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Microdiscectomy L5S1 is it time?

scmgurusscmguru Posts: 103
edited 06/11/2012 - 8:38 AM in Back Surgery and Neck Surgery
I'm a 39YO Male and have had burning pain in my left and right hips on and off for couple of years.

In July of this year I started getting a burning pain at L5S1, mostly at left of center, sometimes at right of center.

Cannot sit for more than 20-30 minutes at a time.

Late july, a dull pain moved to my left leg and I would get tingling down the back of my leg and all the way to the arch of my foot.

Had xrays and MRI done in August, L5S1 broad based/left paracentral bulge (5mm) compressing the L5S1 nerve w/ mild foraminal narrowing.

Been through 2 rounds of epidurals.

1st round, (injections done at left of center and center) the leg pain was gone and the burning pain shifted all the way to the right. Total pain relief <5 days

2nd round, (injection done center), burning pain gone, leg pain gone. Total pain relief <5 days.

Been on anti-inflammatories since Aug.

Tried PT in Aug, it irritated the situation so badly that I didn't go back until October.

At this point the off center back pain/burning is there at least 70% of the time or more.. the left leg is involved

I used to be able to stand or lay down and it would provide some relief. But not so much any more.

The last few weekends, I couldn't stand for more than 15 minutes w/o my left leg starting to throb with that familiar dull burning pain. <-- This was new.

Have been back to PT starting in Mid/Late October. 2st visit (w/ Piriformis stretching exercises) left me bedridden with the most severe leg pain/cramping and twitching I've ever had for hours.

Have done 2 weeks w/o exercise, just electric stim, heat and massage. Hasn't helped too much.

I'm thinking of getting a microdiscectomy at the end of the month and wanted some input from the folks who've done it?

It's been nearly 5 months since the severe symptoms started.. is it too soon?

Been to two surgeons, one is a strict orthopaedic spine surgeon who isn't too sure MicroD will help because my pain isn't all in the leg.

The other is a neurosurgeon/ortho spine surgeon feels it will help..



  • All I can say is good luck. I am making the same decision soon. Had my first steroid injection yesterday. Disc fragment floating at L5/S1 and pushing on sciatic nerve. All my pain is right leg. Microendodiscectomy is on the agenda if two shots do not work. So far my first shot has made a huge difference and i hipe it sticks. But if not I am not wasting time. Both docs feel the procedure will not doubt solve the situation. Both just want to try to avoid surgery first.

  • but I had a microdiscectomy L5-S1 back in August and didn't really have a choice. I've had back issues for about 18 years and managed with PT, ibuprofin, occassional prescription meds, and listening to my body.

    I never had the benefit of an MRI during these years to understand the overall health of my back. I wish I had that because I would have changed my lifestyle (i.e. cut back on the running I was doing).

    This summer, I felt my sciatic nerve acting up and took it easy for 5 days (i.e. barely any exercise). I woke up one morning, stretched and couldn't move. Of course I tried 3 times to get out of bed (mistake). I ended up in the ER with excruciating back and left leg pain. They gave me an IV and the pain area went numb. MRI was severe herniated disc. I had the surgery and had 60% of the disc removed.

    I won't share my current status because I don't think I'm an average patient.

    I can't tell you what is right. I can tell you to get a 2nd opinion and talk to both orthopedic and neurosurgeons for opinions and risks.

    The surgery itself isn't risky. I was terrified going in because I had never had surgery. But it was an 'outpatient' procedure meaning you'll be released in less than 24 hours (and maybe the same day depending on the time of the surgery). My incision is only an inch and a half long. The first week was rough but after than . . the swelling goes down and I was more mobile.

    I will recommend that if you DO get the surgery, follow the doctors orders. Do NOT rush going back to work despite how good you feel. It set me back. Do not drive more than you need to because your body torques more than you think. Do not sit for long periods of time, walk, walk walk, and do not lift or twist.

    Good luck. Keep us updated
  • Five months is plenty long to try conservative measures. If your spinal specialists believe that surgery is a good choice for you, I would seriously consider it. It is a fine line between waiting long enough to see what will happen, and waiting too long.

    You are wise to get several opinions. Do your homework. Take your time in choosing the surgeon. Once you begin this process, there is no turning back.

    Good luck with your decision.

  • done at L3/L4. It did help the leg pain but not the back pain. You are the only one that knows for sure what point you are at as far as the level of pain. Personally I am a firm believer that every conservative treatment possible should be tried first. PT also made my pain worse. Have you considered getting a third opinion from another reputable spine specialist? I personally know 2 people that had a microdicectomy years ago and have not had another problem since. That has not been the case for me but I also have other issues. Good luck making your decision and please keep us posted.
  • Micro-d usually just helps the pain in your legs by getting the disc material off nerves. If you're having substantial back pain, there may be some stabilization issues or arthritis or other things going on there. I have to admit when I first got the results of my MRI I thought the doc was totally nuts. She said I had osteoarthritis, scoliosis, ruptured discs, slight spondy, and disc material pressing on my nerve roots. She recommended surgery with the rods and screws, etc., and I was just totally convinced she was wrong. I tried the injections and got no relief at all. They do work for some folks, but you will see from the folks who end up here, they don't work for a lot of us (granted, most folks who end up here probably have more severe problems). I did have a micro-d in December of 2007. The relief was nearly immediate, although a few days after surgery I had increased pain in my leg as my nerve started "waking up" from being compressed. That eventually went away and I felt great for about six months. Obviously, my first surgeon was correct and I did eventually need the big surgery. One of the nice things about the micro-d is -- it's not terribly invasive, the recovery time (barring complications) is relatively short, and IF there are any issues that can't be seen on the MRI, the doc can get a pretty good look while in there. If your insurance can cover it so you don't have a lot of expense and you can afford some time off, I'd go for it. The potential for pain relief is good and there is nothing like being pain free.

    Weigh the personal costs and benefits and make your decision. Is the back or the leg pain worse? Micro-d will definitely help leg pain.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Well.. like others said only you and your doctor can decide.. but here are two threads from me.. first one is "Should I do it" second one is "I did it!" maybe give a little insight to your issues.

    Should I do it:

    I did it!:
  • Having had a microdiscectomy this year, I can tell you what my surgeon said. A Microdiscectomy will only work to eliminate or reduce leg pain or numbness. It may reduce back pain, but if back pain is your primary symptom then you are unlikely to achieve a satisfactory outcome from this surgery.

    Having said that I do think that you have given conservative methods a fair trial and that if you feel that this surgery may help, go for it.
  • Thanks for the reply. My primary issue is leg pain/numbness and back pain combined.. leg pain/numbness follows back burning pain very quickly.

    I looked up my diag again.. L5-S1 broad based central and left paracentral disc protrusion (5mm) w/ left neural foraminal narrowing.

    The oddest thing is how the pain/numbness will switch sides from left to right (predominantly left).. must be due to the broad based aspect of the bulge.
  • scmguru said:
    Thanks for the reply. My primary issue is leg pain/numbness and back pain combined.. leg pain/numbness follows back burning pain very quickly.

    I looked up my diag again.. L5-S1 broad based central and left paracentral disc protrusion (5mm) w/ left neural foraminal narrowing.

    The oddest thing is how the pain/numbness will switch sides from left to right (predominantly left).. must be due to the broad based aspect of the bulge.
    mate read ur comment above so similar to me but what happens with then they remove the material its still going to degenerate pain might got for a while but it comes back i am looking into ADR
  • Your post was like reading my own bio! Except that I'm a 44YO female!

    I've been struggling with this for over 2 1/2 years and am now scheduled to go for surgery in Dec. My specialist said that if it hasn't gotten better on its own by now, it likely won't. And he did also say that the primary goal of the surgery is to releive the pain in my leg. He said there may still be some numbness even after the surgery.

    I have to admit I'm nervous about the surgery, but I still feel that it's something I want to do. I've had virtually no life since this happened, and I really need some relief at this point. So I'm hoping that's how it will all work out.

    Whatever decision you make, I hope you get some releif soon! Take care!
  • I have to take exception to those who said a md will not help back pain.

    My L5-S1 case was pretty much all back pain and very little leg pain if any.
    The md got rid of 90% of my pain.

    For my L4-L5 md, it was 60% back pain (like a knife was stuck in there) and 40% leg pain.
    The md cured both 100%.

    Every case is different.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Just an update...

    I have 2 surgeons that I am working with and one of them will ultimately do the surgery. (I always get 2nd opinions)..

    I had a long discussion w/one of them yesterday regarding what his plans were for the surgery and why.

    This was the first time I'd really felt like we were both on the same page and I felt really comfortable with his honest candid answers to my laundry list of questions.

    He is planning on doing both a microD for the wide bulge, neural foraminotomies to remove a bit of stenosis and give the nerves more room and far lateral nerve root decompression bilaterally.

    I'm meeting with surgeon #2 tomorrow to have the same discussion.

    Once I'm done, I'll schedule the surgery.

  • I put up with my problems for several months. My left leg and right ankle started getting weak and things were just getting worse... I had enough and was scared I was risking permanent damage so I scheduled surgery.
  • If that's a concern, i'm told you have 3-5 months to try conservative treatment.

    I had microdiscectomy L5-S1 due to significant loss of feeling and strength on left side. Unfortunately I reherniated the disc (I guess I'm the 5-10%) and am going back in soon for a re-do.

    I'm told by others that if it works, the leg pain is significantly better.

    I'm hopeful to get relief in my leg but also feeling and strength back. I suspect I'l still have some back pain but that's manageable.

    Good luck in your decision.
  • are hard to correct with a typical micro-d (I've been told by surgeons). I agree because the surgery itself ends up weakening the disc wall via removing/shaving off the bulge that is irritating the nerve(s).

    When there is a bulge of the outside of the disc, then there are cracks on the inside that have allowed the pressure to get to the outside wall. Unfortunately, our bodies do not heal discs very well (due to lack of blood supply etc) so surgeons seem to cut (shave) and hope in my opinion.

    Wouldn't it be nice to heal the cracks on the inside and regain disc integrity thus disc height again? That makes more sense than cutting stuff out, right?

    There are some doctors who are actually doing that with adult stem cells and platelet rich plasma. Hopefully in the future bulges can be addressed with a healing injection rather than a destructive scalpel.

    Sorry to digress...In any case, the outcome of a micro-d may or may not get the job done. In Paul's case, it worked. Everyone's physiology is different. Some people have a larger foraminal area and have more room for their nerves. Some have less. I hope your micro-d works for you!
  • "...Some people have a larger foraminal area and have more room for their nerves. Some have less"

    You make a very good point.. from what I understand, I have less--> so this type of bulge is causing the symptoms I have.

    Both surgeons I've spoken with would perform the foramenectomies due to the lack of room.

    They feel that will go a long way towards giving me relief by providing more room for my nerves.

    I went and spoke to surgeon #2 (Neuro/Spine) today.. he honestly felt that this surgery was not going to be very difficult for him and he felt that he could get this resolved rather easily and with less than average risk for complication.

    Now I just need to pick one.. I feel they are both exceptional surgeons.. one is in an academic environment, the other total private practice.
  • Ask the surgeon about possible structural integrity being lost (ie hypermobility or weakness of the structure itself). That is something you want to avoid because structural issues seem to end up in a fusion later.

    Also ask about possible scarring in the foramen from the procedure and how he/she will attempt to minimize it.

    Good luck. I hope it works for you if you decide to go with it.
  • had surgery on L5/S1 (MD)on 11/18/09 after 2 months of conservative treatment with no relief (took prednisone, 2 esi, pt). on 11/23, visit with dr. he said disc was a very bad herniation with fragmentation and probably had no chance to get better on its own. said surgery was pretty routine and went well. he appeared surprised when i told him i still have same pain (in left buttocks) and have been taking percoset 2x every 4 hrs, all day and night for the pain since the surgery. he said he was concerned and to let him do the worrying. having heard that from my surgeon, i'm worried now. he recommended taking prednisone again to possibly speed things up. i found that very alarming since i was only 5 days post-op. help!
  • in your recovery, stockbroker. Those nerves have been jostled around a bit and could be pretty irritated. The prednisone may help you. Hang in there and give it some time and try not to worry so much. The pain should calm down pretty soon. Your doc is concerned and that is good that he is on top of it. Your job is to try and relax if you can.

    Take care and keep us posted when you can.
  • today is 1 month since L5/S1 md. have been feeling much better since day 6. i can finally straighten out my leg. sometimes i feel so good i forgot that i had surgery. i have to be careful so i dont do something w/o thinking, and re herniate. it is amazing. i realize i'm very fortunate.
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