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3rd microdiscectomy?

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:36 AM in Back Surgery and Neck Surgery
I'm a generally healthy, active, fit, 41 year old male. I have had 2 microdiscectomies at L5/S1, first in Dec 2008 and then Jan 2009 for a herniated (and then reherniated) disk. My primary symptom was (and is still) on-going right foot pain.

My latest MRI shows residual herniation at L5/S1, and scar tissue surrounding the periphery of the S1 nerve root. I have almost constant right foot pain. I have tried physical therapy for several months, 3 epidural steroid injections, weekly acupuncture. The only thing that seems to help is Lyrica 3 times a day. If I don't take that, the nerve pain is bad enough to interfere all day long and wake me at night.

The neurosurgeon who performed the first two operations does not want to operate again. He thinks the residual disk is too small to worry about and does not want to risk making the spine unstable. A second ortho surgeon wants to do a fusion. (I will not do that.) A third ortho surgeon who I have consulted several times is willing to do a 3rd microdiscectomy without a fusion. He says the L5/S1 level is "inherently stable" and, while he doesn't minimize the risks involved and is generally very conservative about recommending surgery, is willing to do it if I want to, with the knowledge that if it fails, my only surgical option would be a fusion.

Has anyone had similar circumstances? Have 3rd microdiscectomies been successful and relieving leg pain without causing instability? Thank you.

PS - I'm quite active with biking, kayaking, hiking and other exercises. I'm back to the point where I can do these things, I just have constant foot pain of varying degrees. I can probably live with it (although I'm pretty miserable), so it is a trade off between the possibility of finally being free of this foot pain, and the risk of causing other problems or making it worse. Any advice is appreciated.


  • I haven't had surgery yet but just wanted to welcome you to the forum. I take cymbalta for the nerve pain for now but I'm seeing my 3rd opinion Neurosurgeon to see if he'll do a microdiscectomy on me. Best wishes and maybe a 3rd opinion will help you decide. 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
  • The L5-S1 is the one segment that does not have much movement. I currently have L4-5 fused and have been told that when I have L5-S1 fused, I will not notice the difference -- it will not make my spine feel more rigid as that level does not move to begin with.

    If I were you, I would continue taking Lyrica since you get some relief from it, and I would live with the situation for another six-nine months. You have had two surgeries and since nerves take a long time to rejuvenate, there may still be room for improvement. Plus, you have no guarantee that a third surgery will resolve the nerve pain. It may be that the nerve itself is scarred and may never get much better.

    Even if you have the disc removed, it may not cause instability, but it could result in a great deal of pain -- pain in the lower back caused by the vertebrae rubbing together. If you do not have fusion, you will end up with a bone-on-bone situation. This can lead to arthritis in the facet joints.

    Also many surgeons would be reluctant to go back in due to the scar tissue problem. It is possible that another surgery at the same site could cause further problems with the nerve rather than resolving them.

    Considering all the things that could go wrong, I think I would just live with the situation for awhile and see if it doesn't improve a bit on its own.
  • Thank you for the reply and the "welcome", Charry. I did try Cymbalta for about 2 weeks but didn't like the side-effects, so I stopped. Lyrica has been very helpful. I recently was able to cut it from 4 x 50mg a day to 3 x 50mg and it has been tolerable. Never great, but usually tolerable.

    Good luck and I hope all goes well for you.
  • Thanks for your advice. I appreciate it. My strength in that leg/foot has definitely improved over the last few months (it took from November 2008 until April 2009 before I could stand on the toes of my right foot, although I still have the pain. Even though the pain has gotten better, it's hard to know whether to attribute that to "healing" vs. the Lyrica. I'd like to believe it's from healing, but if I stop the Lyrica...wow, it becomes unbearable.

    I'll likely take your advice and wait a little longer to see if there are improvements in the pain. Thanks again.
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