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L5-S1 Herniation: Surgery before 6 weeks of conservative treatment?

L5S1HerniationLL5S1Herniation Posts: 4
edited 06/11/2012 - 8:54 AM in Back Surgery and Neck Surgery
I was recently diagnosed with L5-S1 disk herniation on left side with impingement of the S1 nerve root confirmed by MRI. My symptoms are pretty classic for S1 radiculopathy with left buttock, hamstring and calf pain, numbness along the lateral side of my foot, and weakness of my calf muscle. I cannot stand on the toes on my left foot, whereas I can easily stand on the toes of my right foot. These symptoms have been present for about 3 weeks now. When these symptoms first appeared, pain was the primary symptom, but now it is weakness. The pain was initially severe due to muscle spasms and I was given morphine, valium and baclofen in the hospital. Initially I could not walk or even stand. Now I can walk several blocks before getting muscle cramps, but my calf weakness is very prominent and I walk with a limp. I am pretty sure that I need surgery, but I haven't been able to get an appointment to even see an orthopedic surgeon until 2 weeks from now. I am wondering whether I should call the surgeon's office and ask to be seen earlier just to get my foot in the door and any necessary conservative treatment rolling before surgery. I know the standard course is a 6 week trial of conservative treatment prior to surgery, but my muscle weakness seems to be not getting better and common sense seems to me that the sooner I can relieve the pressure on my S1 nerve root the less likely I am to have permanent nerve damage. Has anyone had surgery before 6 weeks due to persistent muscle weakness? I have not been able to even see a surgeon to ask this question so I am asking it on this forum. Thanks!


  • Hi...6 weeks is a guideline. I was told 3-4 months but with my herniation, I had significant numbness & loss of strength. We tried steroids so maybe your GP can prescribe a medrol pack or prednisone to see if it helps. If it does, there's a good chance other conservative treatment willl work.

    I would definitely try to get an earlier appointment as well as plan time with another surgeon (e.g. 2nd opinion). It often takes a few weeks as a new patient to see the orthospine or neurosurgeons so you might want to find a 2nd opinion even before you see the first...this way you are working your time accordingly.

    As for surgery, do you know you need it or are you just assuming based on your symptoms?

    I know the exact moment when my disc herniated (annular tear) and the result of that was instant loss of feeling in the groin, buttocks, back thigh, heel to outer toe. I lost strength and ankle reflex and limped. I could NOT walk more than a block (at best) without hurting a lot. I didn't want surgery and in fact wanted to try other things. Becuase I had an ER referral, I saw one NS right away and an OrthoSpine 2nd opinion (thanks to my GP) right away. I tried conservative for only the 2-3 weeks b/c of the severity of the numbness and because of how instant my situation was. So yes, they may want to do surgery more quickly but I wouldn't worry about an extra 2 weeks waiting to see the doctor.

    Did they say you can take advil or ibruprofin?
  • I agree with DNice to question if you should be taking Advil. I had a similar experience and did get into see a surgeon two days after a hospitalization. He felt I needed emergency surgery and being on the Advil was an issue. I wish I had not taken the Advil from that hospitalization.

    Only you can decide if conservative treatment is the best route. I was not able to move and had multiple other issues going on. I do not believe I could have tolerated any longer with conservative treatment.

    Best of luck dealing with this.
  • I'm not having any loss of sensation in my groin area, nor any bladder or bowel incontinence, so I guess that's why I wasn't referred for immediate surgery while in the hospital. Right now the pain is tolerable when I am just relaxing at home, but I do have significant pain and weakness when I walk to the store a few blocks away. The biggest problem is that I am not able to work, drive, or sit for long periods of time and I would like to get that fixed as soon as possible, rather than just waiting around for 4 weeks to see an orthopedic surgeon for an initial visit. I made an appointment to see another orthopedic surgeon this Wednesday, a week before my other appointment, so hopefully the ball will get rolling with regard to PT or stopping the NSAIDS if it turns out I need surgery. As you mentioned, I will definitely be getting a 2nd opinion regardless so now I have both set up. I'm not sure at this point which is my 1st and which is my 2nd opinion, but meeting with the surgeons will help me decide.
  • I just wanted to give an update:

    I ended up calling a different orthopedic surgeon and getting an appointment within 2 days. He looked at my MRI, asked me about my symptoms, did a physical exam, and basically said that he could do the surgery the following day if I wanted. I opted to wait a week to be sure that the symptoms were not improving, but I also did not want to delay the surgery much longer to try physical therapy, epidurals, etc. So I had the microdiscetomy last week and I am very glad I decided to go through with it. I am now able to walk without getting muscle cramps. The incisional/back pain was pretty bad on post-op day #1 and #2, but now it is almost gone. I am no longer taking percocet or nsaids. My focus now is to take it easy and allow my back to heal from the surgery, then to regain strength in my left leg through PT, and then to strengthen my core muscles to compensate for the L5-S1 disc failure so that it does not re-herniate. I still have some numbness of my left foot, which I hope will go away with time. I also have a dull ache of my calf muscle after walking that I attribute to repair of muscle fibers after 4 weeks of atrophy due to nerve impingement. I will provide some long-term follow-up as well.
  • Good to hear you doing well after your surgery. I hope the numb foot goes away with time and PT. Best wishes for your complete recovery. 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
  • Glad to hear the surgery went well. Keep taking it easy. The best thing is to walk for 10-15 mins periodically throughout the day to keep scar tissue from adhering to the nerve. And, no bending, twisting, lifting....even when you feel better, don't overdo it. Follow doctors orders.

    Best wishes in your continued recovery!!!
  • Thanks for the well-wishes and all the other stories I read on this forum. Surgery isn't a decision to make lightly, but for me it was the right one. In my case, I had an abrupt onset of symptoms and MRI showed a focal herniation on the side where I was having symptoms impinging on the S1 nerve root. I did not have any other disc problems on the MRI, so the surgery seemed like it would be pretty simple, just go in and pluck out that little piece of disc material. Were I faced with the prospect of a fusion, I would definitely give conservative treatment a try first.
  • Good to hear, take it easy for a long time, full healing takes a lot longer than it takes for symptoms to go away so that you don't reherniate.
  • Thanks for the update and good to hear you are doing better. As others have said no BLT. The more you can walk the better. Multiple short walks worked well for me at first. Soon those walks will get longer.

    Take it easy. It always takes longer to recover then you want. My surgeon said first 3 months it is easy to reherniate. It takes a long time for scar tissue to form after surgery.
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