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  • L5/S1 Disk herniation, On/off pain,Whether to have surgey or not

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    Old 12-28-2014, 11:38 PM   #1
    spinestruck's Avatar
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    spinestruck HB User
    L5/S1 Disk herniation, On/off pain,Whether to have surgey or not

    I had a fall two years ago that resulted in disk herniation at L5/S1. The pain after almost around a year subsided and i thought its gone but then again started again. I have pain in my calves and feet and sometime in hips as well.

    I have been to neurosurgeons, some suggested surgery and others were like you dont need surgery at all. As per the ones that didn't advise surgery, exercise was my way to recovery. With the anti inflammatory medicine and some multi vitamins i continued my life with a change in job, then leaving that job due to its requirement of physical work and now to almost jobless situation. The thing is after two years i feel i am at crossroads to have surgery or not. Doctors are conflicting in their own way and i don't blame them as each one has and can have their own opinion. But the thing is my healing, my recovery. I am almost 30, just when i was about to have a good promotion, start earning good money, get married, help my parents/family/people around me, be a part of their solutions to problems, contribute to society, excel in basketball; there came sciatica and it grounded me( I believe each one dealing with spine injuries has their own background).

    The anti inflammtory medicines after some time started to have a reverse effect on my stomach so i stopped them. Despite the pain in legs and feet, i don't want my stomach to go wrong way. In past 4-5 months i have avoided them at all and am only taking multi vitamins(is it good or bad to leave anti inflammatory medicines, do they help in disc healing or only reduces the pain ).

    I am doing stretching ,strengthening back and core muscles exercises but im not so sure if they are helping at all. Just for reference I have attached my spine MRI just to get a comparison from other members how do it compares to their scans. Does this herniation asks for a surgey. This MRI was done two years.

    My MRI report was, I have deleted the parts where its findings are normal.

    [B]CLINICAL DETAIL[/B]: Low back pain with left sciatica.
    Multiplanar and multisequential imaging of the lumbar spine done.

    Vertebrae are normal in height and alignment. Normal marrow signal in the vertebral
    body and posterior elements.
    There is straightening of the lumbar spine, which may be due to muscle spasm.
    [B]L5-S1 disc[/B]: Has loss of T2 signal, dehydration and there is diffuse disc bulge with a small posterocentral protrusion, which is indenting the thecal sac and there is
    narrowing of the left neural foramina in its inferior aspect. There is also indentation on the bilateral pre-exiting nerve roots.

    Discal degenerative changes at L5-S1 indenting the thecal sac and bilateral pre-exiting
    nerve roots. No disc herniation or bulge elsewhere. Rest of the lumbar disc reveal normal
    T2 signal.


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    Old 01-07-2015, 03:09 PM   #2
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    Re: L5/S1 Disk herniation, On/off pain,Whether to have surgey or not

    I want to be sure that you understand the nature of your pain syndrome. The pain you're feeling is due to 1) pressure on the spinal cord, and 2) pressure on the nerve roots at both sides of L5-S1, which assists in innervating the legs and buttocks. The pressure is due to extruded disc material from the L5-S1 disc.

    I imagine your neurosurgeon can see the amount of impingement of your nerve roots.

    Generally, decompression surgery is indicated when the nerve roots with 90% or more occlusion of the foramenal space, or in cases of severe spinal stenosis where the cord is close to occlusion.

    Your case might be less severe as it sounds like the surgeons feel some ambiguity about operating, maybe because the risks of surgery (scar tissue, damage to ligamentum flavum and other structures that can exacerbate pain) outweigh the benefits.

    For this reason, I think that surgery should never be performed simply to reduce pain.

    Have you consulted with an interventional pain doctor? Some procedures may help, for instance, an injection of steroid and anesthetic into the paravertebral space near the foramenal openings, by reducing pressure on the nerve roots.

    If you are unfamiliar with interventional pain management, it's a sub-specialty of anesthesia. Practitioners are certified by the American Board of Pain Management, so you'll see the initials DABPM as part of a doctor's qualification.

    You may have some difficulty finding a local practitioner. In that case, seek out a medical school or teaching hospital with an anesthesiology program. Chances are they'll have an interventional pain program and the hospital will have a pain clinic.

    The choice for surgery is yours. Just realize that there are risks, and that you must understand and weigh each one against the benefits of surgery before proceeding. Also remember that your pain may be coming from two sources -- the intervertebral foramen and associated nerve roots, plus compression of the cord itself.

    Best wishes.

    Last edited by Administrator; 01-07-2015 at 03:24 PM.

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