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Well, it's official

vermithraxvvermithrax Posts: 21
My back is screwed up.

Went and got an MRI. Looks like my L5-S1 is pretty well herniated/torn open. My doctor (orthopedic surgeon) said he wants to try one epidural injection, and after that, sees a microdiscectomy in my future. Questions for you all:

1. What is the point in getting the ESI? If I'm lucky, it will give me some, possibly short term relief? Why bother? I'll have to pay it out of pocket, since my insurance deductible is $2500. How much will it cost me? Is it even worth it?

2. Physical therapy was ruled out. Doctor said it is a waste of time and money. Is this true? I have heard great success stories with PT. He did say however there is a chance the extrusion may be reabsorbed over time. Has this ever happened to anyone?

3. I am going to another doctor (Neurosurgeon) for a second opinion. If surgery is unavoidable, should I choose him to do it or the Ortho?

4. How painful is an ESI. I'm a huge wuss and pretty terrified of the pain.

5. Anything I need to know going into all of this form anyone who has been there.

I'm really afraid. I've never had any other health problem and this is a lot to take in. Thanks all.


  • I know what you mean, I never had any health problems before my sciatica either. Right now I'm housebound, till I can get some medication.

    As for surgery vs an injection, I'm also deciding between them right now.

    I'm just replying to give you my opinion of PT. I can understand why the doc says it's a waste. I went to a very good PT, at a clinic with a good rep, and they only accept patients on referral. But the PT consisted mostly of exercises to do on my own. The only thing they did differently was try some traction on their apparatus, but it didn't help. Other than that they just have me lie face down, and raise one end of the table a few times, that's it. The exercises they gave me did help, mostly just the McKenzie one. But did I have to spend that much money for that? I don't go anymore - they said just do the exercises at home now.

    Apparently those cheap places where they just give you electro-stimulation, and ultrasound, etc, aren't worth it- I was told it just affects the skin, like using heating pad. Anyway that's my 2 cents.

    discectomy in June 2010 - success! No sciatic pain, just some remaining numbness in foot. And I get charlie horses a lot.
  • The doctor may want to do do the ESI as a way of testing the pain generator before the Micro D. Mine were selective nerve root blocks and ran about $1400 each not including the hospital OR where they were performed.

    Second Opinion Option.
    The MD that was doing my injections also said we would have a Micro D. I am glad I got a second opinion becuase a Micro D would have been a huge waste of time, pain, and Money! There was litterally no disc left and he did not look for the problem- the only test I had had at that point was 1 MRI, no xrays.

    Hang in there,


  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,732
    Welcome to spine health, vermithrax.
    I went for the ESI's Mostly because I'm a wimp too! And many other reasons. I was not financially ready to take the chance on surgery way back then. And the surgery was very invasive and did not have a good enough success ratio for me. I wanted to buy time to work and prepare financially and get my kids through college. And most of all I really hoped that technology would get much better.
    The end result was, the ESI's gave me 4 + more years before I HAD to have surgery.
    They did not hurt that bad and I was medicated. For me, they were successful until the abusive lifestyle I led, degenerated them to far for the ESI's to work any longer. They don't work for everyone as well as others. So it may be a "crap shoot" But a lot of technology can happen in 4 + yrs. and with the technology comes better percentages for the patient to have a successful surgery.
    Second opinions are for more valuable than I thought back then!
    Neuro. vs. ortho. I will pick the ortho.but there would be some who disagree.
    By the way it took 3 ESI's a yr. for me.
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • Hi,

    I think you'll get good advice but at the end of the day you have to determine "what do YOU think is right" after getting some opinions and researching the success of each option.

    I'm conservative as far as surgery goes. Maybe a whimp but maybe because I was brought up realizing that there are many "cut" happy doctors and that surgery should be the last option. This is even more true for back surgery.

    I am also 40 (ok just turned 41) and felt that I wouldn't be facing such a decision until much later in life. I was fit, active, healthy, etc. I got caught off guard.

    As for treatment it depends on your situation.
    First go around...doctors told me ESI and PT was a waste of time and the clock was ticking on my nerve. 3 doctors agreed. However, if I opted to delay surgery, they would have tried the ESI and to this day, I am not sure if I made the right decision but I had an independent spine group look at my records and they were in agreement my herniated mass was so large that it was highly unlikely it would dry out enough.

    I say 2nd opinion.
    As for which surgeon is better? You'll get different opinions but I had an OrthoSpine the 1st time but a neuro surgeon the 2nd time. I believe it's up to you on who you feel comfortable with but I suspect you'll hear that a Fellowship Trained spine ortho or neuro is the way to go.

    I have to admit...not sure I have the right answer but on my revision, I opted for neurosurgeon b/c he has more experience moving nerves around and worrying about scar tissue.

    what to consider?
    1- how bad is your pain on 1-10?
    2 - how long have you had this pain?
    3 - do you have any loss of feeling? if so, how bad? If you have lost feeling in the groin (perineum) the nerve, from what I understand, is pretty compressed
    4 - have you lost foot/leg strength? Foot drop?
    5 - did you herniate a large piece or small piece? If small, you can try to wait to see if your body reabsorbe the piece (or it dries out just enough to come off the nerve). Actually, yes, this can happen. It may not dry out completely but just 2mm will probably allow it to come off the nerve. I believe someone just posted under leg pain (the post title is 1 year 23 days) and he is doing better

    My thought is to try conservative because you can always go forward, you can't go backward. But have time limits. I believe most doctors will use conservative treatment for 3-4 months but if there is NO improvement they will push for surgery b/c they are unsure when permanent nerve damage occurs.

    ok, that was a lot of information. not sure how helpful it was.

  • One more thing...don't feel you need to stop at 2 opinions. My 1st microD failed (either I reherniated or they left a 2nd piece behind). Before 2nd surgery, I got 7 opinions and a remote opinion from specialists. There were 2 schools of thought on revision vs. fusion. And the surgeon I chose actually even thought there was a slim chance the 2nd hernation might dry out just enough.

    He showed me my MRI.
    The initial one...couldn't see the sciatic nerve.
    The follow up MRI...you could make out the sciatic nerve which is why we know it was a 2nd piece of material.

    So...don't feel 2 opinions must = right.
    Doctors will tell you they are human and will give you their best recommendation based on their experience.

  • Went to the Spine surgeon this past Saturday. He looked at my MRI and said I also have a herniation at L4-L5 that the Orthopedist missed entirely. So now I have two herniated disks at L4-L5 and L5-S1. One to the left and one to the right. The only one that really bothers me is the one to the left at L5-S1.

    He wants me to get a series of 3 ESIs and undergo Physical therapy. His idea of PT is using his DRX 9000 or Vax-D machine. Not sure how effective these are, but I know it is expensive. If non of this works, he recommends Microdiscetomy.

    $700 for each injection, plus probably $3000 for the machine. Have no idea how I will pay for all of this. My deductible is $2000, so I guess after all of this, at least my insurance will kick in.

    SUpposed to go in for an injection this week sometime. He is doing it without sedation, just numbing the area first. Can anyone tell me how painful this will be? Any tips on making it more effective? I am horrified by needles and injections.
  • I would call and ask if he's going to use a sedative like valium or something and if not would ask for a prescription for something to relax you. I also took a pain pill an hour before the procedure. I did deep breathing during the ESI and it helped. It's taken me 3 PM Drs to find a gentle hand and my last 6th ESI was painless. Use ice afterwards to stop the discomfort from the injections site. I hope you get good results from your ESI. Take care. 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
  • Hi,

    As people above have stated you will have to weigh all available data and then decide. As a general rule they will want to exhaust all non-surgical options before jumping into surgery. They usually want you to try some physio first. I can't speak for everyone but that made things much worse, much faster for me. Then they will want to try at least a couple of shots. I had 2 sets of shots and a selective nerve root block before I caved in and opted for the microdiscectomy. The shots worked somewhat for a couple months for me but in the end my L5-S1 rupture was just too big to heal on its own. I had all of my shots with no sedation. Only one hurt badly enough to bring tears to my eyes for a minute. But I had a pain level of 9 out of 10 from how badly my nerves were being crushed, so they really could not have hurt me much more anyway! The microdiscectomy wasn't really very painful either, and more than half of the pre-surgery pain was gone already when I woke up. The main thing to remember is that the clock is ticking. Most will tell you that if nerves are crushed for more than 6 months there can be permanent damage. All of my physio and shots took over 6 months before they told me that surgery was my only remaining option. As a result I have a certain amount of permanent nerve damage. It is not too bad and I can definitely live with it in comparison to the 9 level pain!
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