Considering Surgery

[New York Guy]

Hello,

I have had back pain for almost 3 years and now I am considering surgery and would welcome information from anyone. I have tried therapy a few times and have seen results in the past but not recently. I changed my career from construction to technical support which involves sitting all day and this is becoming bothersome.
My primary doctor is against any surgery but finally agreed I should at least speak to a surgeon.
The surgeon recommended a new MRI in jan 2003 and these are the findings.

IMPRESSION
1. Moderate sized left paracentral disc protrusion at L2-L3.

2. Slight central disc protrusion at L3-L4 and L4 L5.

3. Slight diffuse bulging annulus at L5-S1

4. Degenerative arthritis involving facet joints of lower lumbar spine.

I have not had a chance to go over all of this with the surgeon but spoke with 1 of his assistants who says I should have a cage built around the lower disc for stability. He also mentioned a 40 minute laser procedure for the disc at L2-L3.

I have flare ups about every 6 months that last about a month and it makes it difficult to walk or sit or stand. I currently am recovering from a flare up and will return to work in 2 days. I am not big on taking medicine but starting last sept 2002 my right leg went numb and has bothered me ever since. It is not numb now but any time i sit to long or drive my car i get pain in my lower back in my groin and my foot gets hot and my heel hurts real bad. My primary dr. says it is just sciatic nerves and has prescribed me a anti-inflamatory, lortab, and cyclobenzaprine, the last which i quit taking because i could never stay awake and know i take something called methocarbomal which is a muscle relaxer but seems to keep me awake.

I have spent time reading alot of articles since finding this site and have heard alot of people saying they are having there hardware taken out, is it a bad idea to get a cage?
If I do a simple laser surgery how long before i need a second surgery?
Also do they need to operate on every disc or can they find out which one causes my leg pain?
I see my surgeon in 3 weeks and I am trying to arm myself with alot of questions.
Every doctor I have seen so far says I will know when it is time for surgery, how will I know? I go to the doctors for these answers I dont know how to tell if I need surgery.

I am married and have 3 little kids and I hate not being able to carry them all the time and play with them. They are all very understanding but I want to play sports with my kids.
Sorry if this is to long it is the first time I have ever posted anything. Again I thank anyone who would be able to offer any info on how you know it is time for surgery and how you know you have a good surgeon, and any pros and cons to back cages or surgery in general?
Thanks John

[successtory]

Hi John and welcome

Your symptoms sound an aweful lot like a tear in the L4-L5 or L5/S1. Your bulge at L5/S1 sounds like mine and turns out it was a herniated disk. You might want to think about the cages. Before you do ANY surgery, I would recommend a discogram/CT scan. That is how my hernia, tears, fissures and ruptures were found (the MRI showed none of that!).

JUST SCIATICA. oooooooo that makes me so mad! Apparently, he has never had this affliction. Because anyone who HAS had sciatica, would NEVER say "just sciatica". yikes. Sciatica is indicative of L4/L5 & L5/S1 nerve impingement...or herniated disks (we are talking generalizations here).

Let's assume you DO have a tear....the IDET procedure may be an option.

For a contained herniated disk.....the Nucleoplasty procedure is probably the best.

For a (regular?) herniated disk....there are discectomys and laminectomys.

All of the above procedures are known as "non-invasive" (in who's book?) hehe The IDET and Nucleoplasty use larger gauged needles and they go in from your side. Largest hole is like from a 17 gauge needle. The "ectomy" procedures do involve incisions (anywhere from an inch to 4 inches...I think) located where the disks are.

To me....getting cages means putting metal into your back. That's just not right....ESPECIALLY for a first procedure! Not unless you broke your back or some emergency-type thing happened. You've got to look into other non-invasive treatments. Get your discogram/CT scan. THEN....you will be MUCH more ready to make a well-informed and satisfying decision.

Good luck to you.



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successtory
Oct 2000: Repetitive Stress Injury-Inverted Hernia
Feb 2001: MRI. Shows only slight bulge at L4-L5
Dec 2001: Discogram/CT scan shows Inverted Hernia at L5-S1. L4-L5 & L5-S1 ruptured in all 4 quadrants. Unable to walk.
Feb 2002: IDET, Nucleoplasty, Intra-Discal Injections
Sept 2002: Rated in the top 10% for successful patients. Retraining for new career.

[New York Guy]

Thank you successtory,

I was told in 6/2000 that the L5 S1 is herniated the original report had said something about a large herniation in the L5 S1 area.
Thank you for the other options I will be sure to ask about them, you mentioned IDET and I have seen this elsewhere what exactly is this?
I will definatety talk to the surgeon about other options , I was unaware of the nucleoplasty procedure.
Also did you ever speak with more than 1 surgeon?
Also have you or anyone else had any problems with the medicine your taking?, I worry about getting dependant on them.
Thanks again John

[wbaker68]

Absolutely speak with more than one surgeon before going thru with any back surgery. Anything done to back is serious and all options and opinions are needed before making a "informed" decision. With only one doctor its difficult and almost impossible make an informed decision.

As for medications, be very careful on taking only what you need. Most of the medications are very addictive. Try non narcotics first before allowing to be put on narcotics like oxycotin or vicodin. Both are addictive but end up being our only choices in the end.

I personally take Ultracet, non-narcotic, unfort. does little for me but take the major edge of pain. Still edgey but not bad. I use Vicodin only for sleepless nights which are coming more and more often.

Good luck and seek several opinions.

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Auto Accident Aug 1988
L3-4 disectomy 1989
L3-4 now re-herniated
L4-5 DDD
L5-S1 herniated
5/14--scheduled for trial stimulator implant
Hopefully to hold on for Prodisc for all 3 discs

[This message has been edited by wbaker68 (edited 04-29-2003).]

[HNPatL4L5]

Welcome NYG

It is important to find out what feature found on the MRI is causing your pain. If your pain is primarily leg pain (not back pain) and is caused by the large herniation at L5-S1, then perhaps all you need is a microdiscectomy to resolve it. This surgical procedure has a very high success rate (19 in 20), a very low rate of significant complications (1 in 500) and a short recovery period (about 6 weeks).

http://www.healthboards.com/ubb/heart.gif HNP



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HNP at L4-5 late Sept
3 months PT
Reherniation late Feb
Nerve block mid March
Microdiscectomy April 4