5-S1 appears to have a number of degenerative issues.

[B]At L5-S1, moderate to severe osteoarthritis with disc space narrowing, disc desiccation and degenerative endplate changes. Mild facet disease bilaterally. Approximately 2 mm of retrolisthesis is present. A small to moderate left posterolateral disc osteophyte complex is present which results in mild displacement of the descending left S1 nerve root. [/B]

Here you have the moderate to severe arthritic changes that are causes the disc space to narrow and for the disc to dry out. The endplates (the area of bone that adjoins the discs) are showing degenerative changes as well. (These things all go hand-in-hand with DDD). The facets are also showing signs of degeneration, which causes them to enlarge and to form bone spurs. This ends up taking up space in the foramen which needs to be open for the nerves to pass out from the spine into the other areas of the body. These changes are causing the SI nerve on the left side to be slightly displaced.

If this nerve displacement gets worse you may feel pain, tingling and/or numbness down the back of your thigh, wrapping around the calf and going down the foot to the little toe. These things may still be mild enough that they are not causing problems that you feel, but I imagine things will get worse in the future, as you age and there is that much more wear and tear on the spine...particularly if you keep lifting heavy items! (L4-L5 and L5-S1 are the two segments of the spine that take the brunt of any movement...they are the most abused, if you will....)

I didn't understand your comment about risking meningitis. Oh, are you thinking of the contamination from that one compounding lab? You're referring to not wanting any ESIs??

I can tell you that it is possible to have a large ruptured disc heal. My husband had that experience almost 20 years ago...back in the olden days when doctors weren't so quick to operate...as I recall, it took about six months for him to feel relatively normal again.

My best advice to you is to get at least one other opinion before proceeding with surgery...and please ask your surgeon about the issues at L5-S1.

Good luck.

 
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Old 07-05-2013, 12:28 AM   #3
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Smile Re: Can a large ruptured disc heal itself?

[QUOTE=mizkt90;5195486]Just happened to stumble onto this site looking for some answers about what to expect the next few months with regard to my ailing back. After reading several threads, I decided to see if I could get some advice on what to do. So, I'll give a little background info:

I'm 45 and have lived with back pain most of my adult life. About 15 years ago I was first diagnosed with degenerative disc disease. I had several physical therapy sessions before my left calf muscle became virtually useless. MRI at that time showed a bulge on S1-L5. My physiologist insisted that surgery was a last resort, so I took Naproxen for about 6 months until the pain finally subsided and eventually I regained function of my calf muscle. After that, I would have an occasional back blowout that a couple days rest and muscle relaxants would get me back on my feet. The pain was always in the muscles in the lower back.

On 6-19, I felt my lower back give out with two distinct "pops" while attempting to lift something I had no business lifting. I had never experienced the kind of debilitating pain as what I felt that evening. So, after a miserable 120 mile drive home, it was Flexeril and hydrocodone for the night and next day. My back really did not feel horribly bad the next day and I thought that I was going to bounce back like before. During the night on 6-21, I woke at about 1:00 am with excruciating pain in my left thigh extending to the top of my knee.

So, on Monday, 6-23, I went to see a spinal surgeon who performed a microdiscectomy on my 21 year old daughter the year before. He prescribed an MRI and the report is as follows:

[I]The L1-L2 is negative

At L2-L3 a large soft tissue density is present which appears to communicate with a left paracentral disc protrusion. The large soft tissue density extends from the left side of the L2-L3 disc space inferiorly along the left side of the L3 vertebral body. The soft tissue density has a superior to inferior diameter of 26 mm, an AP diameter of 9 mm, and a transverse diameter of 16 mm. The findings are consistent with a large extruded disc fragment. This is not believed to represent a mass, although no significant disc space narrowing is present at L2-L3 as would often be present with a large extruded disc fragment.

At L3-L4, moderate disc desiccation, mild disc bulging. Small annular rent. Small central disc protrusion.

At L4-L5 disc desiccation, right sided annular rent and mild to moderate disc bulging. Mild facet disease bilaterally foraminal narrowing.

At L5-S1, moderate to severe osteoarthritis with disc space narrowing, disc desiccation and degenerative endplate changes. Mild facet disease bilaterally. Approximately 2 mm of retrolisthesis is present. A small to moderate left posterolateral disc osteophyte complex is present which results in mild displacement of the descending left S1 nerve root. [/I]

So, I was scheduled for surgery on 7-9 for an L2-L3 discectomy followed by fusion of L2-L3. After I expressed some apprehension about having surgery so soon after the injury, the surgeon recommended waiting for a month to see how things progress. He said it all may heal itself??

After having some ups and downs, I now have about 70% strength loss in the left thigh, and at times pain that allows me about 3-4 hours sleep. I am now thinking I should have kept the 7-9 surgery date. I hate the way the meds make me feel and I refuse to risk meningitis for some pain relief.

So, can a disc rupture heal on its own, or is surgery going to be necessary eventually? The surgeon said that I would not see any nerve damage for the first few months, but the way my left leg feels scares me. I would appreciate any personal experiences with ruptured discs healing on their own. I need some hope.

mizkt[/QUOTE]

hi there,

i had suffered a spinal injury years ago and as a result ended up with ten damaged disc's in my spine, cervical disc's 4 thorasic disc's 3 lumber disc's 3. I was given the option of surgury and refused as once they fuse your disc's you are stuck with them for life. my friend has her L3,4 and 5 fused and 7 years down the track she spend at least one week or more in hospital on a morphine drip every 3-4 months. don't let anyone touch your spine, as i do believe you will really regret it down the track. the pain will never fully dissipate, but it will ease of in time.

 
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Old 07-05-2013, 09:13 AM   #4
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Re: Can a large ruptured disc heal itself?

Thanks for the reply. I have gotten a second opinion, and he affirmed that surgery is justified for L2-L3. He did not recommend the fusion, but the original surgeon said that with the extent of the injury, fusion would likely be needed somewhere down the road. He said a second surgery would involve scar tissue and healing is much more difficult in that scenario. He is a personal friend and I do trust him. It was difficult for me to get a second opinion, but he completely understood. He did say that it is customary to wait at least 6 weeks to see how the injury progresses, and did recommend putting off the surgery. But the constant pain and weakness is getting old already. Meds do help, but I'm not getting any better. It is getting to the point where I cannot walk steps anymore. And yes the meningitis comment was aimed at the cortisone injection, and the recent problems with those. My opinion is that there is no reason to inject something in my spine that does nothing to fix the problem. I'd much rather try to control the pain with the meds.

My wife and I are in the process of building a new house, and it's depressing not being able to work on things that need to get done. We have a Florida vacation planned for the first part of August, and I'm not sure how long I can ride in a car. I am really second guessing postponing surgery.

Surgeon is equally concerned with the degeneration at L5-S1, but he knows that L2-L3 is what is causing the current problems and needs to be addressed first. I have full function of my calf and can tip toe on the left foot without any problems so L5-S1 is not in play right now even though it appears that the bulge is very close to putting pressure on the nerve. He says it would be too much to try to address both issues with one surgery.

Anyway, I do appreciate the response and explanation. I don't know what I'm going to do at this point, but I am leaning to scheduling the surgery as soon as I can get back in. Having the second opinion recommend surgery makes that decision a little easier.

Again, thanks for the insight.

 
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Old 07-05-2013, 05:09 PM   #5
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Re: Can a large ruptured disc heal itself?

miztk90,

Welcome to the boards, and teteri66 did a great job of explaining your situation.

I would add that I was once told by a spine surgeon that given time (lots of time, like 6-12 months), the body can often reabsorb up to 50% of a disc herniation.

For some people, this is enough to give pain relief, for others, it's not. We all have varying amounts of space in our spinal canal - some are quite wide, and some quite narrow. This then means that some people can recover quite well from a disc herniation, and others aren't able to.

If you have a large annual tear in the side of your disc, the body can rarely recover from this, and in this situation the caustic chemical insides of the disc will leak out on your nerve roots causing severe pain. The only way to tell how bad an annual tear is is to have a discogram (I had one and it wasn't bad at all for me, but others report severe discomfort from the test). Repairing a severe annual tear requires a fusion, but less severe annual tears can often be left alone as they don't go all the way through the disc so none of the interior chemicals of the disc leak out.

Whether you have surgery now or wait until later is a decision that is very personal and you're the only one that can make it. Pain is a great motivator to sign up for surgery, but the down side is that surgery won't restore you to what you were before surgery, and you run the risk of even being worse off after surgery.

Prior to having back surgery, I was in an unfortunate situation that I couldn't work and was basically forced to have spine surgery far sooner than I would have liked to have it as I wasn't able to perform my job as I was. I've now had 6 spine surgeries and have ended up on SSDI, and I had a lot of surgical complications that normally only affect less than 5% of the population.

I have a friend who had 2 herniated discs and was in severe pain, and decided to wait, even though she was in horrible pain on a daily basis. She said after 6-12 months she got much better than she was, but she said it felt like forever to improve. She's back working and said she's really glad she waited as she was able to avoid surgery.

HTH, and best wishes!

 
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Old 07-06-2013, 12:11 PM   #6
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Re: Can a large ruptured disc heal itself?

I would just like to mention that after a lumbar surgery, common instructions include not sitting more than 15-20 minutes at a time. I'm thinking about your planned car trip in the beginning of August...Sitting puts 30+% more pressure on the discs than either standing/walking or lying down. Patients are usually instructed to not ride in cars except for short trips for a number of weeks post surgery (number of weeks depends on the procedure that was done).

You'll need to think how the timing of the surgery, and more importantly, the recovery will fit into your plans. Be sure you understand what is involved with recovery. There is no spine surgery that is an easy fix. Before my first surgery, my internist said something that no spine doctor ever mentioned to me...and it is something that always stayed with me. No spine surgery will return you to the way you were prior to onset of pain or injury. For many it is a life-changing experience.

 
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Old 07-08-2013, 07:51 PM   #7
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Re: Can a large ruptured disc heal itself?

Thanks to all for the insight on your experiences. My surgeon noted my apprehensiveness and insists on waiting at least a month for surgery, which I am in complete agreement. That gets me past the vacation in Florida (I am not looking forward to the drive down), but I hope that the pain and weakness subsides somewhat before then.

I have to take two hydrocodone and a muscle relaxant every night to get any sleep. My thigh is at about 20% strength, and at times it is like I am dragging dead weight. I am very conscientious about every step, as I have fallen up steps several times. The pain is bearable but there 24/7.

I do realize that my back will never be the same, but I cannot imagine being like this for 6 months or longer. I know there are horror stories (as I've read on this board), but for every one, there are so many more successes. My wife and daughter both have had discectomy surgeries and have had absolutely no problems whatsoever. My wife is going on 23 years with literally no back pain. I know fusion is a different story, and that is why I took the time to get the second opinion. Right now, I'll see how it goes for the next few weeks and make a decision at that time. Hopefully, I'll beat the odds and the disc will shrink enough to get off the nerve.

Again, thanks to all for sharing their experiences. It helps to know there are some out there that understand what I'm going through.

 
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Old 07-08-2013, 09:19 PM   #8
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Re: Can a large ruptured disc heal itself?

Especially since you will be traveling, it is important to be aware of "cauda equina syndrome." If you should suddenly develop loss of bladder or bowel control, or suddenly develop weakness such as dropped foot, seek medical attention right away. Do not try to wait until you get home. ( As a matter of fact, it would be a good idea to travel with your MRI just in case!!) It might be nothing, but in the event you have developed cauda equina it is important to get the nerve or nerves decompressed quickly. Otherwise damage can be permanent. Cauda equina syndrome occurs when the nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage. You can also lose sexual function. This can happen if a disc ruptures, there is stenosis, or things like a sudden injury (fall, car crash, etc.), a tumor, etc.

Anyone who has lower lumbar problems needs to be familiar with the symptoms of cauda equina syndrome. It is possible to go into an emergency room and find yourself with a staff that is not familiar with this problem...so if it should happen, be prepared to be persistent and be sure they rule out CES. Don't let them send you home, telling you to keep an eye on things.

Don't lose sleep over this. It is a rare happening...but, I wanted you to know about it for your own safety.

 
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