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so tired

AnonymousUserAAnonymousUser Posts: 49,671
I had a microdiscectomy done on March 2nd at L5-S1. I had a free fragment removed that was compressing the S1 nerve root.

I fell down on March 26th, and boy did I hit the floor hard, knees first, then the rest of me. I was in pretty severe pain and requested an MRI to see if there was more damage.

My first MRI (done on 2/27) before the surgery showed:

lumbar spine shows advanced multilevel intervertebral disc degeneration for age. Large inferiorly extruded disc is present at the L5-S1 level. Multiple other levels of disc bulging are present, accelerated for age.

Normal conus.

The axial images show:

T11-T12: Tiny left paracentral disc protrusion.

T12-L1: Negative

L1-L2: Broad-based disc bulging. No canal stenosis.

L2-L3: Facet joint hypertrophy.

L3-L4: Facet joint hypertrophy. No canal stenosis.

L4-L5: Facet joint hypertrophy with ligamentum flavum thickening. Disc bulging eccentric to the left side. Mild narrowing of the upper left lateral recess. Mild left-sided foraminal narrowing.

L5-S1: Inferiorly extruded disc in the central position, measuring 11 mm transversely, and extending inferior to the level of the L5-S1 intervertebral disc space, posterior to the S1 vertebral body, x 11 mm. There is also inferiorly extruded disc the right of the midline, causing asymmetric posterior deflection of the right S1 nerve root.


1. Large inferiorly extruded central disc at the L5-S1 level, also with inferiorly extruded disc in the right paracentral position, with impingement and posterior deflection of the traversing right S1 nerve root.

So on March 2nd, I had the microdiscectomy done, and both the pre & post-op diagnoses were:

1. Herniated lumbar disc L5-S1 with free fragment and compression of S1 nerve root on the right.
2. Lumbar radiculopathy S1 nerve root on the right.

Operative procedure: Microlumbar discectomy L5-S1 right with removal of herniated lumbar disc and decompression of S1 nerve root.

Fast forward to 4/2, which is when I had another MRI after the surgery, and after I fell, due to continued, worsening pain.


There has been interval postoperative change of the right side at the L5-S1 level. The previously seen central and right paracentral disc is now mainly absent. Minimal disc material remains.

There is epidural fibrosis about the right S1 nerve root, with mild asymmetric enlargement and enhancement of the nerve root.

A postoperative fluid collection is present to the right of the L5 spinous process, likely benign postoperative fluid.

Further superiorly, there is long segment enhancement and enlargement of the intradural right S1 nerve root, extending at least to the L4 level.

The sagittal images also show linear enhancement about the conus.

At the L4-L5 level, there has been interval development of several tiny annular tears. Tiny central disc protrusion is present, not causing canal stenosis.

The remainder of the lower thoracic and lumbar spine are stable, with minor disc bulging.


1. Interval postoperative change in the right side of the L5-S1 level, with the central and right paracentral disc material now being largely absent. Minimal central disc material remains, not causing nerve root impingement or distortion of the dural sac.

2. Asymmetric intradural and extradural enhancement of the right S1 nerve root compatible with radiculitis.

3. Interval development of small annular tears at the L4-L5 level.

4. Element of linear enhancement about the conus. Probably related to postoperative inflammation.

5. Small postoperative fluid collections on the right side of the L5-S1 level, favored on the basis of benign fluid.

I just would like to know how much longer I will be feeling so badly! Is it normal for me to be feeling this awful this long past surgery and injury? I went shopping with my family today, and I could barely keep up with them. I felt like my legs just didn't want to carry me any longer. I felt so weak and tired, like I could collapse any minute. I was probably on my feet all of an hour!
I sleep poorly~ well, I wake when I am feeling pain, and I can barely find the strength to turn over in bed. Getting out of bed in the mornings is so trying!
I have switched to a new family doctor and she has reviewed my reports. She gave me Flector patches and Lidocaine patches for my back. The neurosurgeon also has me on Flexeril 10 mg three times daily; Lortab 5/325, one by mouth four times daily, and Ibuprofen 600 mg, three times daily. After I got the report from the second MRI, the doctor on call for my family doc admitted me to the hospital for pain management, because my neurosurgeon refused to answer any pages sent by the answering service.
The neurosurgeon came to visit me in the hospital the next day, and gave orders to fit me with a back brace. I do feel better with the brace on. It can get a little bit cumbersome when I sit down with it on. I feel like Kate Winslet's character from the Titanic movie with this thing on. :D

My old family doc (and this is why he's now my 'old' family doc) was angry that I had asked his on-call physician to intervene when my neurosurgeon ignored my pages. I know I could have gone to the ER, but all they will do is give me a pain shot and send me on my way. That might be helpful for a few hours! What about the rest of the time I'm in pain? Am I supposed to just keep running to the ER and racking up all kinds of bills? That seems like a poor answer to my problem.



  • In a word, NO. Many people are completely recovered from a microdiscectomy this many weeks out from surgery. Some are not. Healing is an individual thing and some of us just take longer than others. However, there are a couple things on your MRI that I would be asking my surgeon about.

    "There is epidural fibrosis about the right S1 nerve root, with mild asymmetric enlargement and enhancement of the nerve root.
    A postoperative fluid collection is present to the right of the L5 spinous process, likely benign postoperative fluid.
    Further superiorly, there is long segment enhancement and enlargement of the intradural right S1 nerve root, extending at least to the L4 level."

    Epidural fibrosis is scar tissue that forms around the surgical site, where the disk material was removed. It can become a source of pain.

    It sounds like you are still having pain from the S1 nerve root. Have you been given an oral steroid or offered an epidural steroid injection? Sometimes there is a lot of internal swelling after surgery. A steroid will help to diminish the inflammation.

    It seems odd to me that you would be fitted with a back brace since you do not need bone to mend together and you did not have a problem with stability. I would be more worried about what's going on with the S1 nerve.

    When do you see your surgeon?
  • I left out some information because my post was getting so long. During my surgery, radiology was brought in to help make sure they were in the right area. After the draping was in place, a Lateral C-arm was brought in and using a spinal needle localized the L5-S1 level with lateral fluoro. The subcu was infiltrated with 10 ml of 0.5% Marcaine with epinephrine. After that, a time-out was completed.

    They started the procedure. While cutting through the subcu fat & fascia then being dissected, he also injected the fascia with Marcaine 10 ml with 0.5% with epinephrine. He then goes on to explain how he is exposing the L5-S1 joint.

    When they finally get to the area:

    the S1 nerve root identified. With gentle dissection around the nerve root we identified the rupture. There was a free fragment situated just anterior just right in front of the S1 nerve root below the level of the disc space. We dissected. We dissected the fragments out with the nerve hook & then removed them with the Caspar rongeurs. He continued exploring underneath the nerve root & wasn't able to find any other fragments. They then go on to open up the annulus and perform the discectomy. He says he looked medial to the S1 nerve root in the axilla & saw no evidence of any fragments there with the nerve root retractor in place. There was some older calcified-type disc underneath the annulus more medial. With the nerve root retractor there we were able to remove that using the Peapod rongeur & also the 2 mm Kerrison. He then readjusted the nerve root retractor & retracted once again on the dural sac lateral to the S1 nerve root again & then finished the discectomy looking in the disc space again both medial & lateral with the upbite pituitaries. No other fragments of disc material & I think we had a good decompression of the disc medial as well as lateral. The S1 nerve root looked well decompressed. There was some erythema, swelling I think in the nerve root at the initial exposure of the nerve root, & I think that was still evident at the completion. I did have the anethesiologist do a Valsalva maneuver & there was no evidence of any CSF leak or any bleeding. Bleeding was easily controlled during surgery with the epidural veins with bipolar cautery & hemostasis was quite stable at the end. Gelfoam with Depo-Medrol 80 mg was left in the epidural space anterior & lateral to the nerve root & then dorsally over dural sac over the laminotomy site.

    So yes, I was on steroids already from my second ER visit. I was taking 60 mg a day and continued that until the neurosurgeon told me to stop after the surgery. He put that gelfoam with Depo-Medrol in during the surgery, and I'm guessing that's why he took me off the other oral steroids. A few weeks later, when I was still in pain and complaining of it, I got a medrol dose pak to take. I finished it off, was still in pain, so was told to finish off the steroids I had from the ER doc. Those are gone now.
    I initially was on valium for the muscle spasms, but they switched me over to Flexeril 10 mg three times daily. They said I couldn't be on steroids forever; it is dangerous. He put me on 600 mg ibuprofen 3 x daily.

    I had a visit with my new family doc, and she looked over all the reports, and offered me flector patches and lidocaine patches, which are helpful when I use them.

    I have pain in both legs now, but to the left it's mainly in my hip. It starts to feel aggravated down the leg if I spend too much time walking without the brace on. I swear, I thought I was going to drop in that store yesterday. It would have been very embarrassing. I should have had the brace on, but I was trying to hurry and get out the door. I didn't even get time to put a patch on.
    My abdominal muscles are not supporting me well. I've had a c-section, then a tummy tuck, and then 2 more c-sections after the tummy tuck. I think that's where the brace is helpful. I wonder if my back would be in better shape if I had better abdominal support and will hash that out with them soon. I see the neuro on May 1.

    I just can't believe I'm feeling this challenged so far out from a surgery. It's never been that way for me before. I recovered pretty quickly from everything else I've had done.
    I'd like to understand why I feel like I do.
    I did ask the neuro's nurse (who also happens to be his wife) about being referred to a pain management clinic, & she said no, not yet, 'cause they'd want to do trigger point injections & i'm not ready for that just yet. I think I'll find out more on the first.

    Thanks for your reply! I really appreciate it.
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