L5 S1 hurniation w/ step-off

I am 28 years old and have been dealing with a herniated disk at L5 S1, which also has a step-off. The step-off, so i'm told, causes the disk to be unstable resulting in a shifting of it at anytime. I've done PT, epidurals, you name it, i've tried it. Right now i am on a regimin of Nurotin, Flexeril, and Percoset. With very little relief, i am currently considering surgery. I really don't want to do it, at 28 i feel like i'm too young and have been told by more than one medical professional the same thing. I'm not willing to do any more epidurals, as the last one i had caused permanant nerve damage on the left side. I'm just at a loss as to what to do. I have a soon to be 3 year old, and i'm getting tired of having to tell her that mommy can't do that right now. What are the surgical procedures for cases like mine and what are the risks involved?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Just some background on herniated discs:
There is a material that cushions the space occurring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones; this is called a herniated disc. The disc may push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself.

In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muscle relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications.

In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.

One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers.

In some patients, after conservative non-surgical therapy is tried for 4-6 weeks and the pain is still severe or if other symptoms/indications arise, surgery is the next step.

It would be best for you to discuss surgical and non-surgical options with your surgeon.

Regarding your question on which procedures are best and what are the risks, I cannot answer this. I am not a surgeon. I would suggest that you post your question in the orthopedic or neurosurgery forum.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Addie2U]

My DIL (age 32) had the same thing (less the step off).  She had 3 surgeries in one year - the last one was due to a cyst that had developed because of the way she sat.  The #1 risk is - getting addicted to the drugs.  You may not think the drugs you're taking give any relief - but go off of them for a day or two.  She got addicted to Oxycontin and said she'd rather be in pain, than ever take drugs again.  She went cold turkey for a week (which the doc said would allow the drug to get out of her system).

What you personally have to look at is your family history.  For instance, she had a family history of back problems.  You also have to understand that if you have the surgery, picking up your child(ren) - not infants - children, will no longer be allowed.  My DIL was doing fine, until she took the kids they're trying to adopt, to the zoo.  Of course, the 3 and 5 yr olds want to be lifted up so they can see better.  She is now paying for it, and may end up with more back surgery.

If you do the surgery, please make sure you find the best neurological surgeon to do it.