herniated disc- few things

[runagainsoon]

Hi,
After being diagnosed last April by a dr. who I didn't like and didn't want to go back to, I went to a new orthopedic surgeon this week. This dr. was more attentive and seemed interested in answering my questions. What he told me and I hadn't been able to find out myself is that, the herniation would probably heal in @ 4 yrs. He said it wouldn't be that the bulge would necessarily go away and that the tear would close, but that I'd have no pain and be pretty much the way I was before the symptoms started last Deceraber. He did try to impress on me that this was based on research of people who were randomized for surgery and non-surgery treatment of L5-S1 herniation who were good candidates for the surgery. Before anyone jumps on me for being too optimistic, I'm not thinking I'll get back to my ninja-butt-kicking ways exactly 1460 days from the day the symptoms first started, but before this meeting, I thought I was doomed to suffer with this thing if I opted not to do surgery. Now, I can IMAGINE a light at the end of the tunnel.

While looking at the MRI, he said the people with my condition had a 1 in 5 chance of fusion at some point their life. Not great news, considering those odRAB, but again, this clears the air of doubt. He noted that the disk is "diseased" and when I asked what he meant, he said that he didn't necessarily mean that it cancerous, more like it was old before its time. I was able to see in the MRI that it is darker than the others and somewhat shorter/thinner. This was partly due to dehydration of the disk and whatever other factors. At least the other disks looked okay as of April.

While talking about surgery, he said that (generalization again) there is a 5% chance of recurrence of herniation. And that a suture goes into the annulus of the disk to close the tear. Two more things that I was wondering about since April.

I haven't made up my mind. I know there are risks with surgery, but I've tried major treatments. Nothing's worked. I'm considering waiting a year or two, to see if my symptoms decline, but I've also met another person since April who has had an L5-S1 herniation for 20 years and an L4-L5 herniation for 18 of those 20 years, so obviously, the 4 year thing is just a generalization. Almost seems like damned if you, damned if you don't.

I hope I was able to clear the air for someone else. A little knowledge can put some concerns to rest sometimes.

 

[maltluver]

Hi, and welcome to the forum. I think it's great that this dr. isn't trying to rush you straight into the OR and that he listened well and answered your questions.

It would help to know what kind of symptoms you are having with this herniation and what kind of pain it is.

Generally speaking, I agree that rushing into surgery isn't good. On the other hand, if you aren't getting pain relief and if there is any nerve impingement, it might be wise to seek another opinion from a different spine specialist. It's always good to get more than one opinion so that you have assurance that the right advise is being given. If the 2 disagree, then a 3rd opinion should be sought.

Hope to hear more from you soon.

Carol

 

[michlei]

I had surgery on L5/S1 11 years ago. I had back issues for years before that, but not constant -- it was more of a case of moving the wrong way one day or sitting too much or something, and I'd be stiff and sore for 10 days or so. Those episodes seemed to be happening more and more often. Then one day I was at a mall, and all of a sudden my back got REALLY stiff, and about 15 mins later, it felt like lightning hit my leg. My disc had ruptured. I still waited almost a year to have surgery to see if it would resolve but it didn't. This was because (as they found out when they did the surgery) my disc had been forced UNDER the nerve root and was trapped there. There was no way for it to shrink back (which is what your doctor is referring to when he says it may resolve) and reduce the symptoms.

Your disc is filled with fluid, and when it bulges, it's pressing on nerves. Often the disc shrinks somewhat after a period of time, and that relieves the pressure. I was told by my back surgeon that if your symptoms are all in your back (stiff back, aching back, etc.), then do not have surgery as it won't be successful. If it starts affecting your leg(s), then it's possible you may need surgery. I couldn't straighten my leg when on my back b/c of the nerve compression and my leg felt like I had a very tight stocking on it all the time, with nerve "zaps" almost constantly. What was weird was that after my disc ruptured, my back felt the best it's ever felt -- it was my leg that hurt. I never had back pain again after the disc ruptured.

I had the surgery, and my back has been wonderful since then. I still am careful with it (don't lift anything over 20 pounRAB, don't twist and lift, etc.), but have not had any back episodes since then.

 

[CupieCAKE]

Welcome to the board! I'm also curious about your symptoms. I was in your position 6 years ago as well. It's really a quality of life issue...how well are you able to function and are you at risk for permanent nerve damage.

Definitely best to exhaust all conservative treatments first. I highly recommend an exercise program that includes lots of walking and core strengthening. If you have a lot of pain from nerve impingement, an epidural steroid injection can help.

Now if you decide to have surgery, this is where I can share my experience and the mistakes that ive made. I had a ruptured disc along with degeneration/dryness/narrowing, and spondylolisthesis at L5-S1. I tried conservative treatments first, but in the end I had a discectomy/laminectomy. Once I recovered, I felt great for 4 years. I had a daughter, everything went well. During my second pregnancy I gained too much weight and I believe that contributed to me herniating the disc again. Another mistake I made was not exercising, so my muscles weren't strong enough. I think if I had been at a healthy weight and had a regular exercise program, and been more careful about lifting things, I wouldn't have reinjured the disc.

I had a second discectomy when my youngest was a year old. It didn't help. Again I wasn't at a healthy weight, wasn't exercising, wasn't careful enough with lifting. I think the disc reherniated within a month or two. This was last Feb.

On Nov 8th I had a fusion. I went well and I'm feeling good. Keeping fingers crossed that it helps my pain.

I wish you all the best and hope that my advice can help in some way

 

[tetonteri66]

Many years ago my husband received about the same advice as you when he consulted an orthopedic spine specialist after learning he had ruptured L5-S1. At that time, the report had just been published that found after a five year time period, people who had surgery for a ruptured disc and those who did not have surgery were just about the same. The surgeon advised my husband to undergo physical therapy and a program of muscle strengthening and asked if he felt he could cope with the pain while he healed. To make a long story, short, he could and it healed.

I think the biggest mistake many patients make after surgery is returning to all the old habits that helped to create the need for surgery in the first place....they stop exercising, don't watch their weight, slump in their chairs before the TV, use poor body mechanics, lift too much, etc. My husband still does his "back exercises" faithfully, every single day, before he does anything else. He is careful how he uses his back. When he does an activity that he knows is likely to be stressful to his back such as shoveling snow, raking leaves, etc., he paces himself...and he comes inside, lies on the floor and stretches his back after stopping. For the most part he has been able to resume most of his favorite activities -- he did give up playing hockey but he still runs five miles most days and hasn't had anything other than very small flare-ups about every three or four years that last a couple days. He has not seen the spine specialist since.

I tell you this long story just so you know that it is possible for a badly ruptured disc to heal without surgery.

While looking at the MRI, he said the people with my condition had a 1 in 5 chance of fusion at some point their life. I wonder what the statistics are for someone who has a discectomy? I would guess they are at least that high....

Good luck to you....

 

[runagainsoon]

Thanks for the replies.

One or two people have asked about my symptoms. Mostly, it's pain in my low back/buttock/hip, but sometimes, it's down into my calf. It also flares when I sneeze. A couple of months back, I had nurabness almost every day in my toes, but that might have been because of the way I was trying to keep my back. In the 6 months or so before that, nurabness in toes wasn't really an issue. My pain is the worst when I get up in the morning.

I was an activity nut before this happened and I'm short and skinny, so excess weight is not much of an issue for me. I stopped running, but I still stay active and have kept weight off still. During the summer, I"m outside collecting data in the wooRAB, but I'm in school, so I spend a lot of time sitting. I also was swimming for the last 3 months until about 2 weeks ago because of tendonitis in my shoulder (talk about feeling old!). I'm as active as I can be and short of not running, my passion, I'm doing okay exercise-wise.

Considering the quality of life: yes my quality of life is quite altered. I'm mostly functional, but I do have pain when I sleep at times and I'm hoping future plans to be a field researcher won't be heavily impacted if I stay with this herniation.

Considering my future is the main impetus for surgery. If I was going to work at a desk or something more sedentary than what I want to do, I could probably deal with this. Having been a runner, I've got a good pain threshold and with the pain in the 1-3 range, it's annoying, but I've gotten used to it over the year. Am I crazy for thinking that?

Cupiecake, I hope your fusion works out for you.