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Reherniated L5-S1 . . any advice?

DNiceDDNice Posts: 1,962
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
I herniated L5-S1 back in August and had a microdiscectomy.
- 2 weeks post-op the PA looked surprised when I said I didn't feel any better but assured me not to worry.
- 6 weeks post-op I told dr. I felt just as lousy as before the surgery and I felt something wasn't right. He assured me that I was making progress and was just slow but that he'd see me again at week 11. He prescribed Prednisone/steroid and sent me on my way.
- week 10.5 changed my appt and told him I almost came in at week 8 b/c as soon as the steroid ran out, I felt just as lousy. He again assured me I was progressing just slowly. I told him sorry but I just didn't feel right. He said he'd send me for another MRI for peace of mind.

Well . . the results indicated likely reherniation.
My doctor said based on what I told him and based on the images, it appears I did this within the 1st 2 weeks before the scar tissue had a chance to form.

He indicated he believes that I will be successful on 2nd surgery b/c of scar tissue. He told me that if it slips a 3rd time, most doctors will suggest fusion.

I guess the good news is the re-do is free since I've met my deductable this year.

I guess I am wondering
- can they really tell based on the image that I reherniated it early on based on how scar tissue formed?
- would you use the same doctor or pick a new doctor?
- I went to a orthopedic doctor and am getting a 2nd opinion from a neurosurgeon . . but I know this could have happene regardless of doctor b/c I spoke to someone who had this happen and she had a neurosurgeon do the surgery. I guess my biggest question is . . what should I ask for to knwo that a doctor will take my concerns seriously post-op? Next time I won't wait the full 3 months if I'm not doing well so I'm just looking for advice on how to pick a doctor.


oh, I guess the other good news is I have a lot of vacation time to use to while it's not a good time to be missing work, I have enough sick and vacation days to ensure I am VERY careful this time. I will not drive, I will not bend, I will not go back to work, or anything too quickly.


  • if they can tell just went you reherniated the disc. I guess only a medical professional can say that. I know there is often a lot going on that they can't even see with an MRI, but there may be indicators that we don't know about. As far as sticking with the same doctor, I don't imagine you'll have much choice. From reading here and from other folks I know, many surgeons do not like to go in and fix up someone else's work. Trying to get another doctor to work on you might be somewhat problematic.

    It is wonderful that you can get in and get it done before the end of the year now that you have met your deductible. It's also great that you have substantial leave time. Do be very careful this time. Get someone to help you out and enjoy being cared-for for a bit.


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Linda,

    Thanks for the heads up on the doctor.
    I'm convinced I can find another doctor but I do understand what I'm up against. I'm leveraging my health benefit (we have health coaches) to send me for a new provider. I'm optimistic that they can help me get a new doctor.

    This is frightening that another doctor will not take on the patient . . .but I guess it's good to know it could be a reality. If that's the case, do you think his partner (the person I really wanted to do the surgery) would take me on?

    And yes, what I learned is to be ultra careful afterward. I am already 2nd guessing having overdone it.
  • My surgeon's practice has a policy that a patient cannot switch from one surgeon to another within the practice. But I think this varies from practice to practice and I don't know how common this policy is. I never had a problem getting another surgeon to see me for a second surgery, and I have collected a number of opinions for a possible third surgery I am considering.

    Are you dissatisfied with the current surgeon? I have been advised that it is better to stick with the same surgeon as he/she knows your back and what was done previously. However I was not told that until after my second surgery!

    Read the section on microdiscectomy success rates here:

  • Thanks for your insight.
    Yes, my current surgeon is fine. What disappointed me is that I think he was too 'informal' about post op do's/don'ts. I think he should have been more prescriptive about when to drive and/or go to work and how much to ice.

    He did tell me that it's nothing I did, it can just happen and I believe that.

    I think the other thing I'm not thrilled with is that I was not happy at week 2 (ok) but really unhappy at week 6 and even at week 10(11), I had to push him for the MRI. I suspect I could have left there and gone to PT and missed this opportunity.

    I appreciate your insight on sticking with same surgeon b/c they know what they did and they know what they are looking for (but in reality he's seen a ton of patients since me).

    I guess it's what I'm torn between. Sticking with him or trying new. If I slip it a 3rd time I cannot stay with him. He is not in my network and next year my insurance is changing (for the worse). He and his partner came recommended to me by my primary care and I really trust my primary care.

    I guess I'm just disappointed and questioning my prior decisions . . .as anyone would.

    Again, thank you for taking the time to reply and give me more to think about.
  • I talked to my company doctor which was helpful. He gave me a 2 neuro surgeons to get advice from. In addition, he said that he would use a neuro surgeon for the 2nd surgery.

    He's going to meet with me on Monday to help me work with the Cleveland Clinic for them to look at my images to ensure that the redo is the right option (which I suspect it is).

    I also met a neuro surgeon today for a 2nd opinion. Unfortunately after this month he is no longer in network. But he was good to speak with.

    Next steps
    - find Orthopedic spine specialist and neuro surgeon that are in network - > going to one tomorrow
    - get 2nd opinion from neuro surgeon -> getting there
    - settle on a hospital

    I realized that I have to leave the hospital I feel safest at because there are no neuro surgeons in network after this month operating out of that hospital. This stinks but I have to trust that I need to build a relationship with a quality neuro surgeon that is in network b/c while I'm hopeful this surgery is better, I am also realistic in knowing I need a spine doctor to follow my case.

    Wish me luck. I hope to have a final plan before Thanksgiving.
  • you're doing a good job of getting your ducks in a row. I hope it all works out well for you.


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I had a micro done at L5-S1. It lasted 7 weeks. It took being slammed by a tractor trailer on the interstate to ruin it. Other than that it was working. It really is hit or miss from what I can tell. You very well could have done something as simple as roll out of bed wrong the first week. You never really know. You must be absolutely and anal about the 1st weeks. Especially on round 2. Since your chance to re-herniate just went up.

    The choice of doing another micro you need to make with your surgeon. How bad was the disc in the first place? That is a really big question you need to understand. Some surgeons want to do them because it is easy money. It most certainly is the least invasive and should be your first consideration.

    After analysing my situation. With 3 surgeons opinions. I did not go back to the original surgeon. I picked the 3rd one. Based on the amount of DDD in the disc, the size of the tear, the amount of spacing left after the 1st micro. It made no sense to me to do another micro or laminectomy. There just wasn't enough left to save. The car crash opened the tear back up. The disc literally died. On a contrast MRI it was about all black. So no liquid left in it. My pain was getting worse and pills didn't help. Beyond being doped up in narcotics.

    I'm not telling you to get a fusion. Weigh in the facts and your goals and expectations.

  • Ive had two unsuccessful operations on my latest injury, an L5/S1 and L4/L5 herniation 18 months ago. I never felt a re-herniation, I never felt better after the surgeries, so I dont know what happened. I just got a February 2nd date for a 2-level interbody fusion at both levels. My previous surgeon sent me to the best hospital in my state and to one of the best and experienced spine surgeons, to evaluate me and decide on what to do next, which is the fusion.

    My new MRI results show my L5/S1 is still herniated and impinging on my left S1 nerve root. The S1 nerve root is enlarged. My L4/L5 is bulged and I also have moderate spinal canal stenosis at the level.

    The MRI, besides enhancing scar tissue, looks nearly the same as the ones before my last two operations making me wonder what happened. With the fusion I know the L5/S1 disc will atleast be taken off the S1 nerve which I believe causes most my pain. I do worry about permanent damage and a little about scar tissue. Ive had a total of 4 operations on my lower spine. My pain today is the same as when this first happened. Im 30 years old.

    As with your situation, Im not sure what I would do. I maybe would look at getting a new surgeon, I had the same surgeon on both my failed operations. Ive had three lower back injuries at different times in my life that all needed surgery. The first time I was 14 years old and dont remember well, but the last two I felt the herniation occur and it was very obvious. That makes me question these supposed re-hernations and wonder if the surgeon was just unsuccessful. But after surgery herniation may be dfferent and not be as obviously felt. As I said, my MRI's look the same. You will get a more honest opinion from a different surgeon who can compare MRI's.

    After maybe 2 and for sure 3 herniations at the same disc I would get a fusion done.
  • Thank you very much.
    It's been a hectic few days but I'm feeling empowered.

    In addition to the above.
    Neuro Surgeon 1: Indicated he would retry the surgery but to know the disc isn't in the best shape and the re-herniation was large. Found out he can't do the surgery b/c he won't take my insurance after November. This was good in a way. He said he'd highly recommend a neuro surgeon do the 2nd surgery but that he trusted my prior doctor.

    Because I had to find an in-network doctor, I went back to the group that saw me after ER visit. Neuro surgeon's schedule is busy but met with Ortho Spine guy (very dry but found I got the MOST information from him). He told me that it was hard to believe the herniation was a fragment left behind b/c it is very large. He also told me the disc doesn't look good and gave me the risks of trying another surgery vs. doing a fusion. He explained that if the nerve takes another sharp hit, it may not recover.

    He took x-rays. The disc space is less than 1/2 of my other discs and is poor form. He told me that if I experience another herniation the vertabrae may 'collapse' on eachother and guillotine the nerve which will result in permanent damage. He said I have to do something b/c the nerve is still severly compressed. His opinion was fusion but told me to get one more opinion.

    I go next week to another ortho spine person (his neuro surgeon partner is highly recommended but can't see me so his partner will see me).

    I also found a recommended Neuro Surgeon out of a prestigious hospital. I doubt my insurance will pay for this visit but I'm calling him anyhow and will pay out of pocket if needed (my husband wants me to get all the information possible).

    Based on what I have seen and the risks, I am really torn b/c I know both come with their own challenges. I'm leaning toward fusion but will see what the doctors say next week.

    I have had back pain for years. There is a slight chance I re-herniated it in week 2 b/c I do remember losing my balance (tripped) but I never fell and felt I stayed fairly stable) but there's a lot of visible evidence that this disc is bad.

    I will keep you updated and may ask for more advice. I know no one is a doctor but it is good to understand how others make their decisions.

    My story:
    - bad back for years. Suffered sciatic nerve pain on/off since senior year college (about 18 years)
    - Xrays show DDD in upper back taken about 7 years ago.
    - quick on-set of the large herniation in August
    - never got relief from surgery that I remember
    - nerve has been compressed for 3 months so the clock is ticking
    - 2nd herniation is LARGE and while there is no way to know if it was a piece left behind, the size indicates it is unlikely
    - structure of bone is not good. The anterior (?sp) is really close compared to outer part (it looks like < if I had to pick a keyboard character)
    - x-ray shows the space b/t vertabrae is about 1/4 the space that the other discs have

    Thank you all for your experience on how you came to your decisions. I'm taking 1 more week to gather information. I'm very nervous about the next surgery regardless of which one I pick b/c another microdiscectomy is no guarantee and a fusion is a bigger procedure.

    I am just so thankful I found this board and that I have a very supportive family.
  • If I were you, I think I might spend a bit more time thinking about fusion, doing some more research and talking to the surgeons about what type of fusion procedure they could do for you.

    Also, has anyone mentioned getting the disc replaced? Oh I see it is L5-S1...I frankly haven't done a lot of research on ADR because I was never a candidate. With L5-S1, you might want to look into the AxiaLIF procedure -- (http://www.trans1.com/). Also look at the newest ways some docs are doing a minimally invasive fusion.

    I don't usually ever give an opinion, but in your case, and considering the location of the herniation, and knowing that it is a matter of time before you will require a fusion, I would think long and hard about doing it now if I were you. You won't notice a difference in movement as the L5-S1 level is pretty much fused anyway to the rest of the sacral vertebrae (ie., there is practically no movement, compared to any of the other lumbar vertebrae). Personally I think the younger you are and the less wear and tear there is on that S1 nerve, the better. The longer you wait, there is a chance that the nerve will suffer further damage.

    Of course, as you well know, there are no guarantees when it comes to any kind of back surgery. But the odds are not going to increase by waiting longer.

    It is a big decision. You are smart to take your time, to talk to a variety of spinal specialists and see where it leads you.

    Good luck with your decision.
  • Can I PM you?
    So far you have really helped guide me on things to research.

    I was trying to figure out all these achroymns (ALIF, PLIF, etc) and finally realized there are a ton of different procedures.

    I didn't even realize that with last doctor. He was the one that told me to get another opinion so he probably figured that I'd walk away, do some research, and then come back.

    What is ADR?
    I will read the link you sent me too . . I haven't found information on this yet.

    Gosh - thank you so much just for helping me figure out what to research.
  • SpineAZSpineAZ WiscPosts: 1,084
    Do you have the option of going out of network? My neck surgeon was out of network for my second surgery (in network for my first) and while he cost a bit more as an out of network provider - at the time he was worth it and I could afford it back then.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Of course you may PM me. I'm glad if I can help.

    Here is a link that will give you a little more to think about! It is alternatives to spinal fusion....just to further confuse things!!


    Some of these things are pretty cutting edge, and many doctors are not yet trained in doing these procedures.

    I can remember at certain points in my spine journey, I would literally spend the entire day and part of the night on the computer reading articles, medical journals, forums, etc. I knew nothing at the beginning either...so don't be discouraged. If you have the patience to read, and the desire to learn, you too will know more day by day!

    Here's a basic link to fusion if you haven't read it yet:


    You didn't have anything else to do Thanksgiving weekend, did you???
  • I can go out of network and actually did for the 1st surgery. Unfortunately my insurance is changing drastically in 2010 and it no longer is an affordable option. My insurance is actually horrendous in 2010 and I work for a large corporation. I would like to get the surgery done before year end from a cost perspective but also b/c the nerve has been very severely compressed for 3 months now and the clock is ticking on permanent damage. That being said, I'm taking a little time to research everything so if I have to wait until 2010, I will suck it up on the cost but even in network the cost is ridiculous for me due to plan changes.

    Thanks for thought.

    However, if there is a less invasive procedure that has promise of better results, I may consider out-of-network and/or speak to my provider to see how to get the surgery I want covered.
  • Thank you for the articles.
    Just getting started on them now.

    As for Thanksgiving, sadly my boss thinks I'll be doing work for him. My co-worker and friend reminded me not to waste my time trying to explain to him what I'm going through. Luckily my HR folks understand and told me to do whatever I have to do to make a decision regarding my health.

    So yes, Thanksgiving will be cooking freezer friendly food and reading and talking with my husband. He's going to go with me this week to the doctors as well.

    I'll read these and then PM you if I have questions.
    I just want to be sure I ask enough questions at the doctors.

    Everyone here has been helpful.
  • Many surgeons prefer inter-body fusion over ADR. Inter-body is when the dsic is the major problem and it is removed.

    Sometimes minimally invasive options arent available, such as in cases where multiple levels are being fused or when there has been previous surgery's and there will be more scar tissue than normal to deal with. In those cases the surgeon may have to open up the back, as with my upcoming fusion.

    As far as going through with a fusion, it is a very big decision and should be thought about. If you cant live with the problem though and have to go through with surgery, a fusion might be the better idea if it is on a disc that has re-herniated, because of the high chance it could herniate again. A lot of times the policy is to fuse after 2 re-herniations and some surgeons will recommend it only after 1 re-herniation.
  • I spoke to a nurse who is in a very similar situation that I'm in. L5-S1 herniation, microdiscectomy, then reherniation. She is going for a 2nd microdiscectomy but was told if it happens again, she has to seriously consider fusion. She, however, did get a few weeks relief before the disc herniated again.

    I am very scared about a fusion of any sort. I'm also scared about permanent nerve damage if the vertabrae collapse. I have very little space b/t them at that level.

    No wonder people struggle. The pain is bad enough but knowing a clock is ticking on the nerve adds to the stress but yet there is SO much information that there isn't enough time to get through it and do all the research. Sounds like there are less invasive fusions and ADR is something I should ask about.

    The true definition of hind-sight being 20/20 is staring me in the face.
  • Because I know how scary fusion is. I was terrified of any surgery really, as I had never even been in the hospital much less had major surgery.

    Both my L4-5 and L5-S1 disc had extensive herniations, and I was in excruciating pain no matter what. I couldn't even walk to the bathroom without a cane, and some mental preparation beforehand. My Dr gave me 2 options. The first was microdiscectomy which would probably give me relief from my leg pain, but probably not my back pain, and it wouldn't be a matter of IF I re-herniated, but WHEN. My second option was fusion, which of course would give me significant if not total relief from my leg and back pain as the offending discs and herniations would be completely removed. So even though I am only 30 yrs old, I went for the one big surgery, rather than multiples over time.

    And it was the best decision I could've made. On Oct 5th I had an open TLIf L4-S1. I'm now 7 weeks into recovery and feel great! I have ZERO leg pain, and ZERO back pain. And I only really had pain at the incision site for the first 7-10 days, and by week 2 it was gone and I just felt tightness at the incision, not even discomfort. I finished weaning myself off of all pain meds about a week ago, and was only taking the meds to avoid withdrawals.

    I went back to work at week 4 of my recovery (Dr actually released me at week 2 because I have an office job, but I chose to take 2 more weeks so I could get as much of my strength back as possible.) and have been driving since week 3. I'm smart about what I do and don't do, but really feel there is little I can't do (aside from the obvious lifting restrictions, etc.) I've also been walking since the day after surgery and am up to 5-7 miles a day.

    So many have read/heard horror stories about fusion so I just wanted to chime in as someone who has had a good experience, and is doing well.

  • Theres a way to really fiind out if you are ready for a fusion or not. If you can be talked out of the fusion than you shouldnt go through with it. If there are strong doubts you shouldnt do it. Thats something only the patient knows. Many conservative surgeons will even try to scare or talk a patient out of the operation just to see if they really need it or are ready for it. If you have a good surgeon you have to trust he knows what he is doing with what surgery he thinks is the proper one to perform.

    n the TS's case I think a minimally invasive fusion would be an option, its at 1 level and theres only one past operation,. But the MRI also factors in the decision and something on the MRI may steer the surgeon away from a MI option.
  • Excellent post! I agree with everything you stated. Can you tell me what your pain is like and where it is? You are waiting for a fusion so I was wondering about your symptoms specifically ( ie any tingling/burning/numbness).

  • Thank you for a positive story.
    My husband has been great and tries to tell me that people with success stories may not post here. Ah, I'm glad he is wrong.

    I am able to walk to the bathroom but making it through the day is tough. If I work a full day (office job) I come home completely exhausted and fatigued and in pain. I have to go straight to bed to lay flat down and am afraid to move. Stairs are also an issue.

    I realize that I should have researched my prior surgery more b/c I might have been given better advice if more tests were conducted.

    The neuro surgeon I'm hoping to see has already asked for my records, history, surgical report so that he's prepared when I go into his office. Their office even asked what tests I've had to be sure that I have all the facts before making a decision.

    I'm so grateful to all of those that have responded. It is very helpful in that I'm able to understand how everyone has made their decisions and ensure I'm considering many factors.
  • and I'm realizing that my situation is similar to yours. I never felt the re-herniation but I never got any relief from my first surgery. I even suspect that the doctor left fragment behind, however, with how large the 2nd herniation is, it's hard to believe that to be the case.

    I should have logged my progress daily but was told to look at progress weekly with backs. If I logged it daily, I wonder if I could pinpoint when the reherniation happened.

    I am not going to same doctor. He is out of network and if this proceeds, he is not a neurosurgeon.

    I met a young neurosurgeon who knows my prior doctor and agreed withe revision surgery. But he can't operate on me. As a result, I was able to get him to say I should be seeing a neurosurgeon.

    I met an Ortho Spine dr who works with the neurosurgeon who saw me after my ER visit. He recommended fusion and said to get another opinion.

    I have an appt with another OrthoSpine dr (who works with a neuro surgeon that 5 people have recommended but the neuro surgeon can't see me for several weeks).

    And, finally today, was able to find a neurosurgeon from a reputable hospital insitution in my area and he will see me, just waiting to get a call on when. I am hopeful that my case inspires him to see me sooner rather than later.

    Oh - I'm crazy but through work, I can submit my records to the Cleveland Clinic Spine group to get an opinion from them too (since it's a free benefit through work, I figure why not).

    The holidays make it tough but I realize that I need to collect information.

    You pose an interesting challenge about whether or not I'm ready for it. I'm not sure but after I meet with the plethura of doctors and read everything there is to read, I hope to have my answer.

    I'm conservative by nature but I also wonder if I should have had the fusion to begin with b/c I was immobile for 12+ hours when I herniated the disc.

    I hope that one of the doctors above is the doctor I generally trust.

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