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L5/S1 Herniation & Sciatica - Surgery again?

Tree512TTree512 Posts: 24
Hi Everyone - I am new here but unfortunately not to back pain. Always had a back back, but ruptured my disc at L5/S1 in 2000 and had a successful microdiscectomy. I have never been back to previous activities that were back unfriendly, like golf or running, but able to lead a decent existence.

I have had a couple of disc herniations over the years, but they always recovered after a few weeks. I have one now that isn't getting better, with classic sciatica, pain down one side from the butt down to the ankle, numbness in my big toe and pad of my foot, classic nerve root impingement.

Just got back the MRI. The bit that matters - "L5-S1 right paracentral disc extrusion, which has markedly enlarged compared to the prior examination and obliterates the right lateral recess in the expected location of the right S1 nerve root."

Anyone ever have such a clear MRI read, numbness and pain that is pretty intense, and end up not having surgery?

And since it is the level where I have already had surgery and lost disc before - any thoughts on another discectomy vs. more modern replacement surgeries?

What I really want is to be out of pain, and I am doing lots of PT, acupuncture, you name it. But it sure look like surgery again after this MRI...

Thanks in advance for any advice you might have!


  • I have never had surgery, but this seems fairly common (having the need to have it a second time). Has your Dr said to get it? Will they fuse @ that point?
  • I don't know if this will help you at all, but i had the herniated disc at l5-s1 2 years ago. microdisectomy / partial laminectomy in June of 2010. i managed to re-herniate the same disc a week after surgery. It took several months of PT and eventually a new MRI to confirm though. my second surgery was 4 months after my 1st one. Same thing, microdisectomy / partial laminectomy. It didn't get rid of the pain, like the first surgery did. (well for the first week after surgery at least.) I did PT for months after the second surgery. Pain improved, but never went away. Another MRI in january of this year showed the disc is herniated yet again. But in the meantime, i had 2 herniated discs in my neck which ended up taking precedence, and i am now 7 weeks out from a 2 level cervical fusion. I'm going to talk to my surgeon when i go for my next follow up, to see when he would even consider doing something for my lower back. But in the meantime i'm going to push for a new MRI.

    the things I worry about with another surgery for my lower back. I've got the herniated disc at l5-s1. l4-l5 is bulging and has DDD. If i get a third microdisectomy, i was told that at worst, i get bone on bone and have pain (50% chance) and at best, i get no pain and the discs self fuse.

    on the other hand, a fusion at that level, would put more stress on the levels above it. now l4-l5 already bulging and with the DDD, what are the odds that disc will herniate and i'll end up needing another fusion.

    sorry, i know its no real answer or help. but its something to think about...

    Microdisectomy / hemi-laminectomy 6/2010 and revision 10/2010
    Cervical fusion C4-5 and C5-6 9/2011
    Lumbar Fusion L5-S1 6/2012
  • Saw the back doc on Friday. The good news is that he thought that if I needed surgery, he would do a simple discectomy. The bad news is that he thought it was pretty likely I would need it. I am going in for an EMG next week, as well as an epidural, so we'll see how those go, but right now I am not particularly optimistic I will be able to avoid the knife.

    He was extremely good about going through the MRI with me level by level and showing exactly why he thought my MRI showed him the problems and why he thought he could address them relatively easily.
  • I had a similair situation. My first surgery was in may and second was 10 days ago. I would encourage you to go ahead with the surgery. THey say if it hasnt healed in 6 weeks on its own it probably wont. I personally feel like epidurals and physical therapy are a waste of time if you have already had a surgery. I know results vary, but it is your decision. I am experiencing some pain after second surgery, but so far so good. My next step if this surgery fails is a fusion. If you get the epidural and dont experience relief after one I wouldnt waste time getting more though. I went threw a roud of 3 with no success after any. I wish you luck and hope my post wasnt to negative. Back problems are horrible. I wouldnt wish them on my worst enemy.
  • Thanks Amanda. Last time I was in this situation the epidural didn't help, but since I haven't had any oral steroids either, I do want to go the non-invasive route first. I did have a similar bout with sciatica resolve on its own eight years ago, so I am not optimistic, but hopeful.
  • Hi, I had a l5/s1 microdiscectomy in December 1996. I was told the op was to relieve my leg pain and not my back pain. It didn't really relieve either especially not my back pain. I had a further MRI last November and the result was similar to Tree512. I went to see the specialist clutching the MRI report hoping that I would get further surgery and therefore alleviate my constant pain but was told that further surgery would not be beneficial because it would just be a case of excising scar tissue which would of course build up again following more surgery. I was very disappointed and am now learning to live with the pain. I take several painkillers a day and am on antidepressants. This post may not exactly be helpful but wanted to add my opinion. x
  • I thought ur post was excellant and interesting think to think about.. Reason i say this is everyone told my father for 15 years.. FUSION, FUSION, FUSION, but he back pain was HORRIBLE for 1-2 weeks at a time, then it would go away.. He would still walk funny but hardly any pain.. Now his back has self fused.. He did have sometype of laser sugrey to a few years ago(like 6) with THE HOPES of stopped pressure on a nerve so his leg wont shrink.. his leg shrink about 20% comapared and now has been fine since....... Anyhow my father has fought through back surgery and was LUCKY only because his pain would stop after a few weeks unlike other poor folks.. My fathers back pain started at 43, MINE HAS STARTED at 38.. College football and being TOP heavy i guess did not help me.When i think back about the heavy squats i use to do and crazy stuff.. Geez i wish my father would of step in.. My son wont being doing that stuff- if i can stop it!

    Take care!
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