Herniated Disk, had bad epidural, should I have bilateral diskectomy?

[Andrea8]

I am currently agonizing over whether or not to have a bilateral diskectomy at the L5-S1 level, following an apparently ‘failed’ epidural nerve block.

April ’01 CT shows Central and left posterolateral herniation L5-S1, slight inferior extrusion of the herniated disc into superior left lateral recess of S1 causing effacement of thecal sac and left S1 nerve root.  Mild anterior lipping at L5 only.

16 August: epidural using Depo-Medrol, one ml. Vial at 80mg/ml.  Stinging and tingling in central lower back shortly after.  Some nausea for a few hours.  Headache from lying down too long- went away shortly after rising (15 mins?).

Condition was resolving prior to the epidural, but since then, I’ve had greatly increased severe and constant pain, not only on left, but also on right and in a few ‘new’ areas.  Plus much central lower back pain which, surprisingly, I did not have much of prior to the epidural.

A month after epidural, neurosurgeon now recommends bilateral diskectomy.

What may have gone ‘wrong’ with the epidural?  Will the symptoms resolve, at least to the pre-epidural stage?

Could surgery increase the symptoms again, perhaps permanently?

Should MRI be done prior to surgery to see if the epidural caused permanent damage or adhesive arachnoiditis or ??

What are risks of future complications if I don't have surgery?

Any comments or suggestions would be greatly appreciated!

[CCF-Neuro-M.D.-JT]

Because I have not personally reviewed your films nor have I examined you, I cannot give you an accurate opinion regarding your diagnosis and prognosis. However, complications of an epidural placement that could produce your symptoms include a collection of blood called a hematoma at the site of the placement pushing up on a nerve if a blood vessel was hit. An infection at the site of placement can also cause more pain, though this would usually be accompanied by fever. If it is just a hematoma, then it should resorb and the pain should resolve in a few weeks.
You need to talk to your surgeon about his own complication rates. But the complications of an L5-S1 surgery could include permanent weakness, sensory loss, and worst of all bladder and bowel incontinence. As the symptoms have gotten worse, it would not be out of question to get another MRI. It's quite possible that in spite of the injection, the disk got worse on its own. COnsider getting a neurologist's opinion or perhaps a second neurosurgeon's opinion about your films. Surgery is something you need to think about carefully as you appear to be doing. Best of luck.

[pomg]

I had L5-S1 disk surgery, the disk and the lamina were removed.  I had great recovery from the surgery, but am wondering if all the damage inherent in surgery has contributed to some medical problems I have now.

I avoid epidurals, had a few births without them (luckily no back labor), and am also afraid of getting a CSF sample taken.  Because my disk was "exploded", I was told, and also looked up in medical texts, that surgery is indicated in over 95% of cases, other methods of treatment just don't work if the disk is exploded.

My MRI looked like the spinal nerve was squashed into a triangle in the affected area, whereas at other cross-sections it appeared as a circle.  There was also a big piece of disk (1" x 1/4") broken off and away from the main body of the disk.

Note that I went through months of PT based on a negative X-ray (therefore no herniation they said), and I think that helped my disk get worse, the PT people didn't think it was anything other than a muscle strain, and worked with me accordingly.

My advice as a former patient is to find out about your surgeon, what his patient outcomes are for this surgery.  My surgery was done by two orthopedic surgeons, and it worked great, but I understand most people have neurosurgeons do the surgery.  I was able to resume sports in about 8 weeks, YMMV, whereas before that I could hardly walk.