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Help! L4 herniated disc...did I make the right decision??

FaraFFara Posts: 16
Hi everyone,

Was wondering if someone might be able to shed some light on my situation. Back in November I experienced the worst pan in my leg that I had ever had. After the onset of pain, my leg became extremly weak and parts of it went numb.After having several tests done including MRI, CT Scan, X-rays it turns out that I have a far lateral herniated disc at L4-L5 and a pars fracture at S1. They said the fracture is unrelated to the leg pain I am feeling and looks like it happened when I was a child. I have never been one to have back pain so when this happened, it came as a complete shock. Once my leg went numb and weak, I had no pain. No back pain, no leg pain... nothing. I was just stuck with a weak leg accompanied with numbness. The doctors couldn't understand why this was so. My first Dr. recommended surgery as soon as he saw me and said that if I didn't have it I could have permanent nerve damage. So I decided to get a 2nd opinion. This new dr. advised against surgery for now and wanted to see if I would improve on my own. So I waited. It is now 3 months later and yes, my leg has improved but only to about 90-95%.

The 2nd opinion said that he doesn't think that surgery would benefit me and because I was not in any pain, he was hesitant to give me the surgery.

I just went in to get an EMG with my neurologist who saw me at my worst and who wanted me to have the surgery as well. After the test, he said that my results were not normal and my leg was not ok, but that he didn't feel that surgery would benefit me at this point.

My question now is, does this mean that I will forever have to live with this weak and numb leg?? Do I have permanent nerve damage? Did I wait too long? Will I ever have 100% strength in my leg? Will physical therapy help me? (sorry for all the questions!)

All I keep thinking now is how I regret not just getting the surgery and I am starting to feel really sad at the thought of not having full mobility in my leg. I am a very active person so this makes me pretty upset. They surgery wasn't going to gurantee me a 100% recovery, but still, it may have increased my chances of a fulll recovery. Did I make the right decision by listening to the conservative dr. and try to wait this out?



  • are having trouble.

    Ok, so let's start with the "what if" part. It really is pointless torturing yourself on what if's. You will never know if surgery would have been successful and I hear people here, always talk about using conservative measures first before jumping into surgery as you can never undo a fusion. It's possible that you could have ended up being worse, but you'll never know. So put that behind you and focus on now.
    I have to tell you 90-95% is pretty good.If you didn't improve from ther, i'll bet given time you'll learn to adapt and lead a normal and prosperous life.
    Right now you are feeling sad for what you have lost, perhaps if you read some posts from others here you will learn to be happy for what you have. Like no pain, no wheelchair, no heavy painkillers, no walking frames, being able to walk outside in the fresh air without worry that you'll be in bed for day's after. I hope I don't sound like i'm trying to diminish what your feeling, I merely want to point out that there are many people here who would give their left limb to be in your position.
    Are you doing intensive physio to get the rest of your strength back? What are you doing for yourself to get that leg working 100% again?
    Others will be able to give you better insight as to how nerves work and can regenerate, given that yours already has to a large extent it may be that last 10% will come back given time.
    Please try to see that glass half full, because you do have a lot to be thankful for.
    Take care
  • I don't believe any of us can give you the answers you seek. Performing surgery is almost always a judgment call. The interesting thing about back or neck surgery is that it is almost always considered elective with a couple exceptions...one being bladder and/or bowel involvement. Then it is often considered a medical emergency and surgery is often done right away.

    "Permanent nerve damage" is a term without a specific meaning. It is difficult to say what comprises "permanent" damage, or when and why it occurs. I know people from this board who supposedly had permanent damage that occurred in as little as a number of weeks, and others have had a badly compressed nerve for years, and end up without permanent damage.

    I must say, if I understand what you are saying about the leg being numb without there being any pain, I do not ever recall hearing anyone else say that. It is not unusual to not have back pain, but when a foot or leg is numb, it is accompanied by nerve pain in the leg or foot. If your leg has improved to 95% and is only lacking 5% I'd say you are doing very well. That's probably about as good as you would have ended up with surgery.

    If you have concerns, get another opiniong from a fellowship-trained orthopedic spine surgeon or a spine neurosurgeon. Each doctor will have his or her own opinion. All you can do is learn as much as you can about your situation and try to evaluate what each doctor tells you.

    Things are rarely static. I would think your leg will either get better or worse...so perhaps that will influence what you do next. Worrying about a step you did not take is not productive.

    Good luck.
  • To be honest from what I heard about an EMG test I do not believe it to be the best indicator of your situation. Infact most doctors I know pretty much use it mostly to indicate how much pain you are in. In terms of strength only you know how much you loss. Whenever I go to doctors they all use physical tests like walking on your toes and heels and than pushing up your leg while they push it down. It is very subjective as I find some doctors use little to no force. You are the only one who knows.

    As far as the loss of the 5% that is really not much in your case. I would do as gweenie suggested about getting another doctor and get another opinion based on your MRI. I find it hard to believe in only 3 mos you can have long term nerve damage. The fact that you have no pain and just numbness makes me think most doctors will not do surgery. Also as you read many stories on this board surgery is not an option you want to do in anycase but you must do. As my doctor told me the boig question is "How much does it interfere with your life?" I love cycling but now can not but should I get surgery over it...no way but how about the fact that I can not travel and my job needs it...probably than.

  • Thanks for responding Kylie and brining me back to reality. You are totally right in that I need to be thankful for what I have and make the best of the situation.

    I just started physical therapy and tomorrow will be my second session. For now my physical therapist is having me do leg strengthing lifts and ab exercises to strengthen my core. I am going twice a week. My docotr also recommended that I use the eliptical since there is no direct impact on my back as opposed to runing and since I have a fracture at S1, this is what I need to do. Although some days are worse than others and my leg can be very weak one day and strong the next, I do think that gaining full strength might just be possible. I live in a town where you need to walk everywhere (NYC) so at times I get very frustrated at not being able to walk a few blocks without being tired or not being able to walk up subways stairs. I guess the fact that I am even dealing with this is still a shock to me. Thinking the glass is half full is the way that I need to look at things and I thank you for bringing this to my attention. It helps when someone else opens your eyes to what really is.
  • Thanks or reading my post and responding.

    I agree about strength being subjective. I have already gone to, 2 from orthopedic suregeons, 1 neurosurgeon and 1 neurologist. I am not sure if I would benefit from another opinion. Do you? When I was at my worst, the NS and my neurologist suggested surgery and said this would be the best option in getting full mobility and strength. When I go a 2nd opinion, he said that he wouldn't suggest surgery just yet and wanted me to wait and see if I improve... so I waited. My improvement was slight but he said that if I am improving then wait a little longer and see if I improve more. He concluded that surgery wouldn't benefit me and if it was just the numbness that wa bothering me, it would improve.

    I then got a 3rd opinion and he said that he couldn't really tell a difference in strenth but if I felt weak then I should have the suregery. He also said that if I was on the fence about it, then I should have an EMG. My neurologist from day one said that an EMG was pointless in my case, but after 3 months, I went ahead and did it anyway. His diagnosis was that he didn't think suregery would benefit me at this point.

    When I first had severe weakness and numbness I was put on a very high dosage of oral steroids which I think helped me a lot. It has been a slow process, but I hope that with PT and hard work, I can regain all my strength back and be able to have the active life I am used to living.

  • Fara said:
    Thanks for responding Kylie and brining me back to reality. You are totally right in that I need to be thankful for what I have and make the best of the situation.
    Hi Fara,
    You're very welcome and don't worry I needed the same wake up call when I first came here too.
    I read post after post of people who were in a much worse situation than me and it helped to put things in perspective for me.
    You do have a lot to be thankful for and if the surgeon had difficulty telling any weakness then I really believe you have a good chance with PT and time of getting back to normal.
    Even in hindsight, I believe you made the right choice as you could well have ended up worse after fusion, like so many here have.
    There are a lot of people who wish they took the conservative route rather than surgery.
    But what is done is done and should be left where it belongs, in the past. Look forward to your future as I think you are going to have a very happy one, if you let yourself.
  • Hi Gwennie,

    All this is new to me so I didn't really understand what was going on and tried my best to educate myself and I am still tryin to learn as much as I can. Each doctor I have visited with has brought something different to the table and I have learned something new from each. I had one dr. tell me nerve damage is very possible and then another tell me that there is no such thing, so you can imagine the confusion I was experiencing which is why I didn't rush into the suregery. The more dr.'s I visit, the more I learn that each one is different and will approach things in their own way and that it's up to me to decide who I think is right, which was very hard to do. They do this for a living, and I just didn't feel comfortable making a decision based on so many different opinions that were presented to me.

    Some days my leg feels great and others I feel really terrible and weak. I am now having a little back pain, but it's more of an ache and discomfort. As for my leg, it doesn't really hurt as much as feel asleep with tingles. Last night I was having pain in my foot but this could be from the EMG I had a few days ago and the physical therapy. My leg just feels tired and heavy from being over worked. If I do feel pain, its an ache or throbbing. I was having sharp pains in my quad but I haven't had that type of pain in months.

    Hopefully with more exercise my leg will get stronger and not get tired so quickly.

    I am here now and I know I have to make the best of my situation. One day at a time...

  • I really think that is the best course of action IMHO. I feel that in most cases of herniated discs the real breaking point seems to be about 12 mos. If after 12 mos or more you feel you have gotten worse or feel that your quality of life is too low than I believe surgery is an option. Ofcourse there are cases where surgery is needed right away but IMHO you do not sound like one.

    Surgery should be the last option when all other options have been exploited with little to no results. Also you have to weight the benefits and really be sure as all surgeries come with risk.

    As far as number of doctors that really comes down to have you found a doctor who you really trust that just makes sense to you. Meaning he explains it in a way you understand and you agree with his course of action. If you have than I would not go further as you will probably get different courses of action which may confuse you in the long run.

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