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S1-L5 Herniation/Surgery
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S1-L5 Herniation/Surgery

Hello,

My situation is as follows:

"very large", protruding S1-L5 herniated disc
injury 10-5-00
  initially couln't stand at all ~20 min
  then couldn't stand longer than seconds for ~2h
  then could stand & walk with pain, more pain sitting
  
*all of the following symptoms apply to the left side of body
numbness in foot
loss of power in calf
no ankle reflex
pain (varies in intensity at times & location) from back all the
  way down to ankle
tingling & muscle twitching at times
left foot colder than right, the colder the right foot, the even more pronounced the difference (significant)
after applying heat to feet, left foot remains red/pink much longer than right
minor sore on foot present before injury has taken an inordinate amount of time to heal

GP visit 10-11-00
put on bedrest by GP on 10-13 following result of MRI
taken off bedrest 10-17 by neurosurgeon
leg pain much worse when up or sitting, than before bedrest,    but can still carry on activities (sometimes great pain)

Wed --  ~8 days later, PT, does some diagnostics
Thur --  pain much, much, much worse, lower down to ankle & muscle twitching (which had abated somewhat)
a few drops of pee leak, but occurs only once
Fri --  much better, though start getting worse end of day
Fri night -- PT, massage seems to help tight buttucks muscle
Sat -- much worse,  By early afternoon can only walk, stand for minutes before excrutiating pain siezes & MUST lay down
Sun -- can only get up for minutes
Mon -- Extremely difficult but make it to work, very hard
       PT tells me not to come back
Tue-Fri -- can only get up for minutes (befor excrutiating  pain)

Naprosyn- 500mg 2x/day not helping & had a rxn, taken off
Vicoden - of no help for pain!! when try to get up (pain OK when laying)

Neurosugeon is not "pushing" surgery, but says herniations as large as mine do not usually resolve & therefore advises surgery

I am very concerned about permanent power loss in calf, what appears to be a circulation problem in my foot, & the possibility of permanent pain.  

My job is now in jeapardy (which I want, need, & like very much), & I am concerned about ongoing bedrest exacerbating my situation.  But OTOH, even if I could walk & tolerate the pain (which is impossible right now), I worry that I might be increasing the chances that the nerve damage will be permanent.

Questions:
-Should I get surgery ASAP, or what are the odds that I will get better if I just wait.  And if I wait, for how long?  
-By waiting, aren't I increasing the chances of permanent damage?
-Is there anyting else that I can try?
-Should I walk/sit even if there is great pain?

Any help/info you could offer would be very greatly appreciated as I really don't know what to do & am essentially bedridden.
Thank you very much,
Kathy






Related Discussions
Avatar_n_tn
Dear Kathy:

Surgery is always the last option unless it is an emergency.  First, as you well know the outcome can be variable and one can be in pain for life due to the surgery itself, let alone the spinal problem.  Yes, surgery can help many situations but not all.  I would see a good rehab specialist and PT (it does not seem correct for a physical therapist to tell a patient not to return without the information of why).  A herniation can cause problems, but if there is no compromise of the spinal cord itself then surgery will likely not have much effect on your outcome.  I would also get a good neurological exam from a neurologist (no stake in surgery) for another opinion.  Traumic injuries take awhile to heal and the process is usually painful and long.  You need to make up your mind to hang-in there and go through the rehab process.  Then if surgery is the only option, then surgery.  But I would strongly suggest going the rehab process initially.

Sincerely,

CCF Neuro MD
20 Comments
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Avatar_n_tn
i FEEL THE SAME SYMTOMS (symptoms) RX DOES NOTHING FOR ME  i FEEL LOST
i AM ALSO AFRAID OF SURGERY i AM 40 YRS OLD
i THINK SURGERY IS THE LAST OPTION  AN I THINK iLL HAVE TO TAKE ME CHANCHES WITH SURGERY AN HOPE FOR THE BEST
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Avatar_n_tn
Hi all,

I'm sorry to hear you are in so much pain. It can be totally awful. I'm surprised you could type this message - it must have been excruciating.

I've been there twice. You must make the surgery decision. There are risks, but there are risks of not having it as well.

My experience.

I herniated that l5/s1 left side in '97. I was in totally excruciating pain when I lied down. I couldn't sleep for 2 week. NS recommended surgery. However, my mom died when put out. So I was scared xxitless. I did not have it.  If you get past it, you must protect this disc for a long time until it completely healed.

I have arthritis and my knees don't bend well some times. Anyways, in late '98. I bent my back and not my knees when lifting - mistake. That disc went out again, but not bad. I figured I'd just ride it out like before. About 3 weeks later, it really blew. I had to have surgery. Surgery went well. It relieved constant intense pain (probably similar to the pain you have when standing).

In retrospect, I wish I had had the surgery the first time around. However, I still have degenerative disc disease and some continuing problems other places. I also have a complicating situation with the arthritis. The disc may have blown again even with the surgery. SO - who really knows. Not really worth second guessing.

Either way you go. Make sure you use proper back mechanics from now on - forever. Make sure that is a priority. Do not forget when you are feeling better in a few months. Assuming that this was not caused by a car accident or something traumatic, then you are prone to this stuff. Drink lots of fluid (8 cups per day at least), glucosamine chondroitin (not exactly proven, but many are recommending), walk a lot (keeps those discs in better shape) and exercise to keep those tendons and muscles strong, and alway use good back mechanics.

I hope you are feeling better soon.
Judy










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Avatar_n_tn
I have no answers for you, but after reading your symptoms I just had to say that my prayers are with you.  What a horrible experience.  Things have to get better.  I hope you have someone to count on or at least someone to help with the day-to-day things.  I'm sure you are strong on your own.  Best wishes.
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Avatar_n_tn
Sorry about your pain...Bedrest has been shown to actually be determental to recovery. A second opinion from another Neurosurgeon makes sense, but to just go and get the surgery does not make sense in that a very high percentage of surgical patients have reoccurance within 2 years Rehab including exercise and streching is imperative.
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Avatar_n_tn
I don't know how to work this forum but hoping I will get a answer. I had L5/S1 posterior back fusion on Oct.5th,2000. I had a herniated disc that the doctor said was calcified when he took it out. Bone graft from my hip and the fusion with rods and screws. My back seems fine and I am only five weeks postop, no pain and can walk all over. My problem is my left arm went numb during surgery, they said it was due to the position and laying on it for 6 hours, although they did keep moving me. I have feeling back in three of my fingers but the index and thumb are still numb. Also I can't lift above my shoulder. Has anyone else had this happen? The doctor seems to think it will come back but meanwhile it is a horrible feeling and basically a useless arm.
He said it had to do with the "C" vertebraes. Would appreciate any information anyone may have.
Elaine
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Avatar_n_tn
Elaine,
This is not really the way the forum works but....yes it is probably in the cervical spine and could be relieved through chiropractic care. I think waiting may cause a problem. Be proactive, get it checked by a competent chiro. It is not necessary for him/her to work on your whole spine to get results in the cervical spine. Why wait? Get the function of the arm back now! Good Luck.
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Avatar_n_tn
Eight years ago I had a laminectomy for a herniated disk.
Now the same disk is herniated again.

This time I found a good neurosurgeon whom I feel comfortable with and am going to have the surgery again.

For all the other herniated disk sufferers out there,
from my experience, I am so glad I had the surgery 8 years ago and will do it again.  Why suffer and loose control of your legs?  The disk is herniated and the only way to get rid of it is by having it removed.  It is a very common surgery. I think it's
jsut a matter of finding the right doctor.

Please don't suffer with a herniated disk. You will only
loose more feeling in your leg. don't damage your nerve
any longer than you have too.

Susan
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Avatar_n_tn
Kathy
Go for the surgery but make sure you have the right surgeon.  It is a common surgery but after care is important and have to be careful for life as can occur again.  

I just had surgery last week (same symptoms) after waiting for 3 weeks and nothing was getting better except things were getting worse.  Had a lot of doubts about surgery but a herniation like this does not disapperar from your body with rest and time.  No surgeon will give you a guarantee.  I still have no strength in my left calf and my buttocks are still stiff.  Have to now give it time.

In the end remember that taking it easy and peace of mind over time will make things go right.

Good LucK
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Avatar_n_tn
Dear Kathy,

Only you can make the decision to have the surgery.

But from a personal experience, I went through
MONTHS of unnecessary pain. My doctor tried physical
therapy and nerve stimulation. Which by the way ended
up doing more damage than good.

I decided to have the surgery because common sense
told me that this herniated piece would not
go away or get better.  The longer it puts pressure
on your nerve the more damage it does and the more
healing time you will need.

Eight years later, the rest of the disk I had surgery on
has herniated.  and I am scheduled for my second surgery
on December 29th.  

I think the most important factor in making your decision is finding a good neurosurgeon.  My neursurgeon spent an hour
with me showing me the MRI with the herniated disk and
explaining what the outcomes were either way.  

Herniated disks are different from a bulging disk. With
a bulging disk, there is a chance of it getting better
with therapy and rest. But once it's herniated, which
means it is broken and laying on your sciatia nerve,
it doesn't go away.  

I was only in the hospital for 2 days when I had the surgery 8 years ago.  and I felt a heck of alot better once
it was off my nerve!  What a difference. I could walk and sit
and not be in constant pain.  Our bodies heal quickly once
we fix the problem!

I hope this helps. Surgery is scarey but letting something
go like could promote more serious health problems.

Good luck

Susan
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Avatar_n_tn
Has anyone had an MRN (magnetic resonance neurography) scan to detect the location of nerve that is affected?   check out www.neurography.com   Is this a useful tool or just passing fad?
Two places here on the west coast that has MRN.  University of Washington and UCLA.
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Avatar_n_tn
KATHY

HAD THE SAME PROBLEMS ONLY WITH BOTH SIDES. I TRIED THERAPY AND BED REST BUT IT DID NOT HELP, WAS FACED WITH EITHER EPIDOURAL SHOTS (THAT THE SURGEON DID NOT ADVISE) SURGERY OR JUST LIVE WITH IT (HA-HA-HA).

I WAS VERY SCARED TO HAVE THE SURGERY BUT MADE THE DECISION TO GO FOR IT. HAD MY L5-L4 FUSION ON NOV. 16,2000, THE HOSPITAL STAY WAS 4 DAYS, UPON AWAKING AFTER THE SURGERY COULD NOT BELIEVE THE DIFFERENCE THAT I FELT. ALL THE BACK AND LEG PAIN AND THE NUMBNESS OF THE FEET WAS GONE.

NOW 11 DAYS AFTER I AM ABLE TO WALK ANY THAT I WANT, THERE IS VERY LITTLE THAT I CAN NOT DO EXCEPT THE USUAL LIFTING, BENDING, JUMPING, ETC. THERE IS A LITTLE PAIN FROM THE SURGERY BUT THE BACK PAIN IS GONE FOR NOW. I CAN ONLY HOPE IT STAYS THAT WAY.

I AGREE WITH THE OTHERS IN THAT YOU NEED TO FIND THE BEST SURGEON. ALSO I HOPE EVERYTHING TURNS OUT AS WELL FOR YOU AS IT DID FOR ME.

GOOD LUCK!!!!
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Avatar_n_tn
KATHY

HAD THE SAME PROBLEMS ONLY WITH BOTH SIDES. I TRIED THERAPY AND BED REST BUT IT DID NOT HELP, WAS FACED WITH EITHER EPIDOURAL SHOTS (THAT THE SURGEON DID NOT ADVISE) SURGERY OR JUST LIVE WITH IT (HA-HA-HA).

I WAS VERY SCARED TO HAVE THE SURGERY BUT MADE THE DECISION TO GO FOR IT. HAD MY L5-L4 FUSION ON NOV. 16,2000, THE HOSPITAL STAY WAS 4 DAYS, UPON AWAKING AFTER THE SURGERY COULD NOT BELIEVE THE DIFFERENCE THAT I FELT. ALL THE BACK AND LEG PAIN AND THE NUMBNESS OF THE FEET WAS GONE.

NOW 11 DAYS AFTER I AM ABLE TO WALK ANY THAT I WANT, THERE IS VERY LITTLE THAT I CAN NOT DO EXCEPT THE USUAL LIFTING, BENDING, JUMPING, ETC. THERE IS A LITTLE PAIN FROM THE SURGERY BUT THE BACK PAIN IS GONE FOR NOW. I CAN ONLY HOPE IT STAYS THAT WAY.

I AGREE WITH THE OTHERS IN THAT YOU NEED TO FIND THE BEST SURGEON. ALSO I HOPE EVERYTHING TURNS OUT AS WELL FOR YOU AS IT DID FOR ME.

GOOD LUCK!!!!
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Avatar_n_tn
I have a similar problem, herniated L5-S1 on the right side. It was caused by heavy lifting almost 4 years ago. I suffered through all the tests and therapy back then, but could only get by with large doses of narcotics. Finally I had epidural steroid injections and they helped tremendously. I received one every six months for the last three years. Six weeks ago I began to have severe pain again and the injections didn't help. After an MRI and post-myelegram CT, I've just been told the herniation has caused effacement and serious damage to the nerve, and that I should have immediate surgery. I may have permanent damage from this. I guess the moral of my story is sometimes it can be dangerous to wait it out. I thought I was doing the smart thing by treating it conservatively and avoiding surgery, but I may have only made things worse. I have several appointments next week for other opinions, but I'm sure I'll end up having surgery. Anyways, good luck to you (and everyone else with back problems). Try prayer too, it can't hurt :)
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Avatar_n_tn
howdy folks,
never thought i would be submitting a reply about back problems
but here goes..............................................................................
it's bin 8 months since my injury at work that has taken me out of the work force effected my family life and various other negative factors losing job, benifits etc., I have still wanted to keep attorney's out of the loope it looks like that wont happen anyway
Iam a l4,l5,s1'r with 3cm buldge interior to spine, I started with chiropractic helped needed more went to orthopidic and researched aquatic rehab. seems to be helping a lot with walking 3-5 txms weekly Ive been back and forth with I need surgery and I dont need surgery and I am coming to grips my health phsysical, mental, and spiritual is going to have a lot to do with the out come, for now its full focus on positive att.,health and fitness, proper body mechanics wieght loss and conditioning and to avoid the knife at all costs.
age:40
sex:male
Blank
Avatar_n_tn
howdy folks,
never thought i would be submitting a reply about back problems
but here goes..............................................................................
it's bin 8 months since my injury at work that has taken me out of the work force effected my family life and various other negative factors losing job, benifits etc., I have still wanted to keep attorney's out of the loope it looks like that wont happen anyway
Iam a l4,l5,s1'r with 3cm buldge interior to spine, I started with chiropractic helped needed more went to orthopidic and researched aquatic rehab. seems to be helping a lot with walking 3-5 txms weekly Ive been back and forth with I need surgery and I dont need surgery and I am coming to grips my health phsysical, mental, and spiritual is going to have a lot to do with the out come, for now its full focus on positive att.,health and fitness, proper body mechanics wieght loss and conditioning and to avoid the knife at all costs.
age:40
sex:male
thanks
pray hard
Blank
Avatar_n_tn
howdy folks,
never thought i would be submitting a reply about back problems
but here goes..............................................................................
it's bin 8 months since my injury at work that has taken me out of the work force effected my family life and various other negative factors losing job, benifits etc., I have still wanted to keep attorney's out of the loope it looks like that wont happen anyway
Iam a l4,l5,s1'r with 3cm buldge interior to spine, I started with chiropractic helped needed more went to orthopidic and researched aquatic rehab. seems to be helping a lot with walking 3-5 txms weekly Ive been back and forth with I need surgery and I dont need surgery and I am coming to grips my health phsysical, mental, and spiritual is going to have a lot to do with the out come, for now its full focus on positive att.,health and fitness, proper body mechanics wieght loss and conditioning and to avoid the knife at all costs.
age:40
sex:male
thanks
pray hard
Blank
Avatar_n_tn
after suffer with back pain since december 97i went to see achiropractor therapy and finaly l5/s1 fusionwith both cages and rods and screws and thoughin feb 2000 it has releived some of the pain in the back but i still have inthe rigth buttox calf and foot with some pain in the rigth groin area now im having pain in the left leg and  groin my doctor has ordered a mylogram /ctthis has been a long mental and physical battle for me as i lost my wife do to finical and physical problems.drugs dont help with the pain and render me im potent.i needto find out about this up coming test, the risks . i also need to find out about what the furture holds for me like the likely hood of arthritis further spinal instublity sorry my spelling is lousy or any prblems the my be in my future thanks
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Avatar_n_tn
H i Kathy, I feel sorry for you, it is very painfil and the pills don,t make it much better. Its the most annoying type of pain as it affects every thing we do all the time.
I  am 29 had back surgury 3 x now and its looking like number4 . I strongly suggest that you don't rush into the butcher shop and  get as many opinions as you can regarding other forms of treatment
If you do require surgury I wish you the best  and a successful recovery and no re occuring problems.
gook luck kathy

woz
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Avatar_n_tn
H i Kathy, I feel sorry for you, it is very painfil and the pills don,t make it much better. Its the most annoying type of pain as it affects every thing we do all the time.
I  am 29 had back surgury 3 x now and its looking like number4 . I strongly suggest that you don't rush into the butcher shop and  get as many opinions as you can regarding other forms of treatment
If you do require surgury I wish you the best  and a successful recovery and no re occuring problems.
gook luck kathy

woz
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