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L5/S1 Herniation & Sciatica - Surgery again?

Tree512TTree512 Posts: 24
edited 06/11/2012 - 8:58 AM in Back Surgery and Neck Surgery
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!


  • 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.
  • Hello, I am new here as well. Is this microdiscectomy the same as a disk decompression? That is what I am scheduled for soon. I am trying to get some info on this procedure. Is that where they just take out the piece that is protruding on the nerve. thanks,
  • Sorry to hear about that, big bummer. First of all there is no such thing as a "simple micro D" The only thing micro about that surgery is the incision. What they do when they are in there is very invasive. I got a Micro D under the false pretense that it would miraculously cure my nerve pain and back pain, and that I would be able to return to carpentry work after six weeks. Turns out a month later I was back on the operating table for a "decompresion/revision" surgery. Basically they say that they are the same thing but in a Decommpresion they take out more of your lamina and often times have to shred parts of your disc off. I'm glad that your first surgery was successful you are lucky. Most people's first Micro D is usually not. The thing that a spine surgeon will not tell you if you are first time candidate for surgery is that you in NEVER just have one spine surgery. Not everybody has to have another one a month later like I did but If you get a Micro D you will definitely need more surgery some point in your life. Another thing if you talk to a surgeon about getting surgery of course he/she is going to say that you need it even if there might be a better, less invasive procedure out there for you. They make money on surgeries! The thing you have to decide is to what point your pain is too bad that you cannot go on before you consider surgery. In your case it seems like it is pretty bad, similar to how I was pre-op. Then research and examine all alternatives and talk to multiple surgeons and make sure you feel 100% comfortable with them before you let them cut you open. That is a mistake I made, as soon as I met my surgeon I didn't like him but I was in so much pain and felt like I couldn't wait any longer so I let him do it. What ever you choose to do good luck and I hope you can find something that makes you feel better. Cheers, Tom.
  • Hey there,

    Sorry you are back in pain and about possible 2nd surgery. I have had the revision buy my scenario was very different as the 1st surgery didn't work...which I knew within 2 weeks.

    Anyhow, on the positive note...I work with a fellow who had a successful Microdiscectomy back around 2000 and ended up having problems about a year ago. They did the revision (re-do microD) and he is doing really well on the 2nd time too!

    There is hope! I hope you can avoid surgery but if you can't, just wanted to offer you some encouragement.
  • Wow, this is scary. I am really nervous about having this done and have to go back on the table after. I had to do that with one of my hands for trigger finger surgery. And both of them didn't work.

    I can imagine that a failed back surger has to be ten times worse. But I am so much pain right now. It really takes a toll on your spirit and it's hard to look like it's not bothering you so you don't bum out other people about your problem.

    I have been trying to do as much research as possible about this, but it sounds like a roll of the dice when it comes to surgery.

    I am determined to get this extra weight off before I go in so I have a better chance of a good recovery.
  • Thanks for the comments.

    My problem is a re-herniation 11 years after my first surgery. That isn't really revision, which I am pretty sure is going in for another surgery at the same location after a relatively immediate re-herniation (a few weeks later, not more than a decade later).

    I had an ESI last week that seems to have helped some, which is great from a pain management point of view. Hopefully my herniation will resolve on its own, but I doubt it. Time will tell, and hopefully the ESI will buy me a few weeks.
  • Hi Tree,
    I was in almost exactly the same situation you find yourself in. I had a pretty severe herniation at L5/S1 in 1999, had a microdiscectomy done (by a well-respected neurosurgeon), which went very, very well, and pretty much was back to normal until August of this year, went that familiar pain started to reoccur. The pain progressively got worse, I went through 3 epidurals, and a little bit of physical therapy, nothing helped. Had a revision/redo (surgeon's words) by an orthopedic surgeon on November 8th, so three weeks ago. The surgeon said it went very well but it was like night and day from the first time, I was in pretty severe pain for the first 2 weeks and just started feeling better, after an 11 day course of oral steroids (prednisone). A lot of that pain is due to the nerve irritation and inflammation caused by the cutting away of scar tissue (from the first surgery) around the nerve, according to my surgeon. I do feel a little bit better every day, hopefully I will soon return to normal. So there's hope. If there is one thing I would do differently, it is this, I would go to a Neurosurgeon instead of an orthopedic surgeon for my redo/revision. I might be wrong, but I think that is a significant factor as to the two differing results from my surgeries. Good luck with your recovery, I know what you're going through, and it does get better.
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