New to lower back pain/sciatica - looking for advice

[brendaks1]

Hi, everyone!

Unfortunately, after living for 41 years with a very healthy back, about 10 weeks ago I suffered a bulging disc at L4. I had been doing a fair amount of lifting prior to the onset of pain, but don't remeraber a specific event that caused it.

I had an MRI that shows a bulging disc at L4 in the left foraminal zone with moderate foraminal stenosis due to the bulging disc. I have been experiencing nasty sciatica down my left leg into the bottom of the heel and left outer side of the foot. I went to an orthopedic spine surgeon this last week, and they are puzzled because my sciatica is clearly the S1 dermatone, but the bulging disc is at L4 (the L5 disc looks fine on the MRI). I'm going in for a selective nerve root block on L5 this coming Thursday. If I don't have significant pain relief within 30 minutes, they will repeat it on L4. I had an epidural at L4 about 3 weeks ago but it provided little if any relief. PT and chiropractic have provided only slight relief.

The sciatica never goes away - it just varies from mild to severe in intensity. It's really bad when I sit down - I can hardly stand the pain and my leg goes into unrelenting spasms. I am unable to sleep at night unless I take Flexeril before going to bed. I used to work 50-60 hours a week in a professional position, but I am down to working 4 hours a day which is sending my pain level way up.

The surgeon is saying that if the selective nerve root block doesn't give relief (he said it is only a very small chance it will - they are mainly doing it for diagnostic purposes), they will likely do surgery to widen the foraminal openings.

I would love to hear any advice you have about when is the right time to consider surgery. Is it possible this could heal on its own if given enough time? Also, I have a new-found sympathy for all of you folks who have endured long-term back pain - I never could have imagined how horrible the pain can be!

 

[mznell]

Hello brendaks1,

Welcome to the board. You have my sympathy for the reason that you found us.

Two things struck me about your post. The first is that your doctor is already talking about surgery after only 10 weeks' time, and two, the diachotomy between what you've been told is clearly S1 symptomology and the herniated L4 disc.

Disc pain from a herniation can cause a variety of sensations and nerve pain. The dermatome charts are a generalization and not specific to each and every human being.

Herniated discs can and do heal on their own. My husband ruptured a disc about 15 years ago in his lurabar spine. I served him Christmas dinner on the floor as he could not sit in any chair. Two different spinal specialists advised that he was not a candidate for surgery at that time, and that he would heal on his own. To this day he takes good care of himself, does his back exercises faithfully every morning and has not had any further problems.

I on the other hand had a PLIF at L4-5 in January and am in the process of recovering. I had sciatic pain for about 3 years before I finally decided to give up and have the fusion.

Most doctors are reluctant to do surgery without exhausting all other options unless there is bowel or bladder involvement, in which case surgery is done immediately.

If I were you, I would explore other options before thinking about surgery. I would also get at least another opinion from a fellowship-trained spinal specialist. I would see a neurosurgeon and also an orthopedic surgeon, both who only see spinal patients. I found there was quite a drastic difference in what each was suggesting.

Do not make the mistake of thinking that surgery will restore you to the way you were prior to the injury. It may or may not improve your pain, but it will not make you whole.

Feel free to ask questions and read everything you can about your situation.

xx M:wave:M

 

[ms_west]

I absolutely agree - please get a couple more opinions before you move on to surgery. Surgery is a huge step.

Have you tried physical therapy or accupuncture? Epidural shots?

The nerve block is a wonderful diagnostic tool. It will show your doctor is there is a crossover in the nerve pathways. Everyones pathway is unique.

Good luck and please keep us posted.

 

[brendaks1]

Thanks so much for sharing your input and wisdom. I'm seeing my GP this Tuesday and will discuss getting a 2nd opinion with him. I'll have to admit the thought of having surgery to fix this is so very tempting, but I have heard others say as well that surgery will not bring you back to 100% of where you were before having back problems. If you say 10 weeks is too soon to consider back surgery, how long would you recommend before considering back surgery? I'm really getting concerned that I have seen no improvement in my condition over the 10 weeks and it is in fact getting worse.

I'll let you know how the SNRB's go on Thursday!

 

[brendaks1]

Well, I had the selective nerve root blocks on L4 and L5 today. I had a great doctor who did them and it really didn't hurt that bad. More pressure than pain, but not that bothersome. It didn't hurt any more than the ESI I had a month ago. They determined that both the L4 and L5 nerves are being compressed.

I also had one of the strangest experiences of my life - afterwarRAB, from the hip down I was completely nurab from the anesthetic other than the front of my thighs. Now I know how a paralyzed person feels! What a strange sensation! My legs felt like Jello and I couldn't walk or put any weight on them as they would just collapse immediately. That lasted almost four hours before my feeling came back. The wonderful thing about that four hours that I was nurab was that my sciatic pain was gone for the first time in months! It felt wonderful! Unfortunately, as soon as I regained feeling I also regained all of the pain and then some. I suppose that just puts me one step closer to surgery - I'll do some more investigating before I agree to surgery, though.