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BackPainZ 02-08-2015 11:00 AM

Undecided Microdiscectomy L5/S1 Left
I have been trying to avoid spine pain forums on the internet because the sad stories hurt my heart and hopes, but today I am coming to those of you who have had successful microdiscectomies and asking you, how did you know, for sure, that surgery is the right step for your healing?

You see, I am 40 years old and have had the L5/S1 Left herniation for close to eight months now--starting in June of 2014. I think I was injured because of overuse, running, spinning, kickboxing, ect. I have a surgery date of February 27, less than three weeks away. As the surgery approaches, I find myself wishing I was either a little worse off or a little better off, so would know whether or not to keep the date with the knife!

I have exhausted conservative measures: lots of PT, 3 epidurals, traction, cold laser, chiropractor, acupuncture, massage. In October, I had an MRI--mass effect on the nerve-- and the surgeon and I agreed to try conservative measures first. The next few months found me having several epidurals and two and a half months of three day a week, McKenzie method PT. In the end, I was kicked out of PT because my pain levels did not improve and the back bends stopped working--all the stretches seemed too brutal. My back strength and range of motion increased, but that wasn't enough for them. Right now, I walk one hour a day, at a slow pace, and I take private pilates (not what you think, just small movements for function and gentle, standing stretches.)

I take two Naproxen per 24 hours, and 1 Norco at night.

So, back in December, when I signed on for this surgery, I had numbness in my toes. I don't have that anymore. I still have leg pain, but it is manageable. I can walk. I can stand for two or so hours. But what I cannot do is sit.

I am sleeping through the night. So, less foot and leg pain and sleep has caused me to question whether or not I am healing on my own. Do I need surgery?

Here is what makes me think I still need the surgery: 1) Quality of life. While it is true that I am not in as much pain as I was before, I am also not sitting, driving, bending--living. My husband does the house work and makes the meals. So, my pain might have been worse before, but I was still trying to be a normal, functional person. The pain when I sit, is intense, in my thigh, buttocks, and back. Sometimes is so bad, I have to use my arm to push up so I can make it on a car ride home. 2) Drug. I feel freakin toxic. I have been taking Naproxen for 8 months! Yuk.

I spend most of my day laying on my stomach. I sit for car rides of half hour or less. I sleep on my stomach only. It's like I've figured out how to avoid the pain. I've gotten good at nonliving.

If you have had a successful microdiscectomy or know someone who has, can you tell me how you can to the right decision for your healing?

teteri66 02-09-2015 07:32 AM

Re: Undecided Microdiscectomy L5/S1 Left
Welcome to the board. It can be difficult to figure out when things are "bad enough" to go through with surgery. Some people pretty much refuse to have surgery, regardless of how bad it gets. But among those who are willing to try surgery, it can be difficult to decide when.

It would seem that you have given conservative measures a more than fair try...and they have failed, although I suppose one could make the argument that you are better than you were. Does that mean if you continued the treatment, eventually the disc would heal on its own?

The primary issue in most back issues is nerve compression. If the nerve is badly compressed, the symptoms are typically more severe. It is thought that the longer a nerve is compressed, the greater is the risk for permanent nerve damage. Sometimes one can wait too long to have surgery that they will ultimately end up having anyway. It is easier to correct a problem before it becomes larger or more serious.

I would caution you to be very careful with the selection of your surgeon. Too many people take the first surgeon that is recommended by their PCP, and sign up for surgery without investigating the surgeon's education, training and experience, and without getting second or third opinions. One of the primary reasons for "failed back surgery" is because the wrong surgery is performed...that is, the surgeon has not correctly diagnosed the situation/pain generator and performs surgery that is not appropriate. For this reason it is always a good idea to get more than one opinion.

I am surprised you have been through all that physical therapy and are still sleeping on your stomach. Commonly it is recommended that for good spine health one sleep on the side with a small pillow between the knees or on the back with a pillow under the knees. These two positions support the natural curves of the spine.

I cannot comment specifically on discectomy. I've had three lumbar surgeries but none were a discectomy.

Good luck making your decision.

ChuckStr 02-09-2015 02:47 PM

Re: Undecided Microdiscectomy L5/S1 Left
Well, I've never had a microdiscectomy either but I've read a lot about them and did quite a lot of evaluation of MD surgeries with/for my sister. Surgeon selection, as with other spinal surgeries, is critical. Another issue is that they are sometimes not the correct surgeries. There are many instances of failed microdiscectomies where a fusion works to correct the problem. So, my advice there would be sure that you have a surgeon who is experienced enough to have a high degree of confidence that MD is the correct surgery, not just try it because it is less invasive than a fusion. Getting multiple opinions, as Teteri66 suggests will also help increase the confidence (provided they agree on the same approach:))

As Teteri66 says, there is evidence suggesting that the longer a nerve root is compressed, the more likely it is there will be long-lasting/permanent nerve damage. It is hard to predict though if and when that might happen. Also, it is possible for herniated discs to re-absorb although yours hasn't over 8 months of treatment which makes that seem less likely.

One other thing is that these boards tend to have a high proportion of failed surgery stories in general. I think that many people with successful surgeries are off living their lives, not hanging around spine message boards.

So, given all that, I think the "line" for surgery is often a pretty personal one (barring situations where surgery is a "no-brainer"). You have to weigh all the risks (surgery risks, possible failure etc) against rewards (possible pain alleviation, remove nerve compression etc). FWIW, personally, based on the information given, I would delay surgery, mostly because of issues with previous surgeries (and because I'm really kind of a wimp about things like surgery :)).

Good luck and let us know how you get on...

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