Recovery from an L5-S1 microdiskectomy on a 16 month old herniation.

    
      Re: Recovery from an L5-S1 microdiskectomy on a 16 month old herniation.
    


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Posted by CCF Neurosurgery MD on November 19, 1997 at 14:05:36:

In Reply to: Recovery from an L5-S1 microdiskectomy on a 16 month old herniation. posted by Charles Hicks on November 13, 1997 at 18:09:41:

:       My girlfriend had a microdiskectomy at L5-S1 7 weeks ago. Her
  neurological symptoms, pain radiating down the left leg strongest
  in the buttocks and present but much milder in the calf, were
  consistent with a herniation, which was clear, even to my untrained
   eye, in her pre-surgery MRI. She also had weakness and reduced
  reflex response, in her left side. She has felt no relief from her
  original symptoms since the surgery and has felt a similar pain
  begining on her right side, that comes and goes. However an MRI done
  this weak confirms succesful removal of the herniation. She lived with
  this herniation for about 16 months before the surgery. Apparently this
  pain is due to damage or irritation not direct pressure on the nerve root.
  1) Can you comment on the future she faces, statistically at least?
  2) Does the rather generic phrase "nerve damage" imply chronic irritation
  of pain transmitters or just loss of motor function ? or maybe both?
  3)Do any pain killers or anti-inflamatants act at a level which might
  speed this recovery or are they just stopgap measures?  
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Dear Charles,
Recovery from removal of a herniated disc that has been symptomatic for 16
months can take some time.  Usually the pain will be improved soon after surgery,
though not always.  Chronic discs such as this can be calcified and more difficult
to remove at surgery, and they may require more manipulation of tissues to get
the disc out.  Also, after long standing compression of the nerve roots it
may take months for these nerve roots to 'wake up' again.  The typical order
of symptoms to get better are pain, followed by weakness and finally numbness
and other sensory changes.
Since your wife's pain did not change after surgery it was reasonable to get
an MRI to be sure the disc is completely removed.  If there is no remaining
pathology on the MRI, then a course of rest and anti-inflammatory medication
is the best option along with physical therapy.  Usually ibuprofen or another
NSAID is prescribed.  
Short of recurrent disc or other pathology remaining in the spine, the treatment
plan should be conservative.  This can be understandably frustrating and
patience is essential.
Good luck.