Urgent advice - Discectomy or not?

[B-ron]

Hi,

I'm looking for advice regarding herniated l5 s1 disc. Im early 30's fit and energetic not over weight. It started in mid december 2011 and is still an issue to today 28 jan 2012. I got a cortisone injection on the 18th that wasn't fully
effective. It took 5 days to reduce the sciatia and cramp and i still have pain after waking up in the morning and sciatia intermittently. Bending backwards is still painful with more pronounced sciatica but varies by how much i have my legs apart while standing - closer = pain wider =no pain?

I was referred to a nuero surgeon after a mri showing herniated l5 s1 and bulging l4. He opted for the injection and said i wasn't a neurological case for surgery. The 2nd meeting with him 8 days after the injection. He said he was willing to operate based on my degree of pain but again i wasn't a neurological case. He said he'd scedual surgery less than 1 week after the meeting.The following day i met with my GP who has extensive experience
in back injuries to get a second opinion and view of the nuerosurgeons advice and the speed at which he was engaging me for surgery. The GP did a further detailed examination and agreed neurologically i wasn't quiet there yet but based on the sharp pain while leaning back still being present that surgery was inevitable at some stage. He went through my options medication wise and exercises etc as one route but said in all honesty he believed i'd be back into him with my work commitments being the way the are within 3 months.

So here i am. I'm 6wks with a herniated disc. Ive gone from agony to the feeling of being back to wk 1-2 of pain levels after injection no.1. Ive been out of work 4wks with my wage
being the only wage that covers my wife and 2 kids. My gut says surgery is coming down the line but its just so soon. My body gives me flashes of no pain but is that the injection. Then in the same day i get twinges cramps and nerve shocks. They range from soft to stop you in your tracks. I can manage if my life stays as is, ... as in not working and taking
it easy. The reality is, i need to be able to get up and go to work - don't get paid if i don't work!!- its 3hrs commute and 8hrs sitting.

What do i do here? Try and solve it asap in the most effective way with 6-8wks turn around and get back into the gym and try pilates etc after. Or see how it goes by dosing upand working and when the injection wears off consider my options then?

I really really need help and advice here because it impacts my family, ability to pay the mortgage and put food on the table. My head is completely destroyed..

Im due to commit to a yes or no for surgery on monday to be in theatre on wed. 1st feb.

 

[fqhylgcf]

Hi Ricky and welcome

Sorry to hear of your predicament. I would advise you to straight away look at claiming benefits depending on what your work situation is. Don't leave it any longer, as there is a lot that can help you financially whilst you decide.

Hope you find a solution, I am anti-surgery, but then I am a chicken lol!

 

[Leeu]

Thanks for the reply 41 hits and your the only one to offer advice - thank you Cascara.

The financial end of things hit me when i walked out of the GP's office. I'm waiting for work to get back to me regarding what there prepared to do or not to do. In the mean time i'm going to say no to the op this wednesday and get some more time to let it sink in. Sort work and benefits out etc.

In a strange twist today was one of my better days pain wise. Its still there niggling away all day but nothing stopped me in my tracks and i didn't medicate. But then i didn't do anything strenuous. Its just that feeling all day of not being comfortable.. Have to keep shifting around either seat or laying down on couch but not from pain just the feeling of being uncomfortable. Im still white as a ghost / have the strange sickening feeling that my body hurts but i'm not fully feeling it.Very strange to describe.

The pain still shoots down my leg if i bend backwards. I'm still very much head wrecked by it all but have found resolve in the fact that i'll take another week to decide on operation or not.

I'd really appreciate peoples views no matter whether there biased or not on what they would do in a similar situation? I'm not asking for direction or to be led as ultimately it's myself that decides. So don't hold back!!

 

[Philippine Carabao]

Hey Ricky,

I ended up having surgery in 2010 for L4/L5 after starting having bad pain in March I had lots of oesteopth sessions went on holiday in May and was struck down whilst away in the most horrific pain, couldn't walk far and so on.....went strainght to a specialist had an MRI and had an epidural about 2 days later.....eased but still had slight pain in leg and numbness in toes...had a disectomy in June. For me it was the best thing and had a very very active 2011. This last week I have similair leg pain but no numbness and not quite as severe a physio believes its the same disc prolapsed again but having already had surgery on it there is more of a possability that it will go back in. we are giving it 6 weeks with physio and i'm doing the daily exercises that i've been given and I think the pain is reducing. One of the things I have learnt it that I have to change the way I do things to help keep my back in the best possible condition. I did some pilates that was good. I know that sitting for long periods does me no good so I try not to. If I do then I do an exercise to combat the sitting for a long time. I work with children so am always sitting on the floor and picking up babies. If I feel any twinges then I back off and am extra cautious for a few days. I've read that keeping up your water intake is good and that caffeine is bad! If you haven't tried pilates then it can't hurt to try aslong as you've been told its ok.

I'm even looking into changing my car as my seat is not that supportive and i think that there are so many contributing factors I want to give my back the best chance.
I also got my hands on a tens machine from the chemist that was quite relaxing put on the nerve as its a different sensation for your body to think about.

Good luck and keep your chin up

 

[wish~]

Thanks memo,

Yeah it's dawned on me that this is a life changer. I sit at work all day. I ditched the automatic petrol for a manual diesel to save cash. I looked out at it the other morning and thought it might not have been the wiser move. Work have been great. They have agreed to cover me til end of March so its decision time now. I'm going to take the next two days to sort the financial (benefits) end of things and then by Friday make a plan.

I'm leaning towards getting it done now because i think it's coming down the line so if i have work on side the house & kids are covered now - who knows what will happen in the current climate or within 6 months. Make the life style changes you mention and move on with a cautious eye on things.

It's odd, the last 2 days i've been able to do a lot more than i could when i first got the injection. But it's never fully subsided. It's always there twinging or cramping at various times of the day. I get more exhausted than nerve shock pain now. The fact that the doc and Neurosurgeon both mentioned permanent damage if the nerve traps too long has got me worried.. It's also a deciding factor to opt for surgery.

Thanks for your input memo. One thing?...I don't fully understand what you mean that it'll go back in as its the 2nd time its prolapsed? Surely once the fluid / tissue moves onto the nerve again thats it? Back to square one?

 

[!Emily6014]

UPDATE:

Got cortisone injection jan18th 12' Its now 2nd Feb. The injection is having more of an effect but on a scale of 1-10 i can go from 1 up to 4/5 depending on the day. Im still at home without any major stress or daily pressure of commute / work. I've confirmed a surgery for 10th Feb based on the fact that the nerve is impinged and its likely to return in time. I have all commitments covered for the next 2mths and with the current climate i don't think i'd be alble to avail of this again. So its d or die time!!

Can i assume that if the first injection is only partially effective that its a case of this method of treatment is not effective. The next being surgery? OR Opt for a 2nd injection to buy time?

Theres numerous hits to this topic but very little feedback? Can anyone please please give any insight however small it is to aid me in my decision?

 

[rockerchick82]

Hi RickyC

I cant offer any personal opinion as I am currently waiting for my first assessment on March 6th and I havent yet had any injections or an operation. From reading these posts though, I have decided to opt for an injection as a short measure of pain relief while I wait for the operation date. (I'm on the NHS so dont know how long I'll have to wait). I'm set on having the op though as all the other measures only seem to be temporary and I rather have the actual cause removed and hope it works.

However, I have spent quite a bit of time reading through various posts on here and thought this extract might help you come to a decision as to whether to go for a 2nd injection or not. It's written by SPINELF who seems to be a major contributor to this forum and I hope you dont mind SPINELF if I quote your post.

"It's good to hear from you again deboy, I'm sorry you are feeling low, and are not any better!

Tell me, are the leg and ankle pains down the front of your leg or the back?

I am sorry to see that you are on these strong drugs deboy, but don't worry if you are offered an epidural or nerve root block, because I found them great, and they can confirm the location of your main pain source. I had 4, 2 of them where in the wrong place, which did not work, and 2 in the correct spot, which completely knocked out the pain for six weeks.! And I had reduced pain levels for another 5 more weeks .

If you do have this and it 'does not' work, it will be a fair indicator to the Surgeon that he needs to look somewhere else, so be sure to tell him!

Keep your chin up butty, it won't be much longer!

Best wishes for a good consultation.


SPINELF"

 

[Jolly Rancher <3]

Hey ricky,
Sorry only just seen ur question at the end of post. Basically the physio has said that because its the same disc prolapsed and the pain isnt quite as bad she thinks there is more
chance of it sucking back in because part has already been cut off there isnt so much to suck back in. Its been explained to me like a jam doghnut and its the jam that leaks out and puts pressure on the nerve. I seem to be having the pain working its way back into my buttock and back rather than leg which is a good sign, fingers crossed it seems to be working but I guess it could happen again and might not be so lucky.

Surgery was great for me. Was in hospital I think it was 3 days. Wasnt allowed to walk till the day after surgery and then I had to walk up and down stairs with a physio before they would discharge me. I think the first maybe 2/3 days I could even lift a plate but nearly 7 days later we had a prearranged party and I even danced a little. It was about 5/6 weeks later I rode my horse and went back to work in aug having had surgery end of.june Had physio once a week for about a month or so after. As soon as I came round from surgery I could feel no pain in my leg it was amazing.

 

[MiSs FuNkY]

Thanks memo & Catmac,

Here's really good website i found last night after nearly 6wks of searching online for decent info.
Birth of the Disc Herniation

Catmac, your correct with the fact that the injection being a indicator of hitting the right spot or not. In fairness to the surgeon who gave me the injection he did reduce the pain from being bed ridden to being able to walk, sit and drive for small periods of time. The main pain at the moment is stiffness and muscle burn and feeling locked up on my right side. Some days are good and others not so good. These days are all based on the fact im taking it very easy and not over doing it.

After reading that website above its a case of weighting up the odds. The injections are temporary fixes that never fully resolve the problem and can stop working when ever they decide. So id never be able to fully sure say its reliable to keep going that way. In my case its gotten me up on my feet again at the lower level of activity but i'm still unfit for work and i will only get paid for so long. There's the dilemma. So the moment of clarity has finally arrived. The quickest way out of dodge is the discectomy.

The disc issue is here for the next 1-2yrs whether i like it or not. Combine that with 3hrs driving a day and 8hrs sitting and i'm deluding myself that its not gonna show up again sometime soon. I have to say its the most stressful decision i've ever had to make.

Sorry to hear your dilemma Memo, thats a tricky situation your in again. I was told if this situation arises for me i should opt for a fusion. (That's from two different medics). A good friend who had fusion from the very beginning y passed the descectomy because he saw it as the fail safe way to solve the problem in one surgery. That took some balls to make that decision id say! But he's up and about and never had trouble since.

Catmac - after reading that website above they seem to put 8wks - 4months as a limit time to a disc herniation making a successful operation. (Well a better chance of sorting it out without unfixable damge already cause) I don't know how you can endure waiting any longer than you have to - you have my respect. I really hope you get some solution soon.

So booked in for the 10th feb. Some days i say i don't want to get it done other days i say i have to get it done. What a total wreck the head scenario!

 

[Dannnnce]

Hi RickyC

I'm glad you've managed to reach a decision and best of luck with the operation next Friday!! Let us know how it has gone when you can.

Thanks also for the link you posted. I have actually read some of the articles on that website from a link from a previous poster and it seems a pretty good factual site.

I suppose the success rate depends on when they determine the start date from. In my case I first complained to my doctor that I thought I had sciatica in November 2010. I only really noticed it because I enjoy walking and going on holiday exploring the sights and I found my left leg started paining after about 1/2 an hour or so. He brushed it aside as one of those things with ageing so I took occasional Ibruprofen when it hurt. This went on until about last October when I could only walk or stand still for about 10-15 minutes before having to sit down. I had the MRI scan in October which showed a protruding disc at L4/L5 so I was referred for an appointment with the consultants.

Anyway come late December it was really starting to affect my life - ironing etc and I was put on meds. I went back to work as usual in the New Year, but on Monday, Jan 9th I couldnt get off the edge of the bed for 3/4hr I was in such agony. Since then I've been off work, prescribed stronger and stronger meds although I'm still in constant pain, now walk with a stick and then only about 5mtrs; the doctor has requested an urgent consultation with the specialists. Hence the appointment on March 6th. By the way I have said I'm available for short-notice cancellations if they get any between now and March, so fingers crossed.

The whole point of this long-winded dialogue is when do I count as the start date? I hope from early Jan when I could no longer function normally and was signed off work. At least this is what I'm banking on. That would make it 8 weeks between then and the initial assessment and is also the main reason why I am going to request an operation from the outset. I cant see conservative treatment working and dont want to wait longer than necessary as it increases the risk of failure.

I would have thought that with yours moving as quickly as it has you must be well within the time-frame and must stand a very good chance of success. It may be a bit of a silly question , but is there no chance you could get a similar job nearer home meaning less commuting? There may be various reasons why you havent considered it before, but if it helps to prevent any recurrence, it must be worthwhile exploring the options. Especially considering how young you are (I'm mid fifties by the way).

Still I hope it all goes well for you and that you are soon up and running around with the family again. (That's a nice thought to cling on to when you start having doubts)

all the best for now
CatMac

 

[ShaunElisips]

Hey CatMac,

By protruding do you mean herniated or bulging? Bulging being the early stages of rupture but its possible they never fully rupture if spotted in time. If its 2 herniated discs that sounds bloody sore.. I hope the doctors can shed some relief on it for you. I found the surgeon to be all stats and very little help. He's highly recommended when he's in a theatre but not so much in consultation. The GP was a godsend. In fact without him i was totally unsure what to do.

To answer your question id say from the first point that the normal meds become non-effective and your stood still. so Jan9th but the earlier pain was your warning sign. The physio laughed at me when i told him i could'nt put my shock on a few weeks before xmas and said the same - that was my warning and i did'nt listen. (Not the best thing to say to me at the time)

If this helps the GP explained the full nerve set up to me. Theres 5 nerves running into one -the sciatia (biggest in the body - apparanty) these have various functions sensory, movement etc. He said the one that generally gets trapped is the sensory and my case a slight pinch on the movement. He said that the movement one is the one to watch. You'll begin to drag your foot. And thats the damage to watch for otherwise its nerve damage that gives similar symptoms to sciatia, numb tingly etc. This is obviously just my GP and a conversation between him and me so its by no means a medical bible to work from. Trust your own GP. Have a good read of that web link i linked earlier - its a real eye opener. The bigger the herniation doesn't mean the more pain. A smaller one in some one else maybe sorer to them and need surgery. It all seems a bit hit and miss!

I'd be one of roughly one of 15 people that does what i do. Its mega money to buy the machine i operate so to ans your question, changing jobs would only mean going to the competition thats 5mins up the road. I'd still be commuting or else sell up the house and move to the city. Can't see that happening in the current climate and besides i love where i live! I could probably step back and work on lesser jobs and get a high end pc at home but whats the point of 5yrs college and 12yrs working my up the ladder to back out now (pardon the pun).

Today is an odd day. Woke up a bit stiff and achy. Drove to the gym (5mins) and just did pool walk, sauna steam etc. The easy enjoyable stuff. I was sore driving home and lay down for 20mins. Since then i'm ok. I have the usual mid back/lower back pain. But i know tomorrow morning will be sore. So as a result of today i then doubt in what i'm doing.. Should i opt for another injection? etc But then come back to the fact that the injection is masking the issue and how long is that going to last for - who knows?

I have my poor wifes head destroyed with indecision!! I now in my heart of hearts its the only sure way to take control of the situation and reduce the possibility of getting caught out of work again for another 6-12 wks. But that's all its going to do for really. My decision is based on whats the best possible course of action to keep me from working for the minimum amount of time. If my circumstances were different id probably hold off and ride it out a while longer to see if the demon rears its head again. Every forum i've read says it will without doubt come back to catch me out again!

I really hope it eases off for you CatMac and you can resolve this quickly for yourself. Keep the head positive and thanks for the response. Its nice to be able to chat about it.

 

[Sonam]

I think lots of people read and only some wil reply for many reasons, for instance sometimes I read a post and it is too painful mentally to reply at that time, then I forget to go back. Sometimes our opinion may not be helpful so we don't post, lots of reasons, sometimes the title is misleading or too nondiscript. Don't take it personally.

I learnt that the nerves are a bit like a piece of plastic coated wire, when the plastic outside is pinched it hurts like hell! the longer that pressure or pinch is there then the more damage it does to the outer plastic coating until it wears away to the next layer.

This nerve layer is more about sensation and feeling and so the pain goes numb and lose sensation and we may think it is better but it's actually worse.

Then the final stage the pressure wears down to the core centre where the movement nerves are, and pressure and stress, wear on this level which leads to a partial or later full loss of function and movement.

Good luck with the op

 

[518]

Thanks Cascara,

Today confirmed it even more for me. Limping around the house all day. Even the meds took hours to kick in.

Much happier now and more convinced that i'm doing the right thing.

thnaks

 

[lily-jane]

Hi Ricky

My microdiscectomy is due next monday. I suffered a herniated disc at L5/S1 in 2008 and it took me about 18 months before I was almost back to normal only for the same disc to go again big time last July.

My GP was useless, wouldnt refer me to a consultant so I ended up paying for my own MRI, which showed the damage.(10mm herniation ) My employer then paid for me to see a surgeon who looked at the scan and recommended surgery. He got me on the NHS waiting list without the usual hassle of seeing every man and his dog.

I have still had physio etc etc just like the first time around but the lower back pain even now has convinced me to have the operation. The sciatica was very acute for 3 months but has subsided into a dull ache. I have some good days but I only have to bend down for a minute to feel that herniation push onto the nerve and aggravate everything.

My hope is that the surgeon will go in and clean it up so I can start afresh, build my core strength again and get my life back which includes running and cycling and all the the other things I used to take for granted.

Best of luck with your operation- i'm in for 2 nights, out next wednesday hopefully!

 

[i<3electronics2]

Thanks Doog,

I wish you well with your surgery. I'm going in Firday 10th now as they have no bed thurs. Suits me better. Nothing worse than having to spend the night before in hospital.

I should be home Sunday eve or Monday all going well. I'll keep you updated.

 

[noerdudxidbijseic]

Good luck to you both, please let us know how you get on,

Will be thinking of you both xxx

 

[Marcella]

Wishing you both all the best with your ops and hope they solve your problems.

Love, Light and Healing to you both.

 

[Chris Feild]

Thanks for all the kind remarks & best wishes. Great support so thank you all.

Getting slightly concerned today. I seem to be getting numbness and slight twinges down my left side now. While still having the hamstring pain and stiffness on my right side from the beginning. Hopefully i'll have time to discuss with surgeon before theatre on friday.

 

[haha!]

Hi Ricky

Thanks for your last message and I apologise for not having replied sooner but I haven t been on here for a few days.

Anyway best of luck for tomorrow, I really hope it does the trick. And good luck Doog for Monday as well.

Do let us know how you get on, as I'm probably going to go down the same route in the next month or so.

All the best to both of you
cheers for now
CatMac

 

[DeshawnTrump]

Thanks for all of your kind thoughts.

Ricky, I hope you dont mind me sticking with you on this thread, will be good to share post op thoughts.

I had my pre- op yesterday and it dawned on me how serious the operation is. I was in there for 2 hours.

I spoke with the physio who was advising me on getting out of bed, toilet height and wearing a corset for two weeks....oh dear!!!

She also said that very few patients are taken in screaming in sciatic pain, most are long term sufferers looking for a solution when all other remedies have failed. She also said it may not relieve my back pain - I was also worried the surgeon would go in and ask himself what all the fuss is about but was reassured that they wouldn't operate unless there was a problem.....

I had a phone call today asking if I could bring my MRI scan in as they didnt have it...obviously the surgeon saw it in October but there is nothing like planning and prep. I guess they just cut in there anyway and look at the damage and fix what they can!!

here's hoping and best of luck!