Surgical Considerations for Herniated Discs and Scar Tissue

Question: Is surgery something to consider?

I'm 20 years old and I had a discectomy on L4. At the time, the MRI showed I had two herniated discs, L4 and L5-S1, but they only operated on one of them because the surgeon believed this was causing the problem. I was doing fine and running until I started carrying a heavy backpack and sitting for long periods of time, and my back started to gradually get worse. I had a really bad episode of back pain and pain on both legs.

My symptoms go all the way down my inner thighs and big toes, and then I get numbness and pain in the area below the waist, a sensation of having a ball on my left knee, along with this warm sore feeling all over my lower back.

My last MRI was taken a month before this bad episode started, and it showed that I still had the L5-S1 herniation, along with scar tissue from my previous surgery, so my neuro surgeon told me that if the pain got too bad that I should consider surgery. It's been 6 months and all this time I've been lying in bed and only being able to walk for 5-10 minutes (otherwise my symptoms increase and some of them don't go away). Lying in bed has started to give me upper back pain now.

Would surgery be something to consider? Scar tissue alone can't give me this many problems, can it? So far I've tried deep massage, acupuncture, traction, physical therapy, the swimming pool (which is the only activity I can tolerate) and medication.

What should I look for in a surgeon if I consider surgery? The surgeon that I'm seeing now is not the surgeon that operated on me before. I've heard an endoscopic discectomy has helped many because it's less invasive - have you had patients that had this procedure?

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Doctor's response: Discectomy and microdisectomy

I would agree with you that scar tissue would not give you these types of symptoms and it is unlikely that it is a cause of symptoms at all. With widespread pain such as you are experiencing, it is unlikely that a disc herniation alone would be giving you all your symptoms. Taking out a disc is only about 50/50 in terms of success, and is usually much more reliable for radiating pain down one leg (radiculopathy-pinched nerve).

The endoscopic microdiscectomy is really no less invasive than a well done microdiscectomy using traditional tried and true methods. As a matter of fact, the visualization through the scope is so limited most patients are not even a candidate to have it done. In my opinion, it is mainly a marketing tool.

You first need to know if the disc is your only problem. If it is, it may be time to try a discectomy, but with the knowledge that it may or may not work. It would only be reasonable to try this if there is a large fragment, and not just a disc bulge.

There is a chance that more of your pain is coming from pain within the disc space itself. If the pain is from a degenerating disc then either fusion surgery or an artificial disc is probably a more reasonable option than a microdiscectomy alone.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.

Written by Medical Reviewer