Recovery from L5-S1 Microdiscectomy

[Tim]

hello,

I had an L5-S1 microdiscectomy 14 days ago.  The surgery seems to have really irritated the nerve root and my leg is actually more painful now than it was for some time before the surgery (although not as bad as the worst pain I experienced with the disc problem, which I had for about 15 months prior to surgery).  My doctor (orthopedic surgeon) seems unconcerned, but is not the most talkative guy in the world, and I am a chronic worrier!  I am up and around, and seeing some slow improvement, but I am really uncertain as to whether the procedure has worked (the disc is also degenerative and he has pointed out that I may have continuing back pain from the degenerative disc).  I am 41 and very fit and healthy otherwise and I am having a hard time figuring out how much I can do, how much rest I need, etc.  Dr.'s advice is lots of walking, but I don't know where to draw the line as far as "how much is too much".  Also have many other "life" things intruding into my recovery, three school-age kids, job, swim coaching--any advice or words of wisdom you can provide would be much appreciated!!!!

Thanks,

Tim

[CCF Neuro[P] MD, RPS]

Dear Tim:

As you were probably told, recovery is very individual, lesion dependent, and very, very surgeon dependent.  Recovery is based on the above mentioned and rehab.  Rehab needs to be vigorous and supervised by a specialist.  Most spinal surgeries, unless the pain was due to a mechanical problem really are a **** shoot as far as relieving pain. However, we find that most get better.  Talk to the rehab specialist and especially the PT part of the team and see what they recommend.  They know you best and what surgery consisted of and the prior lesion (something that I know vertually nothing about).  It usually takes months for the final outcome to be known.  Exercise is good if it is done properly.  So, as previously stated, see your rehab specialist.  If degenerative disease is a problem then be sure to decrease axial load, use proper form in all activities, be of proper weight, stop smoking if you smoke (anything), eat properly, etc.  After awhile, you will know how much is too much, but until then kept in close contact with your PT.

CCF Neuro MD

[Liz]

I had the same surgery in Oct. 95.  I had a huge herniated fragment that was removed and the nerve root was totally compressed, therefore decompression.  I had a second surgery in May 96 to remove bone spurs and again open the nerve root.  Now some 2.5 years later, I still have occasional problems with the nerve (pain in calf muscles, numbness on outside of foot and no ankle reflex)However, it takes a very long time to get to the point you feel truly "better".  Unfortunately, because the disc fragment they removed in surgery 1 was so large, I now have a problem with instability (along with stenosis and degenerative disc problem in other disc...I'm only 36)and hence the problems mentioned above.  One thing I think all of us who have had surgical intervention on our spines must realize (and believe me it has taken me almost three years to get there) is that our backs will NEVER be exactly what they were before the injury, problem, surgery.  Walking is a good thing to do.  After surgery 2, I had to walk 30 min. 2X every day.  I had back exercises to do eventually to keep flexibility and build strength back.  I know can do some aerobic work, treadmill workouts, etc.  Don't let your worry get in the way of your recovery.  Best wishes to you and hang in there and be patient!  and most of all, listen to what your body is telling you!

[Dear Liz and DR]

Thank you very much for your reponses.  I am actually doing well and am seeing some improvement most days.  With regard to PT, my doctor does not have me ina program yet - he wants me to just keep walking until around Jan 1 (surgery was Nov 19)and then get into a formal PT program.  I am anxious to get started but I know I need to be patient!

Liz, I hope you are doing well and I appreciate your kind words. my disc problem was much less severe than yours, with pain and loss of mobility only (no loss of reflex or numbness), and really no loss of strength in the affected leg.  So I really should consider myself lucky!  Anyway, I really appreciate your response - it is very helpful to get some perspective sometimes.

Best regards,

Tim

[To Tim]

Glad my experience offers you hope.  Back problems are tough.  And given what I've read we are BOTH lucky!  Hope it continues to improve and think positive!  :-)

[jim funk]

I've had continuous lower back pain for 7 1/2 months. i was referred to a physiatrist and received PT for back stabilization for 3 mos initially when my pain started. This didn't help. i had an MRI which showed a small herniation at L5 S1. I've had 2 corticosteroid injections which did not help. Chiropractic has worked in the past but after 8 visits this has not helped. My physician seems to be out of ideas and not very interested in making anymore referrals. I've Done stabilization McKenzie and lower back flexibility and strengthening exercises daily with no results. My experiences with conservative treatment is that my back does not get better with time Only chirpractic has helped in the past, but it's not helping now. I need a direction for this problem, 7 1/2 mos. is a long time to chronic pain.

[Liz]

Jim,  I can appreciate your pain.  Yes, that is a long time.  I would suggest that you find a spine specialist or, if nerves and leg pain/numbness is involved, a good neurosurgeon.  I never tried the steroid injections, but did understand them to be short term for many people.  I definitely would get a second opinion.  Take the films with you when you go and get copies of any other records from the physiatrist you saw.  They may charge you for the records, but it is worth it.  I have had a great deal of improvement when taking Relafen (an anti-inflammatory).  I had tried many others, but the Relafen really worked for me.  I'm not a big fan of chiropractic, personally. I didn't trust someone to manipulate an already problematic spine.  Best wishes to you.  

[Pat Gorman]

Good morning I had surgery on Oct 7 for a hurniated left and central S1L5 partial discectomy.At first I felt that the surgery had work but as I got moving around more the symtoms seem to come back nice a slowly.It has been 8 weeks and I am in the same pain that I was prior to surgery and even more so I think.Went for therapy as per the doctor request but the therapist would not do any type of program with me for she felt that I was in too mych pain for post surgery.I am now going for a mylogram again to see if it has herniated to the right side.My symtoms are numness in the bum leg and back and foot,pain the the back and leg and bum,my foot drops at times when I am walking,can't walk sit or stand for any amount of time,I get this strange type of pain \ in the back it feels like back labor then I get pressure on my bladder and bowels just like if it is going to explode,when I go down the stairs my legs shake like crazy!!! At times I can't even stand I feel like my knees will buckle they are so weak!!! Any
out put would be great I feel like I am loosing my mind my e-mail is ***@****

[Mona]

I too had surgery on the L5-S1 in May of 98.  My pain is worse.  I was tolld it would take time.  It has been more than 2 years and are still miserable.  I was sent to a pain specialist because the doctor said there was nothing more he could do.  I had a spinal cord stimulator implanted in Aug of 99.  It helps with the burning pain but increased the back pain.I am on narcotics, muscle relaxers, paxil, and prevacid.  I had to quit my job because of the severe pain.  I was injured on the job and my workers comp will not allow me to get another opinion.  I think there should be something out there to help with this pain.  I will be 40 this month and need to work to help support my three sons.  My symptoms are low back burning pain running all the way up my spine when I work with my hands.  Left leg burning pain to the knee in front. Weak right leg, no reflexes in right ankle, pain down back and side of right leg with foot getting numb if stood on more than a few minutes.  Always tripping because right foot does not seen to work right. I have had several sessions of physical therapy that always increases my pain.  Nothing seems to work.  I have had several blocks.
I asked my neurologist if the problem could be in the siactic area and he got insulted.  I am not seeing a neurologist at the time, only a Pain Center.  Do you think there is any help for me?

[Liz]

Mona,

I'm not at all familiar with workman's comp.  However, I do know that there are competent people out there who can help you.  I know that finances may be an issue, but can't you get a second opinion for yourself even if workmans' comp won't pay?  Will your other insurance pick it up??  I'm floored to think that just because workman's comp won't pay a second opinion is out of the question.  If it is, then I would suggest that you look into getting a good workman's comp attorney to help you find the medical care that will help you get better.  Good luck to you!  I hope you find a good doctor that is patient with questions, even the ones he may find offensive or unnecessary.  There are good ones out there!!  Best wishes.

Liz

[CCF Neuro[P] MD, RPS]

thank you for the comment.

CCF Neuro MD

[Bennet]

I had a disctectamy back fusion L1-L5 in 1988.I went through 3years of therapea and did not get better till i started walking at least 1to3 miles a day.It helps fite the muscle spasms and bone pain i feel in my back.I have 2 children that are groin up now , and they say it was worth giving up some of there time with me to see me doing better.Sence then we have been able to make up for lost time plus find a few arrowheads walking together,something I thouth would be impossible at one time. Plus you must keep the faith or find it

[CCF Neuro[P] MD, RPS]

Dear Bennet:

Thanks for the comments and encouragement.

CCF Neuro MD

[Pat Gorman]

Good morning
Can bone spurs give off the same symtoms as a hurniated disc???And can they be seen on a mylogram???Is a MRI better ???as far as view wise???Do they have to be looking for them in order to see them???
Pat
Thanks

[CCF Neuro[P] MD, RPS]

Dear Pat Gorman:

The answer would be MRI.  It would depend on where the bone spurs were located. No, any neuroradiologist should be able to see them without very much difficulty.

CCF Neuro MD

[izzet]

To Liz,
   This is my second message..
    
I had discectomy  (L4-5) on December 10, and although
everything seemed to go as predicted, an intense pain
started again about a week ago.. I cannot walk more than
a minute or two and even standing can create a degree 10
burning sensation all along my right leg, but the pain is more
intense around the ankle.. When I manage to sit, the pain
gradually vanishes.. Pain killers have little or no effect..
  Today I consulted a specialist of pain. After careful
checking he asked me to remain calm,and avoid of provoking
the pain and take some stronger pain killers sold with a special prescription, and come back in two weeks. There is a chance
that a degeneration of tissue called fibrosis has formed inside
and said that he could remove it if necessary.
  Patience, and patience are the usual words used by the
doctors,we are the only ones who understand how miserable
life has become. I sympathize with all fellow patients..
    Izzet

[beverly Barthell]

I've been told I have a pinched nerve in the l5-s1 is this an injury that can be a surgical or with therapy will heal. It's beem 2 years since my injury and I'm tried of this doctor and that doctor.  The pain medicine is the only thing they agreed on and that Neurotin and Vicodin for pain.  Please help...

[Matthew]

Hi,

Here's my 2 cents.  On September 1, 1999, I had an L5-S1 diskectomy with fusion and instrumentation (the pre-surgery MRI indicated a L5-S1 disk herniation, a grade 1 spondelythesis at the same site, and bulging disks at L4 and L2.)  My symptoms were a great deal of pain in my right hip/leg, especially when walking.  Several times I fell and began using a cane.  After 4 months of rest/rehab, my right leg/hip was still weak and somewhat painful.  After going back to work for 4 days, ALL my pre-surgical symptoms returned to the same degree.  My surgery was done by an orthopaedic surgeon, who has repeatedly told me, "the nerve is still inflamed, give it time."  Well, after nearly 5 months, i am tired of giving it time and am seeking another opinion.

Matthew

[patrick]

I too am suffering from 2 disc herniations that occurred at work in Oct/99. Workers Comp. is a nightmare. I have good insurance but can't use it. I suggest finding a good neurosurgeon, asking if they take workers comp. and tell you adjuster that you want to go to that Dr.. You do have appeal rights in workers comp for a second opinion. I would also hold off on attorney unless they won't cooperate at all. When you get a lawyer involved, you give up right of communication with insurer.I am awaiting approval for ESI. I hope this works, but if not, then surgery. I have found a neurosurgeon I am comfortable with and it took a lot of work on my end(and patience) to get this Dr. approved by workers comp.. Good Luck---Also, I have unusual hnp, only bulges left lateral with major nerve root compression. Are we talking partial discectomy here?

[CCF Neuro[P] MD, RPS]

Thanks for your timely comments.

CCF Neuro MD

[madeline citrin]

I have been diagnosed with LBP, L radiculopathy.  I have had two surgeries at L5-S1 in the past 8 years and am currently still suffering from chronic pain.  I have numbness, tingling, weakness and no ankle reflex in left leg.  I cannot work any longer, because standing and/or sitting for anything more than 10-15 minutes is out of the question.  Can I have a comment on this condition which I feel renders me disabled?  Thank you.

[CCF Neuro[P] MD, RPS]

Dear Madeline Citrin:

Since I haven't examined you, seen the images of your spine, talked to the neurosurgeon or your rehab physician, it would be highly unethical for me to make a comment about disability.  This would be especially true only based on your comments of your symptoms.

I am sorry.

Sincerely,

CCF Neuro MD

[patrick]

Dear Doctor, I previously posted 1/25/00 and talked about getting ESI. Meanwhile, my neuro had me go back to my imaging center and get 3 mm axial slices(MRI) for better visualization of left nerve root @ level of l-4,5. The condition has worsened. The nerve root is displaced posteriorly and the disc is mashing the nerve against bone. No intrathecal far is observable. The pain is excruciating, especially when sitting. Does this sound like I'm going to need a Lami or Lami/fusion to you. Am 46 years old and in fairly good health otherwise. Thank you for any comments you might be willing to offer. Also, HNP is only on left lateral side, no ventral or dorsal herniation.

[CCF Neuro[P] MD, RPS]

Dear Patrick:

Again, commenting on something I haven't seen is difficult.  If my description of your lesion was as you describe it then surgery sounds like an option.  At 46 years of age, you are very young and all the possibilities and outcomes with risks and benefits should be considered.  If the spinal cord is compromised then likely surgery is the only and last option.  But what caused the lesion and that also needs to be addressed.  What is making the lesion worse: lifestyle, weight, improper lifting and carrying technique, bone density problems, etc.?  These need to be addressed.  Rehab needs to also be addressed.

Sincerely,

CCF Neuro MD

[Sheri]

Your messages have scared me...afraid to do too much too soon. But don't know how to judge what is too much. I'm 45, and was used to being active until leg pain/foot numbness began last June. Lots of anti-inflamatories, and pain killers, 3 epidurals, and PT...pain continued to get worse and worse. Laminectomy at L5-S1 about 6 weeks ago. Two pieces of disk removed, one "old" polished piece, one "new" jagged piece. Surgery went fine but I did not have the instant results of some people. Still needing to lay down a lot between periods of activity or sitting, but pain is subsiding. I've increased walking as per doctor's orders, started at 1/4 mile per day...now up to 1 1/2 mile per day. Slow pace. Discouraging as I was walking that far before the surgery..though the increasing number of pain killers may have helped make that possible. Now almost no pain killers needed. My question: what can I safely do besides my walking program? Doctor has not had me go to PT or rehab since the surgery. Feel I am doing OK, just don't want to do anything that will set me back. Thanks for your comments. Also, do you ever get back to the point that you can ski, or other sports where falling is a possibility after back surgery?

[Janice]

Question

I WOULD LIKE TO ASK A FEW QUESTIONS ABOUT DICS PROTRUSIO:

MRI RESULTS FIRST
RIGHT PARACENTRL DISC PROTRUSION AT THE L5-SI LEVEL WITH RESULTANT IMPINGEMENT OF THE EXITING RIGHT S1 NERVE ROOT SLEEVE
NO ADDITIONAL REGIONS OF SIGNIFICANT APPEARING SPINAL STENOSIS OR FOCAL NERVE ROOT IMP. ARE IDENTIFIED.

I HAVE HAD THERE BLOCKS SEPT. OCT. NOV. AND A CAUDAL BLOCK JAN. 23. SO NO MORE BLOCKS FOR ME. PT HAS HELPED SOME WHAT BUT THE SECOND TIME I WAS ON THE VAX-D IT REALLY HURT AND COULD NOT WALK
FOR 3 DAYS WITHOUT EXTREME PAIN. ONLY DOING EXERICE NOW. ALSO TAKING CELEBEX WHICH HAS REALLY HELPED. I DONT THINK I WOULD BE ABLE TO DO AS WELL WITH OUT IT.

THE PAIN CARE DR. RECOMMENDS I SEE A SURGON, I HAVE NOT SO FAR.
I HAVE HEARD THAT IT DOES NOT ALWAYS HELP. (via internet)

MY QUESTIONS ARE DOES A DISK LIKE THIS PRODUCE FRAGEMENTS THAT ONLY SURGERY CAN CORRECT?

CAN PT CORRECT THIS PROBLEM?

CAN JUST WAITING TO SEE IF IT WILL HEAL PRODUCE NERVE DAMAGE?
(ITS BEEN 8 MONTHS)

WHAT ARE SOME QUESTIONS I SHOULD ASK SURGON?

BEFORE VAX-D I COULD STAND AND NOT BE IN AS MUCH PAIN. NOW I HAVE TO LAY DOWN. I CAN NOT SIT FOR LONG PERIODS.

ANY ANSWERS WOULD BE OF HELP.

THANKS

[George Winter]

I had surgery l5 discectomy in may 1995 since pai has gotten worse to the point Im at now.They say it is caused by scar tissue  and enlarged nerve root my question is there any form of lazer surgery for scar tissue.

[Gerald Griffith]

I have had two surgeries at L5-S1 left for a herniated disc.  The first occurance was 1991, the second in 1993.  At the first occurance, only x-rays were taken, showing only a herniation, when in fact, the disc had "burst" sending disc material into the l5-S1 nerve bundle.  This has caused crippling pain from the buttocks through the thigh, calf and has caused both pain and numbness from the outside of the left foot to about the sole near the second toe.  After the second surgery for the same herniation: please note that laminectomies were performed at each surgery, with removal of disc material, the pain worstened. My surgeon referred to this as "Failed Back Syndrome".  When I asked what, if anything could be done to ease the pain, he explained that scar tissue had enveloped the nerve root and it was being compressed and any further surgery to remove the existing scar tissue would only bring more scar tissue into its' place.  I've heard of an experimental drug and surgery from John Hopkins' Hospital useing Em-101.  A lab mouse was used and the nerve bundle at the L5-S1 area was intentionally severed without any effort to reconnect the nerves at the site.  With the treatment with the EM-101 the nerves supposedly re-connected without any scar tissue!  I'd heard about this experimentation  nearly 3 years ago.  I've been on crutches constantly since my second surgery.  Have you heard of this treatment or experimentation?  When, if ever, will it be available for use on humans? I ask, because, the pain I suffer daily moved me to ask MY surgeon, years ago, to amputate my left leg!  He explained Phantom pains and so forth, but I really did not care!  Is there any hope to be 'pain free' for even a day with this treatment??  Thanking you in advance for any information or assistance you may be able to afford me with my situation.                  Yours sincerely,        Jerry Griffith

[CCF Neuro[P] MD, RPS]

Dear Mr. Griffith:

Sorry to hear about your back problems.  So far, the series of experiments you mentioned have not made their way to the FDA and this type of surgery is not approved.  The neurosurgeon is correct is saying that inflammation is the problem of many surgeries and once formed is difficult to remove.  What does your rehab and PT specialist say about your problem?  I am afraid there is not much left except for medications that may or may not stop the pain.  I wish there was something I could offer.

Sincerely,

CCF Neuro MD

[Mike Fisher]

I am a 34-year-old male.  I injured my back on March 16, 2000 swinging a hammer.  The pain was in my back at first and has since moved to my leg...the usual sciatica pain (really had never reached the bottom of my foot).  I have gone to PT religiously and did exercises every morning and night for a month and a half.  Pain has not gone away and seems to have worsened.  It has now been 3 ˝ months.  I called my neurosurgeon and he suggested it was time for a microdiscectomy.  Am I jumping the gun?  Should I wait longer?  I'm afraid of getting permanent nerve damage if I wait too long?  I still go to work and function...I am just in pain all the time.  I can sleep with almost no pain.  I hear these stories of people getting worse.  I am really confuse.  I have my surgery in 48 hours.  My surgeons advice...If you are in pain, why not try to get out of it!

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