Microdiscectomy Question

[Paulback11]

I have a large disc rupture between L4/L5 which I suffered from for 5 months before finally getting an MRI and an appointment with a Neurosurgeon.  Surgeon said I need a Microdiscectomy and made the appointment for a week from now.  I've googled alot about it but the following are questions I never found anything on.

1.  The surgeon said when describing the procedure that he would go in, remove the disc material that was impinging on the sciatic nerve, and then go in and clean out any other disc material.  I wasn't sure if he meant any little other bits that were loose or simply all the remaining disc material left in that void.  I asked him what he meant and he said something about the known risk of recursion so it was best.  So I said you mean there's nothing there anymore?  And he replied that there was cartelege in a tone like "Its fine, don't worry" and then sort of bum rushed me out.  So my question is:

  -  Is a Microdiscectomy the complete removal of all disc material from the trouble joint because in the past just snipping the bit that ruptured out isn't enough because more material will continue to come out over and over again?

2.  Its been 7 months now and I still have limitations to my motion.  Although, I'm not feeling the anxiety and pain that I did at the beginning.  I have lost 20 Lbs since that time, and I feel like I'm simply just better at dealing with the pain and managing  my motion to avoid the worst strains.  So with 1 week left before my surgery, I'm second guessing whether I should do the surgery or if I should patiently wait and continue to lose weight, (I was 250 - now 230 - would like to get down to 200).  Its a scary decision considering its irreversible.  So my question is this:

  -  What are the actual ramifications of this surgery down the road.  Especially now if this surgery means complete removal of all disc material.  I've read specific cases that track individual experiences for years, but I'm not confident I  understand what the probabilities are of what to expect.  For example, does Microdiscectomy mean that I am definitely facing a spinal fusion surgery at some point in the future?  If so, how long do I have on average?  If I'm 7 months along a natural healing path that might take 2  years, is that a better option than surgery?  

3.  Two sources have told me that if I were an athlete, this would be a no brainer and I would have the surgery for sure so as not to waste any time.  Is this true?  

[Slipsoup]

Hi. Your situation is quite similar to mine; however, my time line is a little different. I had an MRI at the 3-month mark, after suffering from horrible sciatica for 2 months with no improvement. I have an extrusion at L5-S1. At the 4-month mark, I saw a doctor who recommended I have some surgical consults. I saw 2 surgeons, both of whom said I didn't need to have surgery, one suggested it for quality of life issues because I'm very athletic. I was told by one surgeon, as you know, that surgery vs. non-surgery groups are the same at the 2-year mark. I also asked if surgical repair is any stronger than natural repair. The surgeon told me that there's no data to support that. There's a 5-10% chance of reherniation regardless.
I'm approaching the 6-month mark soon. I've noticed great improvement in my daily functioning (i.e., dressing, sitting, stooping, etc.). I recently started the Egoscue Method with the hope that it'll help correct my dysfunctional posture, some of which developed after my injury. You might want to get the book, "The Egoscue Method of Health Through Motion" to familiarize yourself with it.
I've been taking Lyrica for the past 2 months and am in the process of weaning off. I also tried a few sessions of acupuncture. I also remained as active as I could, swimming and riding a stationary bike.
I think you're wise in considering taking the non-surgical route, particularly at this point in your recovery. Had I seen a surgeon within the first month of my sciatica nightmare, I might've had surgery. I asked the surgeon if there's a risk to waiting on the surgery and he told me that the risk of nerve damage exists. However, he has operated on people after 1-2  years of pain with good results. I'm sure you've heard this (as I have) - only you can make the decision that's going to be best for you. Good luck!

[Ellen038]

My understanding from the surgeon who did 2 microdisectomies on me was only removing any protruding material. When I had my fusion they removed it all and now there is bone grown in the space and hardware in my spine.

There is a 50% success rate with back surgeries. I would say if you are having improvement I would continue on the path your on. Acupuncture/ PT, massage, hydrotherapy, LESI (lumbar epidural steroid injections), yoga, inversion therapy, weight loss, muscle strengthening are some things that will help you in your recovery.

Here's a short version of what has happened to me:
Age 31 bent down to pick up a weed to throw in the trash & herniated discs. Surgery 2 months later after trying to manage conservatively. I felt 100% perfect and could do anything and some things I couldn't do before my back injury. I ended up re injuring my back and failed conservative therapies again.  I had a second surgery almost a year to the day. Felt zero relief from surgery. I was in the same amount of pain as prior to surgery. I was then advised to have a 3rd surgery that would 'get rid of all the back and leg pain'. I was worse off pain wise immediately after that last surgery. I had an ALIF (anterior lumbar inter body fusion with hardware). In less then three years time I had three back surgeries and I'm now disabled and can no longer work. I spend most of my time/money trying to manage my pain. Since I had a fusion nobody wants to touch my back and I'm told that nothing really can be done anyways. My last option was seeing a pain management doctor who would love to put a pain pump in my back but I refuse. I go to acupuncture, massage and some exercise and stretches. I use a warm moist heating pad so much I've got burns on my skin just trying to get out of pain and unfortunately I am on medication to help alleviate the pain but it doesn't help as much as one would like. I also have herniations above my fusion which is common since the rigidity of the fusion distorts the natural movements of your spine. I was in a head on auto accident a couple months after my ALIF and I have bad neck trouble as well as cervical herniations. After the experience with my back I refuse to do anything to my neck.  So much for being out of pain right? Anyways, I just wanted to let you know that there is a chance that things won't be any better AND could actually get worse. I wish I would of known a little more back then before I had the last surgery done. It's almost been 6 yrs since the fusion and I am still worse off then before with both back and nerve pain in my leg. I've seen some pretty good specialists in my area and nobody has given me any hope of a less pain free future.

My advice would be to keep trying other therapies and finding a combination of things that help you to heal and strengthen your back. Most back injuries need a combination therapy to be most beneficial. If you can loose a little more weight I'm positive that will be a BIG help. If you don't feel that you are well enough I would get a second and even a third opinion. Don't rush into making a decision like this. I wish you the best in whatever you decide.