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  • New here; herniated disc at L4-L5, Microdiscectomy?

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    Old 11-24-2003, 09:59 AM   #1
    dexter24's Avatar
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    Question New here; herniated disc at L4-L5, Microdiscectomy?

    Hello all,
    I'll start with a bit of my personal history: 36 yo male. 5' 11", 200 lbs (although 15 of that has been gained since May, when my back "went out" and I could no longer get to the gym. I've4 had back pain since I'm 18, but nothing ever major; as I got older I'd have episodes where my back would "go out", i.e., sharp "electric" pain, followed by days of soreness and muscle tightness. For this I would go to the chiropractor, he would do the standard electric stim, manipulation (crack my back) and I would continue with a regiment of stretching and strengthening exercises along with the occasional muscle relaxer and anti-inflammatory (naproxen). I would have these episodes every couple of years, sometimes with as much as 4 years in between. Eventually I had some X-rays that showed a "bulged disc".

    Fast foward to Spring '03, I feel that familiar twinge of the onset of a back flare-up, but when it hit it was different. Actually, it was the same at first--general discomfort, muscle tightmess, etc.--but then it really hit: extreme back pain to the extent that I was bent into an "S" shape. I went to the chiro, but no relief. This was early May.

    By July I no longer had any actual back pain, but rather intense pain shooting down my left left leg with the most pain in my left hip and left calf, with the hip pain far outweighing the calf pain. Still walking like an "S"

    Went to a ortho who told me to get an MRI and to look into PT. I went to PT for about a month--little, if any, relief. Went back to ortho, who suggested epidural cortisone injections. I received 2 shots about 2 weeks apart: the first one did provide relief for about a week, then the pain returned so I went for the 2nd--no effect, I was right back where I started. I cancelled the third scheduled epidural--seemed like a waste of time.

    MRI results: "At the L4-5 level there are anterior osteophytes. There is disc desiccation and disc space narrowing. There is a central and left sided herniation which effaces the ventral aspect of the thecal sac. Extruded disc material extends inferiorly behind the L5 vertebral body where it results in mass effect upon the ventral aspect of the thecal sac.

    At the L5-S1 level there is vacuum disc phenomenon, disc desiccation and mild disc bulging. There are mild marrow signal end plate degenerative changes with elevated signal intensity on the T1 and T2 weighted images. The marrow signal is normal. The conus is within normal limits.

    IMPRESSION: L4-5 left parasagittal disc herniation with extruded disc material extending inferiorly behind the L5 vertebral body resulting in mass effect upon the ventral aspect of the thecal sac."

    OK, so I figure that this means that I have a herniated disc with some other nasty, pain-inflicting stuff floating around in there. I no longer have ANY back pain or even discomfort, but the pain down my left side is incredible, often waking me out sleep several times a night. I can no longer go to the gym and walking is painful. I can not put my socks and shoes on without help and I have moments where I see stars the pain is so bad and I can't get relief from the pain no matter what position I attempt to get in. I've tried Vioxx--little or no relief (maybe it takes the edge off of the pain); and am now currently on Neurontin. I have pain killers, but they don't seem to do much.

    Original ortho recommends surgery, so I go for second opinion. Second ortho looks at everything and says that back and sciatica pain due to disc herniation usually resolves itself in 6-8 weeks (80% of the time) and previously that WAS my personal experience. But now I'm entering the 8th month of this hell and the doc says only surgery will provide any relief and waiting much longer could result in further damage and a lower chance of a succesful surgical outcome. He described the procedure as a micro-discectomy.

    So, in the esteemed opinion of the veterans here, have I looked at enough alternatives to surgery? Am I just forestalling the inevitable?

    Doc says that surgery takes about 1.5 to 2 hours and I will be home that evening with several weeks of recoop time.

    What questions should I be asking? Should I see a Neuro? What is the consensus here on Ortho vs. Neuro for back surgery? I read here about procedures wherein the source of pain is detected--what test is that and is it necessary? I am planning a family vacation for March, if I have surgery within the next few weeks, is this feassible?

    I live on Long Island, so if anyone has any surgeon recommendations I'll listen. Anyone familar with Dr. Arnold Schwartz?

    sorry for the length and thanks in advance.

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    Old 11-24-2003, 07:21 PM   #2
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    carol632's Avatar
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    Re: New here; herniated disc at L4-L5, Microdiscectomy?

    I am certainly no expert, but it does seem to me that you have tried a lot of different things with no long lasting relief. So it appears that surgery is likely. When nerves are impinged too long, the damage can be permanent, leaving you in chronic fun at all, let me tell you!
    You have had 2 opinions that surgery would be best. No one can tell you when you are ready to do that. Obviously, you can't enjoy a vacation in your condition. Talk to your doctor about whether you have any other options, and what his take is on going on that vacation if you have surgery right away. Certainly, no easy answers or decisions. I do hope that whatever you do, it turns out to be right for you.
    2 lami's, 3 fusions
    bone spur removal
    cerv. fusion, 1 level
    morphine pump

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