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l5 S1 severe back pain - no surgery?

manage31mmanage31 Posts: 1
edited 06/11/2012 - 8:56 AM in Lower Back Pain
I am new to this message board but I am enjoying all the information. My problem according to the MRI is:
There is a left paracentral disc extrusion measuring 10mm with severe narrowing of the left lateral recess and impingement of the left S1 nerve root in the lateral recess. Exiting L5 nerve root is spared. no central canal stenosis or right neural foraminal is identified. Right lateral recess is normal.

I am 37 male, 5'10" 200 and I have been experiencing terrible back pain for about a year. Active walker/runner. I have an 8 month old which doesn't help, but to make a long story short. I have had 2 epidurals (no relief at all), months of nsaids (mostly celebrex) and I've done physical therapy. My Doctor who comes with a very good reputation says "no need for surgery because there is no neurological symptoms and you have no leg pain"
Thank you so much for your time.


  • I would definitely get a second opinion. Just because there is no leg pain, doesn't mean that the back pain isn't terrible. Obviously, the treatments you've tried aren't working. What kind of doctor(s) are you seeing?

    I've also found, having seen many different doctors, that just because a doctor is highly recommended doesn't necessarily mean they have your best interests at heart. My last pain management physician was a Harvard graduate, board certified, blah blah blah, and he could have cared less about my situation. He ignored just about everything I told him, and ended up giving me epidural steroid injections, which made my condition worse.
  • SavageSavage United StatesPosts: 5,476
    What a blessing..a little baby! But I know what you mean. It is like aerobic exercise..for a few more years, also Not easy at all.
    For many years now, I have had to ask people, "Please hand me that child."..since it's impossible for me to bend, lift, etc..w/o severe

    I have severe neurological symptoms. Docs tell me no way for surgery..so I don't understand all the criteria. Other issues of mine probably enter the decision making process.

    I didn't have relief from my epidurals either, except partial relief with right foot. Actually, many of my epidurals caused me to feel worse.. and some added nausea. I dunno how anything works :)

    The good thing is you have a doctor willing to work with you. The spinal issues seem so individual even if diagnosis reads same on 10 people..10 different physical symptoms to same apparent spinal problem

    Good to continue to communicate with doctor about meds, treatments and your response to them. Hopefully, eventually there will be a balance giving you comfort for a managable pain levels & improved enjoyment of lifestyle.

    You're not alone. Many different experiences on this site and SO helpful!

    Take care and keep in touch
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • My problems began as "only" back pain, no leg pain. I had 2 MRI's, showed OA and a mild bulge. I went through the shots and they did nothing for me either. Then, one day my thigh pain began. Next was the leg pain in addition to the thigh & back pain. Today I have all those plus severe foot pain. I found out I have a ruptured disc and a tear in another with nerve damage in both legs. I believe your body is telling you something is wrong and in time it will scream at you even louder the worse it gets. Please just stay on top of it and watch your symptoms carefully. It also could go the other "good" way and heal. Our bodies tend to tell us when something isn't right and you never know when/if you may develop the leg/foot pain.
    In my opinion, there are other conservative treatments out there that could help you and it sounds like you have an outstanding Dr so I am sure he will steer you in the right direction for your symptoms. I agree with Savage that keep communicating with your doc. If you are concerned like Mikey said, get another opinion. Only you know your pain.

    I hope you feel better soon.
  • My 2-cents is your surgeon is a good surgeon for not 'jumping' at surgery.

    Surgery, especially of the lower back, is risky business. It's major surgery (like open heart) but tends to come with several other issues.

    I can tell you that discectomies (microdiscectomies, laminectomies, etc) are intended to 'free' an impinged nerve. Impinged nerves in the lumbar area are what causes pain in the legs & feet. It's not to say that these nerves don't impact pain levels in the back but they know the discectomy only gives patient relief in the legs/extremeties.

    From personal experience, I gain zero back relief and only marginal leg relief.

    That being said,
    - what other options did he give you?
    - Did he suggest that you stop running? The pounding is not good for your back. Have you considered an alternate exercise like swimming? If not, be sure to invest in good running sneakers (go to a local store) and consider running on a rubberized track.
    - do you continue doing the PT exercises? For them to work, you need to do them regularly
    - do you ice daily?
    - do you limit your bending, twisting, lifting? tough with a young one that loves being held.
    - have you considered keeping a journal to better isolate what triggers 'bad' pain episodes?

    The other thought is...go for a 2nd opinion. Just be cautious if the 2nd opinion tells you an operation in the lumbar region will resolve your issues. Ask lots of questions.

    It is SO frustrating having lower back pain.
    Waking up is NO fun for the first 30 mins as I grumble around the bedroom trying to get ready for work. Also, at work, I need to get up an walk around every hour.

    The other recommendation I have is to get a remote opinion from the eCleveland clinic. It costs money and you need your treating doctor to support you but most surgeon's welcome the opinion b/c if it differs from what they said, they can learn from the results too.

  • this happened to me too. i was told that if there does not appear to be significant nerve involvement below the knee then surgery is not imminent. i of course, although it was years later, developed nerve pain into the foot, which changed the situation drastically. within a few months i underwent a discectomy. i would absolutely say that if you can avoid surgery at little to no cost, then please try to do that. your back will never be the same once a surgeon tinkers around in there. good luck.
  • awfully dull backache without leg pain .my first though was i agree with your consultant but you should get another opinion .because many spinal operations do very little for back pain {my 16 in pain testify to that } they tend to operate to relieve nerve impingement .but that's not to say you are experiencing awful back ache .you could try a good TENS whilst you wait for another opinion .as we can't suggest pain killers by name or amount .i can tel you what i take for similar problems oxycontin and oxynorm .but i do have leg/foot pain too.back pain can be unbearable and i should hope that your consultant has the decency to make sure that you are comfortable .i wish you well with what ever you decide but remember that should you go down the operation route you are not guaranteed pain relief and its more than likely that as the years roll on you will need revision surgey ..in other words ..its a slippery slope !!
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • If you are going to a NS maybe seek out an orthop surgeon or visa versa. I got at least 4 diff opinions from NS and OS. All recommended surgery but had different approaches as to how they would do it, from aggressive to very conservative. I went with the NS who was in the middle of the aggressive/ conservative spectrum. All the dr's I consulted were tops in the metropolitan area I live in. I have also flown 1000 miles way for an opinion because I know that there are different teaching/ practicing methods in diff parts of the country. The out of state dr gave me the thumbs up on the NS that I had for my first surgery 25 years ago. He has a national reputation, but I figure he is 25 yrs older and I wanted his " new wunderkin" that he recruited from Stanford Univ. My current surgeon could have been chief of neurosurgery anywhere in the country, but chose to work under my prior NS..as an aside, he has a 66 page resume/CV which details all that he has written, published, authored, lectured etc during his years of practice.
  • Manage 31
    I understand you are frustrated, but try and take a deep breath. If you read below my comment it should say what I have... anyways I also suffer form the extreme back pain but with no leg pain. I get very weak from walking or standing to long..and can not lift anything to heavy, makes my legs feel like they are going to go out from underneath me... I have a 21 month old grandson :( who I would love to play more with.. I do..but I pay for it when he leaves, My surgeon also advises no surgery for now, to put it off as long as you can.. THERE IS NO GOING BACK...and from everything I have read and asked around, it seems there is always more to follow. So for now I will contiue to deal with the pain the best I can with the help of my pain mgt spec. (pms, lol) I have had 3 injections with no help at all, still trying to find out what they can do to help me... I am going on 4 yrs now..it has progressed rapidly in the last 6 months and Iam no longer working... both DR's have told me to go on Disability. I to was a very active person, and Ido not like this changing lifestyle, but I guess things could be worse. My husband has been aswesome thru this, as I know I can be a handful at times. So for now surgery is on the back burner and I will just keep managing best as I can.

    From Ohio and I love my Neuro Dr. very understanding, listens, and even makes personal phone calls back to me! :)
  • Good Luck backache99, will be sending you prayers!
  • Good luck my dear friends.

    *Please feel free to visit mysite: back pain relief
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