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L5/S1 Rupture - treatment options? Can I ever get back to my former self?

AnonymousUserAAnonymousUser Posts: 49,622
Hello everyone - I am a newbie here. I am on the steep part of the learning curve related to what was described to me as a "large rupture at L5/S1". I just saw a neurosurgeon today, and have a TON of questions. First a bit of background - I am sure much of it will be irrelevant - but I gotta start somewhere.

45 yr old male. Very active lifestyle. I love riding and racing motorcycles offroad - and want to be sure I can return to that.

7/19/08 is my date of "injury" though I suspect it was really just the last straw the broke the Mike's back! I have had a lifetime of spinal abuse - going back 18 to 20 years I used to run 50 miles a week, then a time period with lots of backpacking carrying heavy packs in the mountains, and of course MANY MANY miles of off road motorcycle riding, and in more recent years, racing off road. The last straw was a ride on my bicycle - nothing out of the ordinary - but a physical sort of conditioning ride - not a crash off the bike, but shortly after the ride - I could hardly stand. Pain was from hip/buttocks, down thigh, behind knee, into outer calf, outside of foot and in heal. After a few days, the pain eased a bit, but was still pretty bad.

I (Attempted to) ignore it for a few weeks - did a couple more races, pushed much more than I should of. Saw a chiropractor a few times after about 1 month with minor relief, overall was feeling a bit better, but still hurting. I continued to push to hard for about 4 more weeks, pained stepped up significantly. I went for several weeks where I felt lucky to get 3 hours of sleep a night. I finally saw a Doc - did one course of Prednisone - which seemed to help a great deal, and started PT. Doc also referred me to a neurosurgeon , which I finally saw today (a bit of a wait for an appointment). I have now been in PT for about 4 weeks.

I am feeling significantly better day to day. BUT...I am dramatically less active than my norm. I used to walk, hike, ride my mountain bike, ride my dirt bike, work out etc. regularly. I rather actively trained for my races. Now, I am basically inactive - the most exercise I get is 5 minutes on recumbant bike, and the various exercises I do during my PT appointments 3 times a week. Walking - well, sometimes I might manage 200 steps with managable pain, other times, it is only 25 steps before I am hurting. Over the last 2 weeks - I would say on a scale of 1 to 10, max pain level is now maybe a 6 or 7, and basically any time I am sitting still I may have a few hours with no pain, or a pretty low level of pain. Sleeping is at times rough - seems I am generally hurting when I try to sleep and have found I can sleep better on the couch than in bed. I have no clue how I would feel if for example, I headed out for a 5 mile hike in the woods like I used to do. So for me to say I am doing much better, I must note, it is with a reduced "quality of life" as I am not doing the things I love to do.

Onto my appointment with the surgeon today. Mixed bag - hard to really follow him! Initially he was clearly going down the " you need surgery" path (micro discectomy I think?), commenting that I am now almost 16 weeks post injury, and have done the conservative treatment paths I should, and I need to "get it fixed" (he would never say the actual word "surgery".). I commented that I dont necessarily want surgery, but what ever path I take, I want to be sure I can return to my prior level of activity. Suddenly he did a 180, saying I should do 4 more weeks of PT, then see how I am doing. So that is the plan I walked out of his office with.

So, onto my questions! ( about time huh?)

1) Which approach is most likely to allow me to return to my prior level of activity? And so you understand - saying I can no longer ride my dirt bike is not an option!

2) I have read of the steroid injections - should that be considered?

3) I understand the ideal time frame for surgical success is 3 to 6 months post injury. (after exhausting "conservative treatment options") If I do 4 more Weeks PT, to then determine it has not worked and I need surgery, I will be looking at a full 6 months (optimistically) post injury before it is done. Is this really pushing it time line wise?

4) Have I really exhausted conservative treatment options? After this next 4 weeks PT, I would be at 8 weeks PT, 1 course of prednisone, chiropractic care, and 5 months post injury.

Any other bits of advice appreciated!

Thanks in advance.

Mike
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Comments

  • Hi Mike

    I had an L5/S1 injury as well. I injured it about 2 yrs ago and then waited about a yr and a half before surgery. I tried everything else in between. Therapy did nothing and the injections did little. I had microdiscectomy on April 1st of this yr and I'm back to normal. The recovery was about 3+ months. The first week to 2 were rough but it slowly got better. I still felt leg pain and numbness until approx mid July. I herniated the disc playing rugby and I have just recently completed my first season back without any reinjury. So I feel that the surgery was pretty successful. I can't say that I feel 100%. But the minor pain or discomfort that I feel from time to time has not held me back. I'm also about 20 yrs younger than you are so I can't guarantee the same results.
  • Mike,
    I can understand your desire to get back to your life. I was also there at one time, when I had my first surgery. I, in no way, wanted to give up my weight lifting. I injured myself while squatting 200 lbs, and I only weighed 100 lbs myself. (I am only 4'11"). Anyway, I went from doctor to doctor begging to be "fixed." All the doctors told me they didn't want to touch me. Now I'm wishing they hadn't. However, you have a large rupture... that's quite different. I had just a bulge when I was young. I guess what I'm saying (and taking forever to say)is that once you injure the disc, it is not as strong as before you injured it. My doc. told me that when they go in, they do not "repair" the disc to normal again. What they do is take out the material that has ruptured through the weak disc. Exercises and stretches keep your back strong and in proper alignment so that you don't bend improperly again and re-injure.

    As far as bike riding again, you may have to do it differently from now on so this doesn't happen again. For instance, avoid leaning forward while landing, because forward bending with force or weight in hand will push that disc material right out again. (Ouch!)

    My weight training has changed dramatically because of my injuries. However, I have invented my own exercises that work for each muscle group while keeping my back straight; and I continue to exercise daily. The exercises are different, but my back is stronger than ever right now. After 22 years of no back pain, I forgot about watching what I do to avoid re-injury. That's why (I believe) I re-ruptured my disc.

    This is all just my opinion of course. It's what works for me. Hope things go well for you.

    csp
  • Mike, please contact me if you want to get back to normal life. His methods of exercises is working for all of us here at Dulles Airport in Chantilly, Virginia. Find time to read my other post to have an idea how he can make you recover. Remember that he will guide and will stand by you until you achieved your goal. But put in mind that YOU, YOU and YOU ALONE with determination can make things possible NOT him as what others have thought. Right now, he was able to help a 300+lbs postal employee lowered down the pain level to 3 from 9 but became lazy and stopped his exercises as he doesn't want to go back to full duty capacity at the facility. He was scheduled to have a back surgery last August 2008 but postponed it. During their talks, my friend asked him if he will still choose surgery IF the insurance pays everything and said, YES. When he asked the same question IF he will have to pay everything, he said a BIG NO. Before this, he was able to help someone from San Diego, California attained a full recovery but intentionally re-injured himself as he didn't want to lose his long-term disability benefits package. Why? that is self-explanatory. Because he had the "first" hand experience with the pain itself and dealt with the pain for five(5) long years, he knew exactly what to do. He will guide, YES; guide/help you how to lower your pain level to 2 within a week and within a month, the pain will be completely gone. He prefers seeing,meeting and helping people with chronic pain problems with NO previous failed/back surgeries.
  • Mine isn't a disc injury, rather spondy and foraminal stenosis at L5/S1. I do manage to weight train and do cardio. I'm in PT and receiving my second epidural shot next week. I'm pretty certain my issue is running related and I ran a marathon through the pain last May, then went to the doc and got the MRI...

    The doc and the PT have said no running, unless I am pain free, which I adhere to. They also gave me a list of weight exercises with a stable back position, such as bench presses with feet up on the bench, seated curls, etc. I can do use the recumbent bike, stairmaster and elliptical. They also gave me exercises to not do, like squats, one arm rows, back extensions.

    Bottom line is that I would check with your PT/Doc and see what they recommend that you can do progressively without making your injury worse, they are the ones with the expertise to do so.

    I *hated* giving up running, but my mp3 player makes the gym tolerable.

  • Mike,

    Your story is about exactly as I tell mine. I am 41 years old. Very active. Played football, hockey, rugby growing up. Love running. Was training for a marathon. Up to 13 miles. Had done 13 miles 6 times at 8 minute mile pace. I know, that is not spectacular but I am 41 years old. Anyway, I woke up one morning with a horrible hamstring pain. Soon spread to hip and gluteus minimus, really my whole hip. Then spread to my calf, horrible calf pain. Then my foot had the numbness and needles as if it were sleeping most of the time. I went to the doctor initially, who sent me to physical therapy. After a few times and continually worsoning pain I went back and told the doctor that my pain was at a 9 out of 10, taking Vicodin like it was candy was becoming meaningless, and I was going to put a bullet in my head if he didn't help me. He referred me for an MRI that day and the next day they called and sent me a picture. It was unbeleivably obvious how large of an L5/S1 rupture it was. They gave me 2 shots of cortizone/steroid epidural. About 50% of the pain went away in a few days. A few weeks later they did 2 more shots of cortizone/steroid epidural. Maybe 25% more of the pain went away. Remained like this a couple of months. Then pain level started to creep back up a little bit each day. They then did a selective nerve root block. This did no good at all. Pain kept creeping back up a little bit each day the next couple of months. Finally, back up to an 8 out of 10. It had been almost 6 months total. I had not been able to work out or run at all and just walking short distances or standing up was getting pretty bad again. I was getting pretty unhappy with my quality of life and not being able to run or work out or do nearly as much as I wanted to with my family. They told me they had exhausted all non-surgical means and wanted to do a micro discectomy. I met with the surgeon and he gave me a 95% chance that the disc would not re-rupture and that my leg pain would be reduced dramatically. The surgery went well and it has been 2 weeks. I went back to work today. My leg pain is already more than 50% gone and will, hopefully, continue to go away as the leg nerves heal. They told me that since these nerves were crushed so badly for 6 months that they would have to heal. I am already walking 3 to 4 times a day for about 15 minutes without much leg pain. The 1.5 inch incision in my back is already healed. My surgeon told me that I should be running again in 3 months. I'm hoping for the best. Like you, I can not pin the rupture on anything except 41 years of abuse. We think we're invincible until something like this happens.

    Mark in Indianapolis
  • Thanks for the replies. I would of responded back sooner - I thought I would get email notification of replies, but did not.

    Good to hear from those of you with active lives, and seeming to get back to it. Though, it seems here, and on other forums (racing related ones) more often the ones saying they are back to racing/prior level of activity etc. are the ones having had surgery.

    As it stands now, I will be seeing my Primary Care doc on Tuesday for a referral for a second opinion. Meanwhile I am continuing the PT (which is what the surgeon ultimately concluded). After a long discussion with the PT - no harm in continuing, and if I do end up having surgery, I would go into it with less of a deficit than I would otherwise.

    The last two or three days have actually been rather good. I did a fair bit of walking Saturday and today - some leg sciatica type pain Saturday, and suprisingly little today, though my lower back feels rather fatigued.

    I do need to comment on why so much walking particularly on Saturday - my oldest son was participating in a scholarship competition (FULL ride!) to start his undergrad Pre-PT program, and later his graduate work to become a PT! So, at least I will have easy access to therapy in the future! (hope he gets the scholarship!).

    Here is one thing I cant quite get my mind around - pardon the mechanical (of course, motorcycle related!) analogy -

    Lets say one of the key frame rails on my motorcycle were to crack, and were jutting out such it was pinching off some of the wiring system. Would I decide to simply wire on some additional supports along the sides of the crack, and simply try to ride it more easily, hoping it does not break at the wrong time, and do nothing about where it was rubbing on the electical wiring? No - I would say it should be fixed properly, have the cracked area welded, and perhaps for saftey's sake, have some added gussets welded in (depending on the specifics - I might more likely say the frame should be replaced), and wiring issue would have to be addressed. Bottom line is I would say fix it right, dont go half way and try to baby it along.

    To me, the non surgical options seem to be like doing a half way fix, and then saying you will baby it so it wont break again, and hope the insulation on the wires does not rub through and short out. As I see it, I have a broken part (the disc) and that part is messing with the operation of other parts (the nerves). The surgical option, while I realize it does not totally repair or replace the disc, it does totally remove the parts of it causing the nerve pain. To compensate for the fact the disc is shot, the role of PT then is to brace things up.

    So, why wouldnt I make sure to take steps to make certain I dont have broken parts interfering with other parts? Of course, I realize this is not as simple as the frame on a dirt bike - and I realize there are some huge potential risks. I guess If my Surgeon had given me a better sense of the merits of each approach, I would likely feel much better about which way to go!

    Anyhow, thanks again everyone. I will post back the results of my Doc's appointment (Tuesday).

    Mike
  • Mike,

    I read your story and thought I would provide some information.

    My injury was L5/S1 with a severe rupture.

    The injury first occured in July '07. The day after the injury the pain level was around a 8-9(10 scale). I blacked out the next day when I tried to walk to the restroom. This is an idea of how bad it was. I went directly to a back specialist who was an orthopedic surgeon. He treated me with methylprednisolone, hydrocodone and a med to help with muscle spasms. When I was injured this time I had little sciatic pain. I started PT within a few weeks and by the mid-October '07 I was feeling great again. I began my normal routine of playing volleyball, basketball, lifting and running.

    Within a few weeks I was in terrible shape again. I began to get really bad sciatic pain in my left side. From my back all the way to my toes. I tried cortisone shots twice. The first time maybe made a small difference, the second time compounded the problem. By the time Christmas & New Year came I couldn't walk erect, couldn't walk on my toes and couldn't straighten my left leg. The pain was a constant 8. The MRI showed a rupture about the size of the end of a finger.

    I had surgery at the end of January '08. I had immediate relief. It has taken a long time to get back to normal but I would say I am 85% there. I have jogged in a 10k. I just began a volleyball league and have been strength training since June. My biggest problem right now is flexibility but it is dramatically better than I was even 2 months ago. I am an impatient person, but I have learned it takes some time.

    I'll give my background if you are interested. I am 31, about 6'1" and before the injury about 180-185. I played volleyball competitively. I trained about 20 hours per week either in the sand playing, doing plyometrics or lifting. I learned that it doesn't matter how good of shape you are in it can get you. I expect to be back doing all of this next summer.

    I feel like surgery was successful for me and thought I would pass along some thoughts.



  • There are pain management Doctors to do the injections. You can find a pain management DR. or get a referral by your family Dr. They are anesthetists that give the injections in the spine and also recommend meds etc. for pain control. Hope things go well for you. Of course it's up to OS or Neurologist to decide to do surgery if necessary to prevent nerve damage. Take care Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I have the ball rolling on the referral for a second opinion. Hopefully I can get in soon.

    Meanwhile - bit odd the last 2 days. I had been managing to feel pretty good, almost pain free when inactive (sitting on my getting fatter hind end!)...then yesterday that seemed to change - now I am back to hurting pretty much all the time - not realy high level of pain, but rather annoying, at times spiking up there. Walking of course still makes it hurt much worse. I am not sure why this would of changed - I did nothing I can think of that would of cause the disc to shift (I assume that is why I am hurting more?)

    More and more it is sounding like the surgical option may not be to bad of a way to go. I dont want to (yet) resort to "pain management" - to me, that is just masking the fact I have something wrong - I would rather first exhaust the fix it options!
  • I hear you, but the issue with going straight to the fix it, at least for me, is that insurance wants to exhaust all conservative (lower cost) treatments before authorizing surgery.

    Personally, I am hopeful that perhaps the conservative treatments work...trying to remain optimistic, since there isn't much else that I can do.

    I sit on ice about 12 hours a day now. I think my butt is frost bit. ;)
  • Since my 11/5 post - pain went back down to rather light pain - occasionally flaring up, with some occasions of numbness. Max pain level has been quite managable, and significant times with little to no pain. I saw Neurosurgeon 11/26. His conclusion was time for surgery - which actually suprised me. I discussed with him that the pain level is way down now - he asked if I felt I wanted to live with that indefinetly - my answer was "no". I then had discussion with my PT - her conclusion was my progress had leveled off and that continued PT was would at best maintain me where I was - no significant improvement. So - I concluded to go ahead with the surgery. I see surgeon for pre-surgical clearance stuff 12/19 and expect surgery to follow possible just befor Christmas, or shortly after New Years day.

    BUT...now roll forward maybe another week or 10 days. Frequency and level of pain or numbness has once again reduced. I have now gone for maybe 5 to 7 days with virtually no pain or numbness (some small bits here and there - but not bad at all). My activity level is up as well - though far from my typical level still.

    So...now I am at a loss - do I bother with the surgery or not? On one hand, I would like to think all is OK now, and surgery is no longer needed. On the other hand, I know that fact is, that disc is still poking out more than it should, and am concerned that without surgery I will be more likely to have "flare ups" in the future.

    I slightly lean towards still having the surgery, essentially as an insurance policy to hopefully prevent future flare ups. I dont want any more down time where I cant do what I want - so get it out of the way now, recover from the surgery over the winter and be ready to enjoy my summer.

    I did get a second opinion appointment set - but could not get in until Jan. 17. (their earliest available for a non emergency) I really did not expect the timeline for surgery to move up before I would have the second opinion. Soooo....looks like I will need to decide without the benefit of that opinion.

    So what are your thoughts?
  • I have a L5 S1 Injury as well.. my feeling is if you keep making improvement forgoe the surgery...

    I was doing well with PT and a Epidural, but slid signifigantly backward thanksgiving morning when something popped.. I have since had a 2nd epidural 2 days ago, and am making some progress with it.

    surgery will be my abosute last resort.. especially if I can live with the pain at the moment.


    i would recommend you check out http://www.chirogeek.com/ as it helped answer alot of my more techincal questions...
  • Hi Mike,
    I'm new to the forum, but once I read your initial post I can understand your frustration. I've always been very active, weight training, cycling and kayaking. I hurt my back in May, but didn't have the horrendously stupid sciatic pain until July. I've had 3 epidurals with little or no improvement and am scheduled to have 3 more, at two week intervals in Jan. In the meantime I've become flabby, fat and frustrated! I'm a 47 year old woman with 3 kids and one grandson and I really want to get back on my bike and into my boat...like you I want my life back. My herniation isn't as severe as yours, but I guess its bad enough, pain at 8 or 9 without meds. And I've had 3 kids without drugs...this is worse. The doc won't even let me do PT until I've had some lessening of the pain. Sometimes I feel like I'm being a wimp, and other times I know I'm not! This sucks.

    Does anyone have any good ideas about stretching or strengthening exercises I could try?
  • thanks again for the replies. Another update I guess. Since I last saw Surgeon 11/26, I concluded i would go ahead with surgery largely based on comment from the PT saying where I was was as good as she felt PT could get me. About 4 or 5 days after that, I realized I was having NO pain! Absolutely none of the high spikes...nada zilch zip. And if there was any low level pain, it was so mild I was hardly aware of it. So Monday (12/15)I called the surgeons office to ask if I should even bother to show up for the appointment tomorrow (12/19). The surgeon asked me to go do some normal full activity stuff - in fact he specifically said to "push it a bit". He wanted to know if the lack of pain was simply due to continued lack of activity. Plan was for me to report back this AM and we would go from there. So I did push it. Some strenuous hiking in steep hills and snow, time on the treadmill, working in my garage, snowblowing the drive etc. Result - a couple minor twinges of pain, but an increase in the numbness in calf and foot. Foot mostly right after activity, calf increased and has basically stayed at the increased level. Still though, no lingering pain at all. Conclusion this AM was I should still show up tomorrow so surgeon could better assess where I am. Concern is the numbness as an indicator of continued issues I guess. I think I have pretty much concluded that if the surgeon says still need surgery I will go ahead with it. I am tired of the roller coaster ride! (and not seeming to even know which roller coaster I am on at any given time!)

    Nancy, From the male side of this conversation, I cant quite relate to the pain of giving birth =D> hearing you say it is worse - yikes... I had some sucess with oral steroids - actually it was that that first brought things under control for me. never did the injection route. If your doc is not willing to prescribe PT, I would be a bit concerned with trying any stretches etc. on my own - maybe ask the doc what you could try?
    And I hear ya on flabby fat and frustrated! (gotta be careful there...not wise to say that to any woman in my experience! - I am solely referring to myself! ) I have put on 20 lbs since all this - gonna need some higher spring rates on my race bike come spring!
  • Hi Nancy and anyone else, just to share a bit about my self, I have DDD running down from L3 to L5, a bulging disc at L2 and L3, a herniated disc at L4 with moderate nerve impingement, a really impressive herniation/rupture whatever you wanna call it really, with obvious impingement on L5-S1, with a large fragment lodge in the spine. Oh and I'm only 19 and just a year ago I was an All-State Wrestler, Football Player, and Track athlete with scholarships to several universities for all three sports--to say the least I was very active. However, I was also quite smart in that I happened to receive a full academic ride as well, which is the path I chose to take.

    While being 19, I understand it may be difficult for you to take any advice from me seriously, but I really hope you at least take it into consideration. I'm actually a Pre-Med student at Rutgers University--and since the beginning of my sciatica troubles, I've put more time in spine research than I have the last 3 semesters of college. Also, being a student at one of the largest research Universities in the country, and what is called the "Health Care City"--New Brunswick, I've spoken with at least 15 different highly respected specialists/researchers.

    My Sciatica began mid-August of this year very mildly, and one day it went to hell. After doing a little exercising I began feeling a sharp pain down my glute at 9/10 scale and could barely walk as my foot would always drag. I had a mix of pain, numbness, and weakness beginning in my right glute shooting down to my calve, and the outside of my foot. This lasted for a couple of weeks, and at first all the specialists I went to insisted that I get surgery immediately or I would incur permanent nerve damage. Primarily because the disc herniation I had was to big for my body to break down the old fashioned way, and it had caused too much damage already. However, when I finally decided to speak to a family member who was a renowned physical therapist overseas, he convinced me not to. Today, just two months since that week where I could not walk and all I could do was really just like flat on my stomach, I can jog, swim, and even sit down for long periods without my sciatica kicking in. I attribute this to diligent work ethic and following proper technique.

    What I've learned is that the most tested and proven conservative form of treatment for disc herniations and radiculopathy is the the McKenzie technique which involves a step by step individual approach to locate the problem and solve it. It usually involves a lot of back extensions when referring to disc herniations causing radiculopathy. A little googling, and even searching it on You Tube will help you familiarize yourself with it.

    For me, the McKenzie techique prescribed a lot of back extensions. The reason is, with disc herniations, when you bend down your vertebrae squeeze down on one side and push the disc out. Think about it, when you bend down that is usually when you feel that pain shoot down your leg. The reason this happens is because the disc is being pressed on and pushed out causing it to pinch the nerve. However, when you do back extensions the disc is pushed down on the other side, and pushed back in. It is therefore prescribed that you do an unlimited number of back extensions--just do them every second of the day you can. The reason is that the more back extensions you do, the more disc nucleus is pushed back in--you should especially do several back extensions after you have bent down, again because you have pushed the disc nucleus out a bit and you want to push it back in. The more extensions you do, without irritating the sciatica the better. Please note that with some cases of sciatica back extensions will actually make it worse. If this is you, where doing back extensions irritates your sciatica, of course do not do them! See a McKenzie Certified specialist for a more individualized approach.

    One thing I've seen with most people with our problem is that we only seek treatment for symptoms and not for what caused the symptoms it in the first place. The annulus holding our discs in are in fact very strong and resilient. It takes a lot of compounding wear for it to actually tear and for your disc to rupture. Your herniation was probably not caused by one single action such as picking up a heavy object--that action was only the feather that tipped the scale. It's likely we terrible posture, we sit down for to long of periods, etc. It's important that we treat our lifestyle.

    During my treatment I very rarely bent down, and if I did, it was with perfect form. I squatted down with my back as straight as possible. I did thousands upon thousands of back extensions and I never did anything that I felt would irritate my Sciatica. That was quite difficult at first, especially because sitting down would irritate my Sciatica. However, I purchased a kneeling chair. It takes all the weight off of your back and puts it on your shins. Pretty cool really. A lumbar roll is also recommended if you must sit down as it keeps a slight lordosis in the lumbar spine helping to keep a flat back and the disc in place.

    For exercising, if you are able to walk without the sciatic pain, walk. Walk a lot. Swimming is also recommended. That's really it though--again, you want to avoid doing anything that may irritate your sciatica as it will set you back.

    If you are in a lot of pain, the steroid injections often do help quite a bit and come highly recommended by many. I had one and it did help. Prior to the injection coughing and sneezing would cause sharp pain in my glute, after the injection I could cough and sneeze as I pleased and I took the time to really go crazy with back extensions as I could do them just about pain free. I would avoid getting more than 2 as it may cause tissue damage, scarring, and all that other bad stuff that is associated with steroids including weight gain and what not. That, and the effect is not permanent.

    Personally, I plan not to get the surgery. From people I've spoken to who have had it, several have had to get additional surgeries and wish they had never gotten one in the first place. Additionally, surgery is just unnatural, and you should one should really try to avoid it as much as possible, especially if you are getting results without it. Many surgeons want nothing but to make another dollar, and it's quite obvious surgeons are pro-surgery. So get as many opinions as possible. Especially from doctors who really have nothing to gain from you getting surgery. For certain lifestyles of course, people have to immediately get back to work or their life will fall apart. That is really the only case I feel like that surgery is acceptable.

    If you have any questions pm me or leave a message here, I'll try to stay up to date on this.

    It's important for me to note that I AM NOT A DOCTOR, this worked for me, but it may not work for you. You should consult a doctor or physio before attempting anything I've described.
  • Hi, I had the conservative microdiscectomy in 2003 and it did not last for me. I had also injured my back in an accident. I finally had the new INFUSE lt cage procedure with pedicle screw. It's made by Medtronic. They have had sever problems and a few deaths when this new bone protein is used due to swelling. All I could advise is to try that surgery 1st and if you later need a fusion, please use you own bone.
  • Hello, I am a newbie & also wanting to learn as much as possible about options for an L5-S1 ruptured disc. I am (or was) a very active 37 yr old male automotive technician, I enjoy hiking, mountain biking,running,swimming etc. I injured my back 06/16/08 lifting a lawnmower from the back of a truck, I actually felt something pop in my back when it happened. I had X-ray's taken & a number of oral narcotic/anti-inflammatory med's,PT and core conditioning and tried to resume life & cope with wishful & positive thinking that it would leave my body & find a new host. Pain management was ok until 12/22/08 until I shovelled some snow & then I could not sit down without great pain progressing & then sciatica & left leg & foot numbness followed by 12/25/08. I've made several trips to ER with extremely severe pain, the prescribed morphine did not even seem to change the acute pain, I managed to have an MRI & noted ruptured L5-S1 referred to a neurologist 01/12/09, I am still contacting my doctors office & have no Idea of when this consult or appointment will happen. Pain management scale 1-10 varies 1-4 at times depending on how much I do but the main thing for me Is to resume my quality of life & be able to Perform my job without this reoccurring. I've found all these blogs very informative, but still very confused on the surgery vs. non surgery, as for a second opinion I'm not sure how long it will take to get a first opinion from a neurologist, or even how many different surgical options there are? I honestly think case scenarios will base my decision. Can't wait to read KTM's next post.
  • Hey Mike,

    Any update? I have had the L5 S1 with moderately severe spinal stenosis problem for about two years now. The problem was probably caused by high school and college football compounded by getting rear-ended by a drunk driver, which totaled my car, but I walked away from it thinking I wasn't injured. At first it felt like a pulled a hamstring. Then 6mo. later it hadn't healed and I started to wonder. Then one day (4 days before my wedding) I was unable to sit up or walk and was stuck in bed for 48hrs. I'm talking 10/10 pain and having to urinate in to a water bottle because I couldn't get up or walk.
    The pain very slowly went away but I suffered muscle atrophy in my calf (now half the size of my healthy calf). I did some exercises and bought an inversion table (back swing). I thought I was out of the woods then a year and a half later here I am and the pain is back (no pun intended). I can hardly sit annoying throbbing pain with high spikes to 7/10 pain all day. I have checked everything out (chiropractic, have had one epidural with and second scheduled, PT, regular surgery, laser surgery and even acupuncture. I have no idea what to do to solve the problem. I chose laser surgery to get instant relief and because it is minimally invasive. Then I found out insurance covers very little of the procedure and it is a $30K procedure. Now back at square one and need to do something. There are so many options out there how would anyone know what to do? Every doctor says something different and as Steve A eluded, they all say their option is the best course of action because they want to make a buck. I am convinced that doctors no longer care about fixing a problem but would rather extend the problem in order to ensure job security. And insurance is crap because money comes out of your paycheck every month and then when you need to use the insurance they find a way not to cover you. I must sound bitter... Hmmm I am!
    Have you done the surgery yet and if so how are you coming along? I understand what you're talking about. My quality of life is crap and I can't accept that? I want to get back on my 4-wheeler and tear up some mud, run, hike, lift weights, and have fun.

    Best wishes brother and let me know how you are doing.

    Garth



  • Hey guys - sorry I have been away from this web site for quite some time. I guess that is a good thing though?

    Since my last post - I did see the surgeon 12/19. He does a quick examination, asks how I am doing - and says "You would have to shoot me with a poison dart gun before I had surgery If I were you" (that is pretty much an exact quote even). He went on to say, if I have no pain - dont do it! Or if it was even managable pain, dont do it (provided it allowed me to live my prefered lifestyle). He did say I have some permanent nerve damage, and that I likely always will have the numbness in thigh/calf/foot. He said I needed to continue the various exercises I did during PT, but to take it easy for 3 months - no get serous work out routines - just take it easy and live my life. Since then, still no pain, though my calf nearly always feels like it is about to, but not quite cramp - it never gets there..just feels like it is going to (dunno if that makes any sense to anyone or not...) I did do some easy short cross country skiing - went fine - though I sure am outta shape! I have done some time on the tread mill here and there - again, I do OK - but that calf issue seems to flare up a tad more. My leg muscles do feel weaker than I was before, and I am honestly wondering if i will get back to riding "race pace" on my motorcycle (which can be suprisingly leg intensive).

    Steve - I had read of the McKenzie method - could not find a local resource for it - but to me, it made total sense. I would seek it out if I could find a source. Your Premed path sounds like my 18 year old son! He will start Pre PT next fall, but more recently has commented about how similar that undergrad program is to Pre Med...gee maybe he should consider that. He had better pull down a few more bucks in scholarships!

    On the topic of surgeons looking to make a buck. Maybe I lucked out... but honestly, I guess I dont have such a jaded view of the profession. I have worked on the admin side of health care for about 17 years now - and I would say 99% of the health care practicioners are there for the right reasons. Of course, there are those there just for $. Sad fact is our health care delivery system, health care finance is one major screwed up mess (this is coming from someone who used to sit on the board of directors of an HMO even). It seems everyone is waiting for the perfect fix, and as they cant find that, they do nothing. I say we need to be a bit bolder and willing to try SOMETHING! Doing nothing will only result in one thing....Nothing!

    Troy and Garth - hang in there. Boy, if I think back to how I was feeling about all this in say October...man life sucked! Steve had many good suggestions. READ READ READ all you can online and else where. ASK ASK ASK questions of your Doc. If you dont get the answers push for answers. Call around to find other surgeons for second opinions (which I ended up never having). Talk to your primary care doc and have their office help with second opinion referrals. IF they drag their feet on getting appointments set up for you CALL.... remind them you are in pain and need to get things moving.

    I learned long ago, there is a reason it is called the ART of Medicine - yes there is lots of science behind it, but each practicioner sees things differently, has different experiences, different resources they know of to refer you to. Its like taking your car to a mechanic - and without taking it apart, getting a diagnosis of some complex internal issue. You might have one insist it is a cam chain making the noise, another insist it is piston slap, another insist it is a bad lifter.... but if they took it apart they would know for sure. Well, when It comes to medicine, the taking things apart is a bit more complex!

    You need to find a mechanic...err doctor...you trust - but verify what they say. Dont take "no" for an answer when it comes to discussion of options. But dont make the mistake of shopping until you find one that happens to agree with what you want...sad fact is, the medical facts may not support what you want.

    When it does come time for the decisions of surgery or not - be brutally honest with your self. Decide what the bottom line is - how much risk vs potential for improvement can you accept. What are your priorities. Troy - as a auto tech, your back issues can have a big impact on your ability to earn a living - swapping out a tranny with a ruptured disc would not be fun (I know...I tried to do an engine swap in my plow truck in the midst of all this back crap going on!) Your timeline needs may demand a quicker fix than say a desk jockey like myself could get away with.

    And, have some brutal conversations with yourself (just dont let anyone see you talking to yourself to much - you may find yourself dealing with yet another type of specialist!) - as Steve suggested - maybe some life style changes are mandatory. This sounds stupid - but my motorcycle racing is a HUGE deal for me. I can not fathom not riding a bike. Stick me with a fork and call me done if I cant ride anymore. But a close friend of mine, an 80 year old guy that STILL races off road! (an absolutely amazing guy), told me that sometimes we have to decide if we want to do what it takes to be riding when we are 80, or do we push such we have to stop when we are 50. He really got me to understand that maybe I dont need to push for that next series trophy, and maybe I can just kick back and ride for fun so I can ride for a longer time. I will continue to race, but honestly this experience has resulted in a different view for me. Next year all I will do is a select few events that I particulary enjoy, do some races with my son, and screw worrying about points standings. I will likely get back into street bikes more, my riding may continue to transition away from racing. I am now OK with that. 3 months ago - no way would I have said that. BUT... I WILL be riding when I am 80!

    If on 12/19 my doc had said to do the surgery, and with me no longer hurting, I would not have done it. Had I been hurting like I had been just a week or two prior - I would of said go ahead. Just that one week made a big difference. Maybe you guys will end up as lucky!
  • Thanks for your comments.
    Received my second epidural on Wed. and it seems to have knocked some of the sharp pain out. I can sit now for extended periods, which is good. I am still meeting with a surgeon on 2/19 to get some idea of success rate and what not. He is supposed to be on of the best in the nation, but still do I want someone cutting near my spine?? I have been walking every day with my chocolate lab, which I think might be helping a little even though I feel some pain toward the end of the walk. Oh, and I know what you are talking about with the almost cramp in the calf. Happens all the time to me. Especially in bed or if my knees are bent beyond a 90-degree angle.
    I am going to try and let my body take care of it (back extensions seem like a good idea) if at all possible, but I will let everyone know what the surgeon says about it.
    Thanks Again Everyone,
    Garth
  • Wow, I have a new back!! Since my last post of what almost sounded like doom & gloom in the land of uncertainty & uninformed, I would like to thank you Mike & everyone else for their experiences & information, as I have processed alot of information in a relatively short amount of time. This has enabled myself to base one of the most important life changing decisions that I could not have made with confidence, without the help of the knowledge everyone shared with me. Things really started to roll along quickly after my consult on 02/10/09 with the neurosurgeon basically not too much pain before the consult 2/10, but after the evaluation of bending light pushing pulling checking reflexes (almost no left ankle reflex) pain seemed to increase to 6/10 that evening. During the consult the neurosurgeon reviewed my MRI 3D image (really impressive) & informed me my surgergical & (non surgical options 6 months basically of doing nothing) which I don't think was an option for me cause the bulge/rupture was so profound that he explained that with Intense activity work/Play etc, bladder & bowel function could be affected in the future & surgery would definitely be required & no guarantees of no permanent damage from nerve impingement. It made perfect sense to me that the surgical option(microdiscectomy) was the only option I had for me. The surgery was booked & performed on 02/18/09 was hopefully going to be about 1 1/2 hrs which turned out to be about 4 1/2 hrs, As I was previously told as good as these MRI images are there can always be challenges. The surgeon had said that the disc bulge/rupture was quote (Huge) & separating the nerves & fragments from each other seemed to prove the most difficult part of the procedure. I am now going to have my sutures removed today 03/02/09 & feeling better everyday I have feeling in my left foot now & some surgical area discomfort. I will make sure to follow up with more posts if anything else changes in recovery. Thanks for the medical/mechanical transcription Mike it totally made sense & enlightened the moment.

    Troy
  • Well so i guess u opted not to do the surgery which i think for a first timer its better not to do the surgery but back in 99 i had the same symptoms as you and i chose to do the surgery but the pain would not go away. I have had nothing but problems since, but the first surgery did give me 5 good years then the bulging disks started pushing on my sciatic nerve again and the pain got increasingly worse with more frequent episodes of pain which lead to my second surgery in oct. of 2007 which a car accident in dec ruined the hope for a normal back again, now im awaiting approval from my HMO for a spinal fushion, take care of your back rule over it dont let in rule you, I am defined by the pain in my back that runs my life so i am anxiously awaiting my surgery in hopes to regain some of my life back
  • Good for you im glad the surgery went well for you. I have had two surgeries of the same type and the first gave me 5 years of relief but exercise your back build up those muscles or you may end up stuck in a bed at 37 awaiting a spinal fusion on L4 L5 I was not patient in my recoveries i push myself i went back to work after 10 days after the first one, and ran my daycare after the second one but a car accident 45 days after the second one probably didnt help me much. The best advice i can give you is walk and build all the muscles around your lower back to give it more support this should help prevent further surgeries good luck...Christie
  • Hi SteveA,

    Thank you very much for sharing your experience and information. Let me introduce a little about myself. In mid Dec 2008, I have a mild back pain and waited for a month for the pain to go away on its natural course but then it did not and so I decided to visit a Chiropractor. Sadly, things went wrong on the 3rd treatment and I suffered a disc extrusion over L5/S1. I was in a lot of pain as it compressed on my right transversing nerve root. The MRI showed I have DDD running from L2 to S1, disc herniation at L5/S1, disc bulge at L2/L3 and disc protrusion at L4/L5.

    I personally feel the same, not to opt for surgery. I have gone to PT and did the extensions, pulling of hamstrings and core muscles strengthing. It has helped me alot. I am now able to walk a little quicker and sit without pain. However, it has been 2 months now and still experience numbness in my right sole.

    May I know did you experience numbness in your right leg? If you did, when did the numbness (pain) go away? I am worry that my herniated disc is still compressed against my nerves since the numbness did not go away.

    I do have a few questions to ask. Firstly, how do we know if the herniated disc has come back to its original place if one were to adopt conservative treatment? I know the obvious answer is MRI. But then, does the straight leg test provide the answer?

    May I know what is the brand of the kneeling chair you have bought? I would like to get one to relieve my back pressure.

    Thank you for your great help.

    Michelle
  • Hey Troy,

    I don't know if you are checking thE site still, but I wanted to see how you were recovering since your surgery. I too decided in the end that microdiscectomy was the route to go. Recovery has been interesting. I still have some pain in my sciatic nerve and they said that it was due to inflamation from the surgery. Do you still have any pain down your leg? Amost 8 weeks later I still have some pain in my butt and a slight bit down the back of my leg. It better go away or I am going to be one pissed off dude. What are you able to do now physically(run, bike, lift weights etc.?) Thanks man and I hope you are just like new!

    -GARTH
  • hello i am jim 38 ,factory worker. in may of this year i picked up a large piece of metal,or tried too . it was about 400lbs . later that night i was unable to roll over in bed. i found out i have a 8mm tear in my L4 disc. today i had a steroid outpatient injection. first of 2. i am still hurting ,still have numbness down my buttocks and leg. my question is without a replacement. does this ever get back to normal to where i can go back to full duty and do my very physical job. i love my heavy industrial job .
  • back are like virginity ..once it gone its gone!
    STRAKER
  • Sorry to hear about your pain.

    My own experience with the same level herniation (L5 S1) is that surgery (after trying everything you have been trying) relieved 100% of the pain. I too was very active (running, yoga, house projects, gardening) and was so miserable.

    However, the surgery wasn't a long term fix for me. I reherniated the same disk 2 years later. The 2nd time was MUCH worse and I could find no position or drug that helped the pain. The surgeon did a 2nd diskectomy and I again felt immediate and full relief (I would occasionally get a Charlie horse in the middle of the night, or faint pain in my hamstring area if I went dancing). The second time around I didn't try to go back to my "life before back injury". I switched my exercise to swimming several times a week and hiking daily with my dog. No more yoga. Minimal gardening.

    Turns out I wasn't conservative enough. I don't know... maybe it's human nature or maybe I'm just an idiot, but I herniated again. I think it was some landscaping work I was doing or maybe lifting something heavy (hey, I am a single woman living alone... who else is going to lift the heavy stuff? The UPS driver?).

    Anyway, I now face spinal fusion. I'm trying to hold off and hope it gets better without the third surgery. But from my experiences I am afraid to say you will not be able to abuse your back like you (and me) could before the injury.

    And if you do get surgery, please learn a lesson from my experience. DON'T overdo afterwards. Life has changed; it's hard to face but it's true. If you have a successful diskectomy, don't blow it like I did and face having to have fusion with metal bolted to your spine!!!!

    Good luck.
  • This was one of the best threads I've read re: L5/S1 herniated disc. Oldie, but goodie! I hope I can go the conservative route and get good results!

  • I had an anterior fusion, they went through my stomach, at L5/S1 and have been skiing and horseback riding since that fusion took about 9 months after surgery. There was very little to no pain after surgery. Before surgery I was using a cane to walk since the sciatica was so painful. Sitting is the worst. Sitting puts more pressure on your back then any other position. I would avoid the discectomy as I think you will be going back to the doctor in a year or two with the same problem. My disc was ruptured and collapsed so the vertebra was pressing on my nerve. You may not be having that issue now probably the disc is pressing against the nerve but if you want to continue biking etc. you will most likely have it later. I know because now I'm having a problem with L4/L5 which was herniated when I had the fusion but not pressing against the nerve. I need a discectomy but I am also 46 years old and since my kids are in high school I only need to be crazy for about 4 more years. A fusion at this level would really limit mobility. L5/S1 my only issue was I had to bend my knees more to get the ability to catch a ground ball.
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