Possible 3rd herniation of L5/S1 within 2 months?

40 year old, very active, healthy male.  Herniation symptoms starting mid-Nov 2008.  Lumbar microdiscectomy L5/S1 on 12/23/08 with "huge" portion of disc removed.  Recurrence at same location within 2 weeks.  Second microdiscectomy L5/S1 on 1/12/09, removing 2 more large pieces of disc.

Initial symptoms of herniation were level 10 pain in R leg, numbness and tingling in R foot, loss of R foot reflex, R calf weakness (unable to stand on toes).  MRI and surgery 12/23/08.  Following 1st surgery, still had numbness and calf weakness, as was told to expect, but also developed sharp level 7 pain in R foot with each step.  Several days after initial surgery, had a 2nd "attack" with brief, sharp pain in R big toe, spreading numbness & tingling in R leg, additional weakness in R leg.

2nd MRI showed "even worse" re-herniation again at L5/S1.  2nd surgery on 1/12/09, 2 more large disk pieces removed.  Pain in R foot immediately better, still numbness in R foot, some weakness R calf, can't stand on toes - understand that this is expected for now.   However, 2 days after 2nd surgery (1/14), again felt sudden *increased* numbness & tingling in R foot, up R calf, and increased weakness in R leg.  Felt like a "mini" version of the first re-herniation.

Surgeon says it would be "unheard of" for this to be 3rd herniation of same disk & there is little or no material left to herniate anyway. (Other disks appear OK.)  Says may just be irritation of nerve root after surgery, not to worry.    My concern is that increased tingling & weakness that I now have feel similar to those that were an indication of the re-herniation.  Foot/leg were actually somewhat better on the day after surgery than right now.   Could this really just be normal post-surgery progression?  Do I ask for another MRI?  Have been limping since mid-Nov and afraid of permanent damage.  Next follow-up is in 1 week w/surgeon.

[tinabae]

Hi there,
Your situation sounds almost like mine. My 1st microdiscectomy was 3 weeks ago, I re-herniated 5 days post op and hurt like hell. yes numbness and 9 pain from right sit bone down the leg to the foot. My right foot is much colder than my left which means poor circulation. I didn't go in for another micro because the whole experience has been horrific for me and Im scared out of mind of another surgery. Worse my surgeon now wants to do spinal fusion! I have a feeling the success rate for microdiscectomy is much less than 90%. I personally think my spine has been permanently damaged by surgery. I should've researched much more before trusting a dr's recommendation. Hope you seriously get a 2nd,3rd opinion to be sure any more surgery is right for you.

[missywv]

I can't imagine having surgery three weeks apart!  The first one was bad enough - I had a microdiskectomy of the L4/L5 on 12/15/08.  Was doing very well for the first two weeks - absolutely no leg numbness at all.  Then BOOM, same leg numb, but just in calf and heel this time.  So much numbness that when I press my finger hard into my calf, it's just like pushing into a rump roast on the counter, no feeling at all.  I called the neurosurgeon and he said it's just nerve irritation.  I see him next week.  If it isn't nerve irritation, then I herniated the disk below, because I have no disk left at the L4/L5.  I have a strong suspicion that its another herniation.  I'll give this one some time to heal on it's own and pray that it does.  The L4/L5 had been herniated for so long, the disk had calcified so I also hope this isn't permanent nerve damage.  Best of luck to you and let us know what happens next week!

[Back123]

Thank you Tina and Missy for your replies.  I am going for my follow-up this Friday for the second microdiscectomy that I had on 1/23.  I was afraid I herinated the same disk (L5/S1) yet a third time because I had very similar symptoms as the second herniation just two days after the second surgery.  They are now somewhat better, but I know that doesn't mean it didn't actually re-herniate.  My doctor thinks it's just nerve irritation, but I am going to insist (as much as possible) that he get me another MRI for my own piece of mind, so that I can see there is no third herniation there.  If he's reluctant to do so, I'll go to another surgeon and ask for them for the MRI.

I know that the original symptoms of the herniation (weakness, numbness, etc.) can take weeks, months or longer to go away even after a successful surgery.  What I want to make sure of is that I don't have another herniation in there that's going to be confused with "nerve irritation" and going to make that healing process even longer!

Good luck to you both.

[realest]

Hi I definately know what you are going thru.... I am 39 year old healthy active male who has had 2 L5S1 back surgeries in 4 months... After the first surgery 9/08 my left foot throbbed continually ...Because i was in  so much pain in Jan 09 My Neurosurgeon went back in and cut more disc off and made sure S1 root nerve was clear...  

Now almost 4 weeks later my whole left foot throbs and have weakness/ numbness in calf, i can not walk that well. Putting a shoe on is painful and impossible to keep on. My pain increases when i am sitting and laying flat

I used to work out dailly and now i have been confined to my home which is frustrating. I am off the vicoden which did not do that much for pain and neurontin only masks the pain. On the phone my doctor mentioned Neuropathy which i thought was for diabetics only???

I see my neurosurgeon next week for follow up...
Curious to see what your Doctor says and how much pain u are still in?

[Back123]

Hi there.  I actually saw my neurosurgeon last week and asked for an MRI to make sure that the pain/numbness/weakness that I started to feel after my second operation wasn't in fact a sign of a third herniation.  I got the MRI just last week but haven't heard the results yet.  However, the surgeon said that no matter what, he is not going to recommend a third surgery for me.  (I had two within 4 weeks for a recurrent herniation.)  He said if they went ahead and did something like a fusion, he can almost guarantee even more surgeries in the future because the disk above it would eventually herniate as well.  (I don't think he was implying that that is the case with everyone, but based on my own level of activity and the fact that the disk above is already showing some degeneration and bulging, he said he would be doing me a favor by treating anything they did find very conservatively rather than getting a new operation.) In any case, he thinks what I'm feeling isn't a herniation anyway, just the nerves that were irritated from the first herniations and back-to-back surgeries.

Have you thought about getting another opinion and maybe further tests to see what's causing your pain?  My pain right now is minimal.  It's really the fact that my calf muscle isn't responsive and makes me limp that I'm most concerned about, and I know that you're having similar problems walking along with all of the additional pain.  

As for neuropathy, that refers to just about any kind of disease or damage to the nerves for many reasons, not just related to diabetes.  For example: http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics

Good luck, man.  I really hope they can get things under control for you (and me too).

[Back123]

For "realest" and anyone interested, I learned the results of my 3rd MRI.  This MRI was after my second microdiscectomy of L5/S1 (after a reherniation that occurred within 2 weeks of the first surgery).  I got the MRI because even after the second operation, I was having similar/sometimes worse symptoms (mostly leg and foot related).

The MRI showed "residual" herniation according to my doctor.  He said it was very small and "of no concern".  I'm not totally convinced of that, since it is definitely causing problems and even since having that MRI done, I've felt at least two other "tweaks" which instantly led to increased numbness, etc. again, so I don't know if this "residual" herniation has actually increased since then or not.   For all I know, even this 3rd MRI is now "out of date" and more herniation may have occurred.

I'm going for at least two more "second" opinions over the next week.  Chances are I won't be getting a third surgery, but I want to make sure I've heard about all of my options...again.

[realest]

I would definitely get more opinions before more surgery... I only did the second disc surgery because i still had left foot pain 4 months later!

I had 2 MRI"s after the 1st surgery and the previously heirnated L5S1 was just bulging but my surgeon thought something could be hitting S1 root nerve. He went in and cut more disc material and made sure nothing was hitting root nerve.

Unfortunately my foot pain is worse than before and the only relief i get is taking Neurontin which has too many side effect (dizziness ,drymouth, forgetfull etc). I hope to get off the meds next week and hope the pain decreases so i can keep a shoe on my foot.

The frustrating part is not knowing whats wrong. I picked the best spine  hospital in Boston ... NE Baptists and im still having issues. Most people that have L5S1 discetomy are pain free that day and back to work in 2-3 weeks???

I have an appt with my neurosurgeon on friday and i hope he can explain the pain I am in. My next step will be getting a second opinion  from another neurosurgeon .

Hopefully your numbness improves