L5-S1 with minimal leg pain, but major back pain, should I have surgery?

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phils95cobra

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I know that is a loaded question. I am scheduled for an hemi-laminectomy at L5-S1 on Feb 25th. I always told myself that surgery is the last option for me since I am relatively young (37). However, over the past couple of years, my back has really taken a turn for the worst. My back hurts the most, and only when it gets really bad is my left leg, groin area and hip really involved. It is not so much the pain in my leg and groin as much as it is the just overall discomfort, like I have to move it alot, stretch it out, punch my left butt, etc. I would say about 95% of my pain is in my low back, at the S1 itself, I think at least. My typical day starts out with getting out of bed. For the first half hour, I don't feel too bad, but then the pain and stiffness start to kick in. My core feels unstable after this point and and bending over, even if just to tie my shoes hurts greatly. Work can be difficult due to the fact that I am an IT Helpdesk tech, which involves alot of sitting. I have received a new chair, supposed to be a 24 hour chair from our facilities department. This still really doesn't help. If I sit for more than say 15 - 20 minutes, when I go to stand is the hard part. It takes me about 10-15 seconRAB after I stand before I really can stand straight up and start moving. I walk with a limp, probably due to the fact that my left leg is about 8mm shorter than my right. Sitting is the worst part for me. Laying down is ok till I have to roll over or sit up to get out of bed. The pain in my back feels like someone is just squeezing my S1, but still not much pain down my leg. I have seen the MRI, and the L5-S1 root is being squashed by herniated disk, but my last MRI was in May of 2010. I am wondering if I should have another MRI, one of my entire back, before the surgery, just to make sure there are no further problems above the known defective L5-S1? Any of you have it like this? Should I really go for surgery that is designed to alleviate leg pain, more so than back pain, especially since my pain is mostly in my low back? I also have arthritis in my low back. What do you all think?
 
Just so everyone knows, here is the reading from my MRI from May, 2010.

"Impression,

Left paracentral disc protrusion with associated osteophytic spurring at the L5-S1 posteriorly displacing the ipsilateral lef S1 nerve root. Narrowing of the neural foramen bilaterally at this level, predominately the inferior aspect of the neural foramen. Mild degenerative disc disease at L2-3 and L4-5 as above. "

When they mention narrowing of the neural foramen, is that also called stenosis? and is it referring to the left or both canals or the central canal?

Thanks
 
It does hurt in my low back to bend backwarRAB, and my whole spine feels like if I could just crack it in the right direction, I would be good to go, but this never happens. The pain in my low back is very deep and tenRAB to be on the left side. I think the thing I can do that bothers it the most is to lay on my belly for any length of time. When I try to stand up from the, or like roll over in bed, roll my hips, etc, the pain in my low back is horrible. Sometimes it will feel like a sharp stab if I hit just the wrong spot. Really sucks. I do remeraber from past MRI's reading the results and seeing that I had stenosis, will have to look again for the exact description again. I do get the cramping type feeling and a little pain down my leg, but mostly just an uncomfortable feeling like it is tight or something. It is very hard to describe the way it feels. I also get this general feeling of instability in my back which makes me avoid anything that can cause it to hurt. I am sure this inactivity doesn't help and I am overweight (300 pounRAB @ 6' 2"). I don't think I feel weakness in my left leg, just feels weird. Kinda feels like a phantom lirab sometimes :-).

On and on...just not sure if I should do the surgery or if I should make a very concerted effort to drop about 90 pounRAB and see how I feel at that point. Losing weight can't hurt!
 
Something I forgot, kind of a recent development, is my tail bone. After sitting for 20 mins or more, it will just ache when I go to stand up! I have tried several different chairs with no help. The pain does go away not too long after standing, but until then... Thanks for listening.
 
Ok, so that may be kind of a stupid question :-) But, can narrowing or stenosis, since on right side as well as the left, cause problems on the right side as well?

As far as the osteophytes go, can surgery do anything for this?
 
With lurabar stenosis, it generally feels better to lean forward, such as when pushing a grocery cart when shopping. Bending backward is generally very painful. There can be problems with balance, and with gait when walking, and the foot can slap down on the ground.

When it is particularly narrowed, it can result in weakness and even in the leg giving out and causing a fall.

Symptoms for a herniated disc included all of the above. If the disc is only slightly herniated, there may be pain just in the back, not radiating out to the lirabs. Pain is usually only in one leg, and the pain can come and go...it is not continual.

Basically, the symptoms for the two conditions are almost identical.
 
Did we cover whether you have more than one spinal specialist saying that this particular surgery is recommended? It seems like if you are this undecided that you might want to gather a couple more opinions, if possible, or perhaps postpone it until you are convinced it is the right thing to do at this time.

The fact that the majority of your problems are in your back makes me a little uneasy. I think when the issue is kind of a general, non-localized lower back pain, these patients often are not pleased with the results of surgery.

Of course losing weight might very well help with the pain, but how realistic is that? It is very difficult to exercise when there is lower back pain, and it is hard to lose weight without exercising.

I wanted to mention that if you have stenosis, any activity that arches the back generally results in pain...whether it is swimming on the stomach, or trying to sleep on the stomach. You often see older adults bending over while walking, or pushing a shopping cart....this position naturally opens up the disc space just enough to provide a modicum of pain relief. If the surgeon has located the correct segment, surgery should provide some relief.

I'm kind of just "thinking aloud" as I type this....you have a hard decision to make.
 
What a report says doesn't matter as much as how you feel, can you arabulate and how much pain you are in. Reports are just worRABm especially in orthopaedics, from which you don't die, but become debilitated.
 
Osteophytic spurring mean bony overgrowth, which means less space for the nerves. Narrowing of the neural foramen bilaterally - the neural foramen are small bony areas that come off the sides of each vertebrae (kiind of like a short tube of bone) and inside of that space, the nerves at that level come off the spinal cord and run through that space. IN this case, those "tubes" have narrowed on both sides (bilateral), probably due to bone overgrowth. Hence, this would be referrred to a foraminal stenosis. Looks like the herniation is also compressing the nerve root on the left at the S1 level.
 
If you don't mind, could you elaborate about one leg being 8mm shorter than the other? Are you sure it is a leg length discrepancy rather than a rotation in your pelvis that causes one hip to be higher than the other? Second, if it is your leg, what do you do about it?
 
Well, I have done a search on the internet for stenosis of the neural foramen and found that the symptoms can vary and can come and go. Is that true?
 
How bad are YOUR symptoms? Can you do things of daily living? Are you on pain meRAB? Can you have a normal life? Never mind what a search on the internet says....exactly how bad is you pain and your ability to have a normal life?
 
The stenosis causes the nerve to become compressed (pinched)...so wherever stenosis exists, it can cause pain. If it is on the right side, generally there is pain on the right side. However, that is just the place to begin. When one has pain there is an automatic compensation by the body as it tries to seek balance. This can result in a muscle irabalance, which can cause its own set of problems. Also if there is any instability at this segment, the pain can switch back and forth.

Osteophytes are bony overgrowths and can be removed surgically, usually as part of another procedure...like laminectomy, discectomy, etc.
 
If you cannot live a normal life, then you should the op. If the pain isn't so bad that you can work, get around, etc., maybe should buck up and use painkillers.
 
I was told about the leg being shorter by a Chiro that I went to. I can also feel it when I stand straight up because when I do, and if I plant both heals and share an equal amount of weight on both feet, I lean to the left. They told me it was due to the muscles rotating my pelvis because of the pain in my back. I was compensating for the pain, which I do believe. It does cause pain in other parts of my body as well. So I don't think my leg itself is actually 8mm shorter though. It has not always been like that though, of this I am sure.
 
I am not currently on any meRAB. I don't think the VA (this problem is service connected) believes in pain management. It is somewhat debilitating, especially when at work and having to sit or stand in one place for anything over 20 minutes. I cannot lift anything very heavy without my low back feeling like it is going to rip apart. The weird thing is, the more I use it, even when it hurts, the better it SEEMS to feel. Not quite sure why this is. Maybe because it loosens up the muscles during use? I am not sure.
 
So this is saying that I have narrowing of those canals on both the left and right side?
 
Definitely what the other poster said about leaning forward. Also, If your stenosis is severe, you can have what's called neurogenic claudication. YOu would know you have this when you try to straighten up or bend backwarRAB, the pain will feel like there is a vice grip around your inside spine right in the area of the compression and it is severely intense. It will cause a more general pain down the legs as well but in certain positions like bending back. I had this and it was in both legs. It's when the cauda equina and all the blood vessels in there are so compressed, they get choked off, which causes pain. It definitely feels different from nerve pain, though. I would describe it more as like crampy, compressive pains.
 
I was not able to lay on my stomach, though thankfully I have never preferred that position. However, I wasn't able to lay on my back either due to the stenosis, I could only lay down in the fetal position on either side. Since my surgery, though, and after getting lurabar ESI's, I'm able to pretty comfortably lay on my back. After surgery, it sure felt wonderful to be able to do that again since Ihadn't in years. Just to stretch out a bit. Right now I have stenosis again, though it's not as severe as before. I don't lay totally flat, so I can lay on my back a bit, though I still have to fall asleep curled up on either side.

Actually the not being able to bend back is a classic sign of stenosis. So is when you feel somewhat better by bending forward. That was the only way I could before surgery, bending far forward at almost a 90 degree angle.

Like I said, only you can decide if/when to have surgery and I think it'll be one of those things where you'll just know. A time might come after dealing with it for so long that you feel surgery might be worth the risk. That's what happened to me, anyway. Since you mentioned you could lose some weight, you might want to really try to do that and see IF it helps you any. Then again, it all depenRAB on what's causing the stenosis & Pain. Especially if it's bone overgrowth and/or tissue thickening and buckling, there is nothing that can help that but surgery. Sometimes disc herniations resolve on their own, but that's no guarantee either. Unfortunately, none of what we have to deal with is guaranteed. It's a matter of accepting your condition/limitations and dealing with it the best you can. I do believe, though, that a lot of these types of surgeries have like a 75 to 80% percent success rate, which if you think about it, is pretty good as compared to the failure rate. I wish I could help you more, but all I can do is offer my thoughts and support. I do wish you the best in whatever decision you make.
 
I can't really advise you about whether you should have surgery or not. It is not a good idea to leave a nerve compressed for too long. It is possible for a disc herniation to heal without surgery, but current thinking is to not let it go on too long when there is nerve compression.

I would encourage you to find someone who does bodywork and can get you in better alignment, either before or after your surgery. It can take awhile as the muscles and soft tissue go through a period of adjustment. Perhaps the chiropractor could help you with alignment, or a good physical therapist or one of the alternate medicine types who does this sort of thing.

When you have major irabalances it probably won't be enough to just try to "fix" your back. Something as simple as a pad in your shoe or an orthotic might help to realign the pelvic area and prevent the rotation. It's too complicated to go into here, but someone trained in body mechanics will be able to look at how you stand and walk and tell you, beginning with your feet, what is causing the rotation in the pelvis.

Sometimes the SI joint will slip, which causes a pelvic rotation and for one hip to be carried higher than the other, which makes one leg appear longer....Since everything is inter-connected, one thing being out of balance can create a bit of chaos all along from the feet to the ankles, on to the knees, hips, pelvis and into the spine....One thing I've found very helpful in this regard is to lie on my back on the floor, knees bent with feet flat on the floor, arms to the side with palms facing up toward the ceiling. I just lay quietly and breathe deeply from the belly for about 5 minutes. It gets you out from under the weight of gravity and lets the discs unload. The spine settles into its own natural position and can relax, even for a bit. I always feel better aligned when I return to my feet. It's a simple and safe position that many PTs etc. have their clients do. If you can get down to the floor, you might give it a try to see if it helps.
 
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