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Discectomy - How long to wait? When to try alternatives?

This is my first time posting here but I've been reading the forum for several weeks and have found it to be very useful!

I'm 25 years old and have always been pretty active - lots of yoga, hiking, and spin classes. About six weeks ago I was in a yoga class and felt a sudden sharp, searing pain all down my right butt/hip/leg. Initially there was more sharp pain than numbness, and sitting/driving was nearly impossible, but then the numbness set in and I could barely walk down the street. I went to the Doctor, they did an X-ray and prescribed me a Medrol dose pack, which did very little to help. Then I went in for an MRI which showed an 8mm bulged disc along L5/S1. The doctor IMMEDIATELY pushed for an epidural and I went in the next day for 7 cortisone injections, which was painful and did a little to help some of the pain but I still have all of the numbness and tingling while sitting.

The Dr seemed very concerned about my loss of strength in the right leg/foot and wanted to do a Discectomy ASAP. I honestly was shocked when he said the word "surgery" - I had no idea my injury was so bad.

I'm studying for the Bar exam which is July 24-26 (which involves SITTING for 3 hours 2x/day for 3 days in a row) and was very concerned about being in MORE pain than I already am. At least now I can manage the all-day studying by switching positions, propping myself up with a cushion, and ice. From what I read on here, once you start with surgery it's another slippery slope of additional pain and it takes many weeks to even begin to recover. My Dr had all these claims that I'll be "totally fine" for the bar exam, and that I'll be able to study and focus during this next month while recovering but everything I've read seems to suggest otherwise. So, I decided to put the procedure off and feel relieved that I at least know what my next month will be like and am not entering into the unknown of post-op.

I went in for my first round of Spinal Decompression Therapy today, thinking that if I'm putting surgery off I might as well try an alternative and see if that helps. I've tried looking through the forum for information about Spinal Decompression Therapy but it seems like there's not much out there. Does anybody have experience with this?

Also generally, I'm wondering - how long do people seek out alternatives before deciding to go through with the Discectomy? I believe my Dr when he says he is concerned about my loss of strength and potential nerve damage, but at the same time I feel like Chiropractors/people who go to Chiropractors tend to say that alternative measures CAN help and that rushing into surgery is a mistake. Have any of you had experience navigating the two worlds of "traditional" medicine/surgery and alternative therapy? How long do you "wait" and do you, if ever, end up getting the surgery?

I'd love to hear anybody's advice/experience about this. I feel really overwhelmed by conflicting information and want to make sure that I'm making the right choice. Thanks in advance.


  • My 2-cents is that you are asking all the right questions. I would caution you to avoid a chiropractor for lower back. I'm not saying that they are not good but I'm saying be very careful. The one I saw was great b/c he would not treat me unless my doctor approved (which he didn't). Conversely, I saw a physiatrist (Muscular/skeletal) who worked a special program with me and a trained PT (who knew several techniques including several things by chiropractors)...I think Physiatrist is a better approach mainly b/c he will work with all the other doctors for a holistic program.

    Now, for the surgery...it is a personal decision. And you are right, can be a slippery slope. Back surgery (micro or not) is major surgery. Remember your spine services all the nerves and houses them. So surgery on the back comes with risks.

    Can I suggest you get a 2nd opinion? If you saw an orthopedic spine surgeon/dr, try to see a neurosurgeon.

    As for the decision....I'll come back to give you some 'food for thought'. I'm happy to share my experience as well (had a microdiscectomy and it 'failed', so I had a revision which was partially successful).

    I have to get my dog out so I'll try to come back later tonight.
  • I don't know why it seems like these problems occur when you can least address it. I wouldn't try any other modalities without the ok from your surgeon or primary doctor. Getting a 2nd opinion is important to me - to get a different opinion and compare notes. I agree with your waiting a month+ until you take the Bar Exams. I would definitely be concerned with a chiropractor doing any "adjusting". How are your other discs? I don't know what the spinal decompression is - is it like traction? Would your surgery by discectomy or microdiscectomy (this is less extensive, quicker recovery).
    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Zeus2006ZZeus2006 Posts: 23
    edited 06/27/2012 - 6:20 PM
    I don't have experience in the decompression therapy.
    I think the most important part to be concerned with is the potential for nerve damage.
    If you can tolerate the pain without surgery, then you can try taking the Bar exam. I don't know what I would do if I was you. Guess it depends on how bad the pain is.
    I had a fusion, and a partial discektomy, so my surgery was different then yours. Maybe you recovery will be easier then mine. I had a two level fusion in the cervical spine. With my recovery, there is no way I could prepare for a test for the first two to three weeks post op. But as I said, my surgery was very different then yours.
    Just be careful about risk of nerve damage, you don't want to spend the rest of your life with the pain symptoms you currently have.
    I don't know the bar schedule, but if you could push it off for one month, that might be worth considering.
    I recommend getting a second opinion from a Dr. and see what they recommend.
  • mollykmmollyk Posts: 13
    edited 06/27/2012 - 9:15 PM
    Thanks for your perspective. That's kind of what my gut was telling me - to go with what my Doctor recommends. My Doctor didn't say not to seek out this alternative treatment, he just expressed skepticism that it would help. The Spinal Decompression therapy is similar to traction and isn't an adjustment but can still rattle things up...

    I'm going to see a Neurosurgeon tomorrow for a 2nd opinion, so I'm glad to hear I'm on track! Do Orthos and Neuros tend to have different approaches?

    When you have a moment I'd be interested to hear your experience. Thanks so much!
  • i myself have been putting off the surgery, because i have only read one or two succesful outcomes on here, and it seems these were people tha did not have physical jobs also, although i also think that people who sit behind a desk all day are risking it too, because sitting is also bad for your back.
  • Thanks KarenD! I agree - the timing is always so perfectly impossible when it comes to injuries. I'm going today to see a Neuro for a 2nd opinion, so I'm glad that I'm following the right path. I went yesterday to try the Decompression Therapy - it's like traction but I think more "precise." It felt pretty good to just kinda lay there but I'm disinclined to do more of them; I'll see what my Doctor thinks. My other discs are perfectly find, it's just that pesky L5/S1. And I'm not sure whether it would be micro or discectomy but today I'm seeing a Neuro who definitely does the Micro, and I'm thinking of switching to him from the Ortho.
  • Hey there,
    I had decompression therapy- approx 50 sessions. It did help me- mainly the awful leg jolting pain. I continued on it, (and kept a very specific journal to write in), and when I felt I was at a standstill,(hahah,), ok, when I felt I had improved all I felt I could, I stopped and started other treatments, like acupuncture.
    The hardest of all this for me- is my brain thinks I can physically do something.. but body isn't agreeing. I also was very active, hiker, yoga, taught ice skating and rollerblading for 15 odd years. Worked through pain-- never stopped, I worked through it because I thought it would get better.. just a relax was all I needed. Nope. Didn't stop until I couldn't get out of bed, literally.
    Keeping my journal has helped me connect what does and doesnt' work. Hot baths I love.. feels great.. but the next day.. wowzers. crap day! I wouldn't have realized it was the hot baths though without the journal. Now, I have warm baths, quick luke warm ones... dont' really enjoy the same, but body is happier next day for sure.
    Surgery is very personal. I have been told I am not a surgical candidate, which I will admit made me happy.. cause I didn't have to choose.. do I or don't I?? But, I now have to learn to have a life with pain. Some kind of life. Some stories I have read.. about surgery.. scary stuff. But then again... some amazing recoveries too. So, half dozen of one and 6 of the other! What do you choose?
    You are at the right site for information and support. I wish you the best!
  • DNiceDDNice Posts: 1,962
    edited 06/28/2012 - 1:23 PM
    I forgot to come back last night.
    I'm not familiar with the decompression option. But sounds like Sally711 gave some good input.
    My situation is quite different than yours. I ruptured a disc (L5/S1) and even with that (trip to the ER b/c I literally couldn't get out of bed even with some mild muscle relaxers and pain killers that my dr. prescribed), I was still given the option to make my own decision.

    I had immediate loss of feeling in my leg, strength, etc. They were worried about me and told me it was urgent to get surgery b/c I lost feeling in my perineum (groin) and a large portion of my left leg and I couldn't urinate without a catheter. They were worried the nerve servicing my bladdar/bowel may have been impacted. Long story short, after IV of meds, I was able to go but still had lost significant strength, ankle reflex, and feeling in my of my left leg, buttocks, groin, foot.

    I took 2 weeks to get a 2nd opinion and weigh my risks and other options. ESI would not have worked but all doctors said that if I was worried about the surgery, they would work with me to try other treatments. I opted for micro-discectomy (L5S1). It didn't work and i sort of knew it upon waking up but was optimistic that in a few weeks I would improve. At the 2 week mark, I realized it didn't work and despite doctors assuring me healing takes time, my recovery experience didn't match that of what I was told to expect.

    Long story short, they re-MRI'd at the 3 month post op and sure enough -> there was another LARGE piece of disc sitting on the nerve. I may have reherniated but they really think I had initially lost 2 big pieces and when they removed the first piece, the other piece had room to 'fall' onto the nerve.

    Now, with that...I did a ton more research. I was told revision by the initial surgeon. Another opinion said "Fusion". Thankfully there was a disagreement b/c it allowed me to do a ton of research and seek input from other prof'ls.

    Long story short I was really given 3 options - wait (sometimes the disc dries out and shrinks alleviating the pain), revision, or fusion. I went for revision b/c I had already sort of waited 3-4 months healing from surgery #1. Fusion was permanent and came with another set of risks. I thought...try revision, pray for the best.

    I had the revision and I would say I improved about 50% which is really a big deal considering how bad I was.
    I still have no feeling in all the places I said, but I did get strength back and my pain is more manageable.

    Neurosurgeon vs. Orthopedic Spine Doctor (fellowship trained) - they don't necessarily have different approaches.
    But a Neurosurgeon goes to school longer b/c he knows nerves.
    I won't say one is better than the other because I think folks will argue both sides.
    I just went with a Neurosurgeon the 2nd time b/c I knew I had scar tissue and needed to make sure I wasn't aggravating the nerves more than they already had been.

    For picking a doctor -> be sure they are willing to take time with you to explain risks/benefits, alternate treatment plans, explain what if things go wrong, what would be your next option, I even asked what they'd recommend if it were their spouse or child. It was important (the 2nd go-around) that I had a relationship with my surgeon.

    Often times the surgeon does a good job assuming all will go well. I needed to know that my surgeon was going to listen to me if things didn't go well. The 1st one didn't do such a good job at that...he just kept telling me the surgery should have been gratifying. My 2nd surgeon...will still take calls from me 2 years later. Hence the reason I went to a Physiatrist (my surgeon suggested it).

    Physiatrist - used him b/c I was almost feeling like I had arthritis in the back. He has worked wonders in regards to keeping stiffness at bay.

    NOTE: I was 40 when I blew out the disc. Very active. The most frustrating part of back issues, and surgery, is the recovery and balance of doing and not doing.

    Good luck
  • And I also saw my Ortho for a follow-up post-epidural. It was a long day of appointments!

    Neurologist thought it would be okay to wait for surgery since I'm past the initial point of excruciating pain. There is loss of strength/sensation in right leg/foot but he doesn't seem to think it's urgent that we fix that, and sometimes these things fix themselves.

    My Ortho, on the other hand, still thinks I should do the surgery ASAP but I told him there's no way I'm doing it this month. He says I'm risking serious permanent strength loss, especially in my right calf. It's so interesting how different these opinions are...

    Either way the surgery is elective and I will be revisiting it in a month. Tentatively put a date on the books with the Ortho for microdiscectomy in mid-Aug.

    What have peoples' experiences been with loss of (calf) strength and loss of sensation - how long does it take to come back, either without surgery or post-op?
  • Kwilson400KKwilson400 Posts: 42
    edited 07/15/2012 - 3:49 PM
    Good luck
    June 2011 L5-S1 Lamenectomy/Discectomy
    Dec. 2011 Repeat L5-S1 Lamenectomy/Discectomy
    June 2012 New tear L5-S1 w/ Perm. Sciatic Nerve Damage
    Currently- restrictions (including no work duties) for a min. of 3 months to allow disc time to heal
  • PaulPPaul Posts: 730
    edited 06/29/2012 - 11:18 PM
    I have experience with decompression treatments.

    Around 2001, I learned about a traction table treatment by the name of VAX-D. Unfortunately for me, the nearest one was located in Hollywood CA, about 3 hours south of me. I had to travel to L.A. on business once a week, so that is the only time I could get traction pulls. I thought they were great. But because I could only do 1 pull per week instead of the 3 or 4 they recommend, I only had limited success.

    In 2006 when my pain was at its worst, I found a VAX-D table practitioner in Santa Barbara. That is only a 1 hour drive so I was able to go get treatments more frequently. Back then, gas wasn't expensive, but the treatments were. I don't have insurance, so I was able to negotiate a cash price. They were about a hun thirty each for 45 minutes of pulling. When you add up the 3 to 4 pulls per week they recommended, it got to be pricey, so I had to limit my visits.
    I had faith in the traction modality because it made sense to me. I kid you not, I was online searching for a used VAX-D table to buy for myself. I did find some for about $20K and I was very tempted to get one.

    Finally, I just had enough and got a transforaminal endoscopic microdiscectomy in L.A..

    Fast forward to 2008: I've moved to L.A. By this time, I've also had problems with L5-S1, and had the same kind of surgery on it as well. The surgeries were successful. In the course of going about life, I did something stupid and reherniated my L5-S1. Lots of pain. I sought traction again, and found a Triton brand treatment practitioner.

    These treatments were more affordable and I was able to go 3 times a week for several weeks. They worked. I was pain-free again.

    2010. I reherniate L5-S1 again. Yes, I'm stupid. Anyways, I found out that there are home traction units available now. I found and purchased a Saunders Hometrac on eBay for $130. I thought I'd give it a try.

    You may not believe me, or people may say it's a bunch of b.s., but that thing has saved my bacon. It has really helped me. 3 times now, I have re-injured my L5-S1, and 3 times that table has gotten me pain-free. When I haven't done something stupid and things are going good, I'll use it once a week for "maintenance."

    Maybe I got lucky, or who knows, but for me, it was worth trying.

    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • PaulPPaul Posts: 730
    edited 06/29/2012 - 11:27 PM
    Now, on your other questions:

    In my L4-L5 case, I spent 9 months in severe crippling pain. During that time, I researched my options. I didn't notice it, but my left calf was shrinking. The neural impingement shrank my calf.

    My surgeons told me that 9 months is about the limit for a herniation to be compressing a nerve. After that, I risk permanent damage.
    He also said I could get it back to it's previous size with a year's worth of building it back up.

    After the surgery, it took a good 6 months for all lingering irregular sensations in that calf to fully resolve and go away. I have no weakness or tingling, or any other issues with it, and I have not done any muscle building excersizes for it. I just kinda got on with life. To look at it today, you couldn't visually tell a difference like you could in 2007. I'm sure if I get a tape measure and measure it, it might be different to the right calf, but I'm not worried about it.

    Well, I wish you strength and courage in this challenging time you face. Let us know how it goes if you're up to it.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Thanks for all your comments. I've done three treatments of the Spinal Decompression and I think it's been helpful - it's also been a week since I had the epidural injections, I'm taking NSAIDs, and it's been 6 weeks since the initial injury, so due to all these things I'm feeling MUCH better. Plus I'm using better lumbar support when I sit and study all day.

    My Dr is STILL pushing for surgery, he seems concerned that I can't do even one heel raise on my right foot. Second opinion Dr says wait and see re: surgery, which I'm doing no matter what since I have the bar exam at the end of the month.

    It's so hard to know what to do re: loss of strength... I'll re-evaluate in a month but this is elective surgery and ultimately I will have to make a decision.
  • You say you have the surgery tentatively scheduled with the Ortho. What about seeing a Neurosurgeon? Maybe that's what you meant you saw. Either way, the Neurosurgeon should be able to do the same surgery on your back and why not go with the one that is not pressuring you to have the surgery so quickly.

    As for nerve damage and permanent loss of strength...there is no way for anyone to know for sure. I was told 4 months before possible permanent nerve damage but realistically I had surgery right away and still have nerve damage but my doctor told me that the nerve may have take SUCH a big hit when the disc blew that it may have been damaged then. As for strength...I got most all the strength back and turns out, I never lost ankle reflex 100%.

    So the strength can come back.
    I think you are going about this all right...good luck.
  • KarenDKKarenD Posts: 742
    edited 07/01/2012 - 10:39 AM
    It's your decision when to have surgery and if you will have surgery. If you have surgery, choose the doctor with whom you have confidence or have another opinion. If you decide to wait until after your bar exam (which I would do) then schedule your surgery as soon as practicable after your exam.

    Best wishes,

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • I have had the same disc prolaps 5 times in the last 8 years. I have tried many alternative therapy’s, Yoga, Gym routine for core strength, Pilates, healthy diet, but the second I become complacent, the disc pops out again. I think if I was 100% dedicated, I could potentially get away with not having surgery, but I’m 32 and I know that there will be a period in my life where I let my defences down and that’s when the disc will pounce.

    So I have opted for a discectomy, with a 97% success rate I think I think it’s a no brainier, considering that in the past 8 years I have been rehabbing for 5 years of it and not been able to do any sort of physical activity without anti-inflammatory medication.
    Robbie M
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