Treatment for ruptured disk

[julig]

6 weeks ago, following an episode of lower back pain, I had severe burning pains down the back of my left leg; standing for any length of time made the pain worse. I'm a 50 yo F, no prior history of back or other medical issues, except Raynauds for about 10 yr. MRI shows L5/S1 extrusion (left) & L3/L4 protrusion (right). PT Assessment was muscle weakness & absent achiles reflex. After PT, leg pain is minimal but weakness/stiffness in my left leg/foot & difficulty raising up or balancing on my left foot (toes).

PCP sent me for a Neuro consult  after MRI results (I've not seen PCP since the original visit, so referral was w/out knowing result of  PT). Consult w/NS raised a number of questions, as NS indicated surgery based on history and MRI. NS said I should have surgery now or as soon as I can't live with symptoms (interpreted to mean pain level)- & emphasized I had a LARGE herniated disk. Why would surgery be indicated now, as the pain has nearly subsided and is manageable; I don’t have numbness & only slight pain at the back of my thigh if I tighten my lower back muscles.

My concern is muscle involvement; NS says that he’s taking my word for it, as I'm able to walk on my heels & toes; stretching exercises have helped, but I feel I'm using my hip/upper leg to swing my leg forward, not rolling off of my toes to walk.  Do I wait & see what develops, as pain is not currently an issue, or do I risk future &/or irreversible nerve/muscle damage?

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

The tieming of disc surgery is dependant upon your recovery. Most (70-80%) of patients who have disc herniations recover with medical therapy and physical therapy. In individuals with significant weakness and pain surgery becomes more critical. Surgery may not help with your current situation (we hope it does but not a guarentee), but is desgined to prevent further damage. If you develop new weakness or pain you should see your surgeon immediately. Otherwise the decision to proceed with surgeon becomes a personal decision at this time. You should discuss with the surgeon the benefits and recovery from the surgery and what your wishes are with surgery. Then you can make an informed decision. Good luck

[ipjanet]

I'm no doctor, but my recommendation is to not have surgery until the pain becomes unbearable.  My mother had one surgery (for a herniated disk in the lower spine) that led to another that finally led to a spinal fusion.  She will never be the same, has perpetual sciatic nerve pain and, as far as I can tell, has become a prescription drug addict.  A good friend of mine has had a similar experience after two disk surgeries on her neck.  While there are definitely positive outcomes to these surgeries, one must make absolutely sure to weigh the benefits and the risks very carefully.  Spinal surgery is not something to consider lightly.  It is a huge risk, the wager of which is your functionality in life, and should only be taken when 100% necessary.

[jan]

I agree with ipjanet!  After seeing what my brother went through, I will hold off surgery just as looooong as possible.  I don't like being on oxycontin and U S Healthcare stinks with their coverage of PT, but surgery...  I will wait.

[merle]

Before submitting to surgery, even microdiscectomy, for herniated discs, please try Physical Therapy using the McKenzie Techniques. Be sure the therapist is thoroughly trained and proficient in the McKenzie Techniques.  Many times surgery will not be needed and the problem can be successfully treated in just a few sessions.  If surgery is warranted, that fact can be definitively established at the first PT session, so no time or $ is wasted.