Here we go! Just found out MRI showed Herniated Disc at L4/L5 with nerve impingement

[rutman]

For anyone that has had Back Surgery this is new to me. Been in the greatest of health, but for some unknown reason had pain shooting down right leg going to front and back of calf and even on top of the foot. Excruitiating pain at times. MRI done on last Thursday and now finding out Herniated Disc @ L4/L5 with nerve impingement and bulging at L3. Please advise what if anything can be done to avoid surgery--go back tomorrow for further review as I was told on phone, but sounds like surgery to me. If anyone has any words of wisdom or comforting words please advise. All the medicines in the world have not helped since I incurred during the first part of Thanksgiving Week. Hard to walk at times. Any recommendations including telling you better have the surgery is encouraged. Thanks in advance! The Rutman

[mmglobal]

It's not an attractive prospect, marching down the road towards spine surgery. Hopefully, your spine will be good enough to recover without surgery... conservative treatment. If you must entertain surgery, please do your homework and discover all your options.

HOw severely degenerated is your 4-5? With good disc height remaining, if you fail conservative treatment, there may be minimally invasive options.

Good luck... ask away if you have questions...

Mark

[Michelle]

I've known people that have severe herniations that were treated with epidurals for years. I know more that had to have surgery, but it happens. I think that's why you have to have a lot of conservative treatment before anyone will operate, except in extreme cases. I know the idea of surgery isn't fun, but I'd say it's better than 'we don't know why you hurt-live with it!'. Good luck! I hope you get some relief.

[dshobbies]

Rutman,

You havn't posted where you live. For years prior to my surgery, I had success with flexion/distraction therapy on the Cox table. It kept me from using heavy meds, though I also led a very sedentary lifestyle. Each therapist is different and I feel comfortable only recommending one in the San Fernando Valley. It's something you might want to look into, especially without prior surgeries and scar tissue.

Good luck, Dale

[rutman]

Thanks for the feedback! Well--first I live in Danville, VA (45 miles North of Greensboro, NC) but the Spinal Surgeon that I saw today has a very good reputation, Dr. Jeffrey Beane--located on Benjamin Parkway in Greensboro, NC. He apparently was the Chief Orthopedic resident with the Penn State football team and has been practicing for awhile. Has been in the Greensboro, NC area since 1993--so if anyone knows about him please comment positively or negative. But he seemed very confident and I was pleased with his discussions with me.

Bottom line--first time I had seen MRI pictures and even I could tell what I was looking at from what I've read on spineuniverse.com Yuck! Definitely the L4-L5 is blown out and I can see where the annulus part is just smashing into the nerve--no wonder my whole right leg is going numb and weak. I was basically told yeah you can do epidurals but just a band-aid effect and doing the surgery will definitely relieve the pain. I was also told yes it could rupture again and no promises and there is possibility of scar tissue, but bottom line I would rather fix now while I'm just 42 and then prolonging and making matters worse or causing the bulging in the L3 to become ruptured as well. For those that are reading my comments do you feel that makes sense--I just feel like fixing now the best he can instead og making matters worse and not being able to move right leg at all or causing further damage. Please respond at your earliest convenience! Look forward to your responses. Thanks again! John

[dshobbies]

Please define 'fix it'. Are you talking about an adr or discectomy?

[RoinMd]

Since most people 'recover' from a herniated disc with time, most surgeons are very reluctant to jump right to surgery. I've been living in constant pain on standing or when walking since August. I've been treated with just about everything conservative -- Lyrica, Ultram, 2 courses of oral Prednisone (the first course was like a miracle -- the second, no effect at all). I start 3 weekly injections on 12/28 which I don't hold much faith in but to get to a microscopic discectomy I've had to demonstrate that nothing works I would have given anything to have not been in pain for the last 4+ months. Good luch to you! RoinMd

[mmglobal]

The decision about which surgery to do is a very difficult one. Often, there are financial implications as people cannot afford to go back to the well again if they need a second surgery. Or they feel that they cannot afford to be disabled longer if a less invasive surgery is attempted in order to try to salvage a disc or to keep from a more invasive surgery.

I am often dealing with people who have failed less invasive attempts and are graduating to more invasive surgery. Look at my history... 2 failed microdiscectomy/laminotomy procedures before my ADR. In my case, knowing I needed more surgery earlier might have saved me 2.5 years of my life, but also might have caused me to do the wrong surgery. (I came very close to doing a 2-level 360 fusion... then a 2-level BAK fusion with NO POSTERIOR INSTRUMENTATION. Both surgeries, I believe are less desirable options than the ADR surgery I ultimately had. (Note that I am not anti-fusion... for many of us, fusion still represents the best option.)

There is an interesting discovery process as we are hurtling towards surgery. Early in the process, the prospect of 4 more months of pain seems like a hefty price to pay.... and it is. However, 3 years from now, when you look back, it will seem unimportant whether you waited and suffered for 2 months, 6 months or 10 months. What really matters is long-term relief... getting the most appropriate surgery... getting the least invasive surgery that stands a good chance of solving your problem... getting a surgery that leaves you further options if it's not successful... THESE ARE THE CRITICAL ISSUES.

Obviously, I do not intend to understate how severely our lives are affected by our problems. Our careers are on the line. Some will lose their houses. Some situations are made worse or intolerable by our horribly dysfunctional workmen's comp and insurance systems. I still submit that getting the most appropriate treatment to minimize the prospect of spending the rest of our lives in chronic pain and in a fog of depression and medications is more important than our careers, houses, etc... (I know that this is easy for me to say and I had many advantages as I went through my 5-year ordeal: most importantly, a supportive spouse and a house with enough equity to allow me to get the surgery I needed.)

Also, these decisions are not black and white. Everything is a trade-off. It's easy for someone with disc herniations, good disc height, no instability, early in the DDD process to consider getting a discectomy/laminotomy. They stand a VERY high chance of success. Success may mean getting immediate and total relief and never needing another surgery; or it may mean partial relief and staving off additional surgery for just a few years... but that is still success.

But, if you have poor disc height, huge annular tears, advanced modic changes, instability, etc... you may be putting more at risk by trying less invasive procedures... you may be causing further damage to critical elements that may limit your options later.

Spine surgery is something that should be avoided. With spine surgery less is better. Decisions should be based on knowledge and an understanding of all your options... not just hearing what you want to hear from a doctor that wants to do surgery. When I returned from Germany last week, I rode to the airport with a cancer surgeon who just had apparently successful endoscopic surgery with Dr. Hoogland at the AlphaKlinik. He said something that I wrote down for my list of quotes:

Desperation is not a good consultant!

One last note: When we are looking at the less invasive procedures, do what you can to preserve future options. I've had multiple clients who had minimally invasive discectomies but graduated to needing ADR. Sadly, they discovered that what they thought was a minimally invasive discectomy because it was done endoscopically as an outpatient procedure, actually removed all or too much of their facets and disc replacement was no longer an option. So, if you are having less surgery, which is best if you are a good candidate, make sure that you are with someone who has an eye to the future and will not burn your options unnecessarily.

Mark