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L5/S1 Disc Herniation

jason78jjason78 Posts: 3
edited 06/11/2012 - 8:54 AM in Lower Back Pain
Hello, I am looking for some advice from others on how to proceed with my situation. Any input is greatly appreciated. Looking to hear from anyone going through this or experts on what generally works and what does not work. I realize everyone is different but there seems to be alot of general information on this and not many secifics. Just trying to get a feel for the experiences of others.

I am 32 and I herniated my L5/S1 disc to the right side in January of 2010. Initially this was VERY painful. I was put on a Prednizone pack followed by tons of NSAIDS and light duty pain meds. After the initial injury, I was able to make a 80% or so recovery in about 6 months. This means I could walk OK again without limping and was not in constant pain. All reflexes returned except achilles. Sciatica went away for the most part.

I have since had 3 or 4 "flare-ups" where I reverted back to maybe half as bad as I was the first time. This was due to sleeping wrong twice and standing for several hours another. 2/3 times I used NSAIDS to get through it and once I got another steroid pack to help get me through it.

I have seen 2 Dr.s so far both recommended in my area. Both have said the MRI suggests I would definitely be a canidate for surgery if I had more constant pain but because it can be treated and eventually goes away, that surgery should be avoided at this time.

Generally after a "flare-up" has "healed" I have a little pain but I am basically afraid to do anything physically challenging. I cannot stand for more than 20 min or so without getting a sore back and having to sit down and rest for a few minutes. This all gets better sometimes. I have been given a precription for Celebrex which seems to help as well. It has been suggested that I have physical therapy too but have been afraid to do it to this point because I didn't want to inflame the nerve again.

I have been told there is still the option to do a nerve block and/or some injections (not sure the order)as a next step.

The right edge of my right foot is numb and has been since about a week since I herninated my disc. They have told me this may be permanent. I can live with the numbness but the pain during "flare-ups" or fear of pain has got me going crazy.

I guess my questions is, can someone really live a normal life with a hearinated disc against the sciatic nerve? Or am I going to have these kinds of problems until an injection or other action is taken?

I do not want surgery. I personally know someone who had surgery for a similiar problem and ended up WAY worse off. You also hear so many bad things about surgery. It seems like there is also a reason two Drs at the two major practices in my large city are telling me to avoid surgery.

What is generally the success with the nerve blocks or injections? Any other suggestions?



  • Your condition sounds almost exactly like mine except that my pain has been constant after my initial 'recovery'. Felt good for 4-6 weeks then started going back downhill... now I'm about 3/4 of the way to where I was last year initially and seem to stay there. I have the same pain down the leg and numbness in the foot, no reflex in ankle etc...

    I have been in physiotherapy since the beginning though I stopped for a while due to insurance. I think the exercises help a bit with strengthening the core muscles for support but it hasn't made any dramatic difference. If it has been recommended I would suggest trying it for a while, it shouldn't make it worse at least if you have a good therapist.

    I just had my MRI last week and will see the orthopedic surgeon on Monday to discuss the results (two herniated discs and facet joint degeneration). I will let you know what he has to say but I don't think he'll be recommending surgery. However I have two Aunts who had it done and came through terrific so I'm not as scared of it as many are. Best of luck to you, I hope you find some treatment that will work for you soon.
  • Don't be afraid of physical therapy, I was for a long time then finally said to hell with it and started once I was not recovering how I expected.

    T hefirst few months the recovery from physical therapy was very gradual but eventually it got better. In the beginning I didn't understand how a lot of the exercises would help and it was very hard at the beginning because I would get sore from the exercises. It eventually subsided or when I do get sore I just take a nsaid and I'm ok. Tell your therapist everything about your symptoms, they will or should know what will help you.
  • Your condition is very similar to my inital problem back in 1990. If you need to sit, by all means do it, it can save you the flare up. Or lie down if that's better. I've been known to lie down in public and too bad if people think I'm odd. Physical therapy is also worth a go (you sound like a good candidate for it), and walking can help; it helped me back then, but as always, ask your physician. Nerve blocks and epidurals were good for me at that time, especially the epidurals. I do not endorse radio frequency ablation as my own experience was horrible, and I've heard from others it also made them worse. So yes, PT approved exercise and injections when the pain lingers more than a few days sound reasonable.

    Good luck with your treatment! :)))
  • Hi, I have a huge bulging disc in the same location and today am having a flare up. There is no known cause of my disc problem (and I am 38). I had a steroid injection and it took 10 days to kick in but when it did, it was like there was never a problem in the back whatsoever! Amazing! Lasted for about 6-7 months. The only reason I haven't gotten another one is due to financial reasons. My insurance considers it surgery and right now we just can't afford it. I was taking Naproxen 500mg twice a day until it caused gastritis. Now, rest and a heating pad seem to comfort me mentally and Percocet will slightly ease it but nothing really takes the pain away. If you can afford it, the ESI is the safest route to go, though it has its risks like anything. Just make sure your physician is competent.
  • Thanks for all the replies. Just wanted to update. I am still in pretty much the same condition. I have mild back pain in the morning but it goes away once I start moving. I got a new firm mattress and that helps a lot. Other than the numbness that remains in my foot, I generally have only mild or no pain. The only exception is when I stand for hours at a time. I went to a trade show recently and was walking around for about 4 hours. There were not really places to sit so I was a little sore the next day or two but it seems to have gotten better. The tingling in the right edge of my right foot stays constant but varies in intensity. It also moves around the side of the foot.

    I had a follow up with the Dr last fall and he advised me to keep stretching and told me essentially I am "fine". I have not yet had another flare up since March 2011. I have not been "babying" my body but I have not gone on any hikes or jogs either.

    He last told me the tingling could be permanent at this point so still not worth the risk of surgery since I have good strength in that leg and foot. He said ESI would only be used if the pain comes back. To date, I have had no ESIs at all, initial injury and flare ups were treated with Prednisone and NSAIDS.

    Just trying to see if there are any other thoughts from anyone here with medical knowledge or related experience. I seem to have run across a handful of people recently that have had the surgery with successful results so that has me thinking about this all again. I am not someone who wants surgery but at this point I am not sure what to believe. I know Dr.s are being pressured to avoid surgery. I just don't know if I want to have limited physical capabilities for the rest of my life to avoid the risk of surgery. It may already be too late for me but if not, it sounds like it could be soon. Unlike other medical problems there seems to be very limited [useful] information out there for this type of injury.

    Has anyone out there made a full recovery without surgery for this type of injury? Just to be clear the disc is still touching my sciatic nerve, it did not resorb. This has been verified with MRIs Both Drs I have seen seem to think it is possible to recover. Other things I have read say that problems will always continue until the pressure is relieved (surgical removal) of disc so I am not sure what to believe.

  • I'm glad to hear you are not suffering any serious pain regularly. It is a shame to have to limit your activities but it could be so much worse. I can tell you from my experience that the disc can shrink. I had an MRI about 6 months after my initial CT scan and it showed the herniation had shrunk considerably. Unfortunately I still have alot of sciatic pain and numbness. Due to this I have been on disability for the last year and still have alot of pain on a daily basis. i take a number of medications to deal with it but it is not getting any better at this point.

    Keep doing whatever you're doing. I would avoid surgery if you are not suffering. I don't think any doctor would do surgery anyway, if you are not even in pain. Hopefully others will have some input on this as well.
  • Hi Jason,

    I had the same situation as you 7 years ago -- the same disc was affected, and at the same age. Physical therapy helped me *tremendously*. I first went to a couple of bad physical therapists but eventually found one who offered a consistent, gradual program that really, really helped me. It took about 6 months of PT, but after that I was great for about a year. After that I'd have a flare up about once a year, then I'd go back to the same physical therapist for a month or two of treatment and I'd be fine for the rest of the year.

    This is just my story -- some people don't have recurring flare ups and just need a couple of months of PT.

    Eventually my pain got worse and PT couldn't help me anymore, so I just had surgery a month ago. However, when I was in your shoes my doctors told me the same thing: that surgery is a last resort and if I could manage the pain with PT and by going to a Pain Managment doc for meds, then that was the best treatment.

    Good luck, and let us know what you decide to do!
  • I would get several opinions from another Orthosurgeon or Neurosurgeon to see what they think. Did you have an EMG/nerve test done on your leg with sciatica yet?

    I often wonder if I had surgery right away for my herniated L5-S1 if I would be better off but my herniated disc healed itself within 15 months. Instead I have another bulging disc and sciatica which isn't as bad as it used to be after 4 years and DDD which has me out on disability.

    So yes get a few more Surgeon opinions to see what they say and their treatment protocol which doesn't always include surgery. I know a lot of insurance companies and Dr. make you have Physical Therapy first before any surgery unless in the case of Cauda Equine Syndrome which would be a medical emergency.

    Find a PT that works with spine patients and that's their specialty. Keeping a pain diary may help also explain what you're going through with the Drs and what triggers the flare up and what you do to resolve it if anything. There are some sites that have a pain diary to give you guidelines.

    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
  • Thanks for all the thoughtful responses!

    I have tried PT but due to my own lack of personal responsibility, I have not followed through as I should have. I am going to try and make a new commitment to stick with it. My current Ortho referred me to a PT who showed me a number of exercises to build my core. I just need to actually do them on a regular basis. That is on me and I accept responsibility for my lack of doing them. I do not have a PT that I go to on any kind of schedule. I have been to him twice and they showed me what to do and sent me on my way.

    As for the EMG test, I did have one from the first Dr. and he said he could see some mild damage but he did not think enough for surgical intervention.

    I have little if any Achilles reflex but they said that is not too big of a deal.

    Both Ortho practices are considered the best around and also have surgeons within the practices but I have not yest seen a surgeon.

    I have been told if I see a Neurologist they will want to operate immediately because their job is to relieve the nerve of pressure, not necessarily be concerned with anything else. I guess I would not have reservations if I did not know a couple people that had this type of surgery and ended up worse off or no better. Just has me spooked.

    My Dr now acts like I should be able to recover from this or eventually live a normal life by leaving it alone but then I read everything about how nerve compression can lead to permanent problems if not treated. I can adjust and live like this if that is what I need to do but I also would rather not start have trouble walking at age 60 due to an long term untreated problem. I also don't want to make it worse now with surgery if it is not absolutely necessary.

    Not trying to sound like a complainer, it is just all of this seems so confusing. I just don't know what Drs to believe and what to do. This is just the first time where I have had a medical decision to make with such different options.

    I guess I will try PT again. It does make sore but I think it is what I need to do. If I don't start getting some regular exercise, I will have far worse health problems than a bad disc.

    Thanks Again!!
  • Hi Jason,
    not much time to post.. but you said it all in your first paragraph... GO TO PT... not yelling, think of it as Bold font! lol.
    Gotta go to PT, learn the "good pain" from the "bad pain".. and get going!
  • Hi Jason,

    I'm also 32, and had a herniated disc at the same level. Unfortunately, PT and all other forms of treatment made it worse and didn't help, so I didn't even think twice when my doc suggested a microdiscectomy. I had it 9 months ago, and am 98% (but for a nagging problem with hard floors) better. Many people I've spoken to that have had this done have remarked that "I can't believe I ever waited this long for surgery!". The consensus seems to be that everyone wants to avoid surgery, but when they have it and wake up with no pain, they wish they would have done it years ago.

    I'm glad I did it right away, and I would do it again in a heartbeat. No reason to live all that time in pain when you're an otherwise healthy and young individual.
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