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When is it time to consider surgery?

I hurt my lower back six months ago(right side of lower back). When I went to my normal doctor, she thought it was just a hurt muscle and sent me to physical therapy. I went to physical therapy for about two months and at one point it seemed to get better, but it started hurting again, it was almost as if the physical therapy made it worse. So after having no luck, I went to an orthopedic doctor. I had an MRI but the doctor told me that nothing showed up on it even though he said that my symptoms are that of a bulging disc. I have leg pain that is in the right leg and sometimes can go all the way down to my ankle. Sometimes I even have the same type of pain on my left leg that stops at the knee. Walking for long times makes my back hurt a lot. Going from sitting to standing hurts a lot as well. My doctor wanted me to try physical therapy again and I am in my third week of it and it still really doesn't seem to be working. I have good days and I have bad days. I just wonder, when is it a good time to consider surgery for this? I'm going to be in college in the fall and doing marching band which will put me in a lot pain. Should I go to a different doctor to get another opinion? And if I am to get surgery, what would be the best and easiest to recover from?


  • Hi,
    Sorry to hear about your troubles. You have found a good place to talk with others that are going through the same thing. I have had problems for over 17 years, and have seen so many different doctors i cant even count. I can tell you this - the pain you are describing sounds like nerve pain. An MRI will show structure problems, but will not show nerve problems. For that you need a test called a CT Mylogram. I win;t lie 0 the test is not pleasant at all. It starts with a spinal tap, ad injection of dye into your spinal canal. And it does hurt. After that you are taken for a CT scan, and an MRI - this test will show in detail what is gong on, how your nerves are affected, etc. As far as Doctors - i advise a neurosurgeon. they are the best when it comes to back problems and nerve pain. Get more than one opinion also. You might benefit from some conservative treatments (lumbar steroid shots, meds, nerve blocks etc.) I have had several surgeries, including one last week. And every time they go in there, you get scar tissue, etc which makes it harder for the next one. If you want to know more about my story - I have been keeping a video Journal after my recent surgery. Here is the link:

    I have subscribed to your post and will be glad to talk with you more. Peace and good luck.

    Larry F
  • No easy answer here. Surgery decisions are different for everybody. Being that you are in college and in the marching band you may get to a point where you have to decide how much pain you can handle. I am sur you have many things that you need to do in the next few years and surgery can hinder those things greatly. Even if you have "only" a micro-D you could be looking at a year long "break" from your normal life. And being that the herniation did not show on the MRI a doc may not even want to recommend surgery at this point. The likely next steps for you are probably steroid injections & stronger meds. Hopefully you can recover or at least put off surgery until you are out of college, have a good job with insurance, and all that good stuff.

    Good Luck!!
    L5S1 REMOVED herniation. Years of pain & compression. Microdiscectomy complete!! Trying to be super smart & safe with recovery!
  • tlewisttlewis Posts: 14
    edited 03/13/2013 - 5:52 AM
    From my own personal experience, I have found that surgery should be a "last resort" and most insurance companies may not cover surgery unless other conservative treatment has not brought relief. I've had a herniated disc and spondylolisthesis for about 10 years. Until recently, the pain would come in episodes every six months or so. My treatment started with PT, oral steroids, both non- narcotic and narcotic pain meds and has progressed to include chiropractic therapy, epidural steroid injections, medial nerve branch blocks and traction for decompression. My most recent MRI showed a piece of the disc was causing severe encroachment on my L5 nerve roots. A visit to a neurosurgeon last week finally brought up the topic of surgery. However, they cannot perform a simple decompression because of spondylolysis. Whe they cut into the lamina, there would not be anything to provide stability to that vertebra. So, I have to go forward with a full spinal fusion of L5-S1.
    I know how the pain can be and the radiation down the legs makes even simple tasks seem impossible. However, I would strongly recommend that you work with your doctor to find he root cause of your pain and try conservative treatments. I know a lot of sources say "after six months" but going from onset of pain to surgery within six months seems a bit drastic unless you have sympoms like unable to control bladder or bowel functions, in which case would be an emergency procedure. Conservative treatment can help and it may be an inconvenience to repeat the treatment every so often, but surgery has far more risks. I am 32 now and have waited 10 years until I considered surgery. But everyone is different and every condition has different treatment, so my personal opinion is to really discuss with your primary physician, maybe get some more diagnostic imaging, and go from there. This is my first post on the site, but I have read A LOT of other posts and I would also recommend using this site to help you out as far as answering questions. We've all been through the pain and are at various stages and some are both pre and post operation. However, you and your physician should decide when is right together!

    Hope that helps a little,
    Tim Lewis
    Philadelphia, PA
  • Thank you for the stories with y'alls experiences. I've tried conservative measures of taking Motrin (which is now where it isn't helping anymore), I took muscle relaxers but that didn't help either, I have taken hydrocodone but even that didn't seem to help, I have been on one of the steroid pack (prednisone I think?) and sadly that didn't help anything either. The last thing that I have tried was physical therapy. I tried it for two months in November/December and it didn't help with anything and almost seemed to make it worse. I took a break for a while from that and started it back up again three weeks ago. Let's just say I hurt from it. I have good days and bad days but mostly bad days. I had physical therapy this morning and it was terrible, my exercised got upped and then I also had some new ones. My physical therapist also popped my back today and usually when he pops it, it doesn't hurt, but today when he popped it, the spot where I have the bulging disc and all the pain, it hurt a lot. And I mean a lot. It hasn't ever hurt before when he has done that so I'm not sure why it did today. I can now barely walk though because it hurts when getting up from sitting and the pain doesn't wear off as quickly as it used to. Just sitting down even hurts now. I'm probably going to make an appointment with a neurologist very soon and go from there. Once again, thanks for the information!
    Brianna Reid
  • Hi Brianna,
    I think making an appointment with a neurologist or another specialist is a good next step. Before you go, though, you might want to talk to your primary about getting some new diagnostic images. MRI is usually great for such conditions, but in your case it sounds like the radiologist didn't find much. I think having images that show a condition will greatly improve reaching a treatment plan.

    In your original post you had asked which surgery is the best and has the least amount of recovery time. As far as spine surgeries go, there's no one that's better, per se, it's all about repairing a condition you have been diagnosed with. If it is a disc pressing up against a nerve root, for example, a micro discectomy might be an option with a relatively short recovery. But again, it would have to show up on an MRI or CT scan.

    I can't imagine having such pain and it not showing up on radiology studies. It would drive me crazy! Maybe you could also be referred to a pain management specialist, too. They can do a variety of steroid shots used for treatment. but they can also just numb certain areas and be used for diagnosis to some extent. There are also medications, like gabapentin, that might help with the pain that radiates down your legs.

    Again, I am not a health care provider and don't want you to think that I'm providing medical advice -- I'm just sharing my experience :)

    Keep us posted. Wishing you the best,
    Tim Lewis
    Philadelphia, PA
  • Has your doctor recommended lumbar injections as a treatment? It works wonders for some folks.

    As for surgery, I'm a graduate student and had a TLIF on L5/S1 at the beginning of the semester and really wish I would have been able to take the 3-6 months off that my surgeon wanted me to take....but I couldn't. I put off surgery for 5 years until I wasn't able to walk further than my bed to the bathroom (I was using a wheelchair on campus).
    1/16/2013 Minimally invasive TLIF with rods, screws, and cage on L5/S1 joint to treat grade 2 spondylolysthesis, pars defect, degenerative disc disease. Dealt with chronic pain & nerve issues since at least 2007.
  • most docs consider surgery a last resort. I injured my back in 2009 and was told to try to hold off as long as possible. I am having surgery next month. I have the same symptoms you do but worse and on both sides. You will have to go through non invasive stuff first, therapy, chiropractor, injections...etc if those fail and pain has not improved then surgery may be an option. good luck to you. back pain can suck the life right out of you
    injury 12/29/09. L2 henamgioma L3-S1 desiccation protrusion narrowing, L5-S1 nerve rood displaces, L4-5 annular tear DDD L5-S1. surgery 4/24/12
  • I can feel your pain. :( i am dealing with nerve pain since April, 2012 after the birth of my first daughter. I tried physio, pain killers, ibuprofen, and epidural injections. Nothing worked for me. My doctor prescribed my Lyrica which helped me a bit. But still im not able to do what i wanted to do. I had a major flare up last January this year, since then i am bed bound. The pain is getting less but it doesnt go away. That's when i decided to get the surgery. I don't have a life anymore. I can't even take care of my own child. I only go out when i have doctor's appointment.
    I hope you can get the proper treatment. And wishing you no more pain. All the best!
    Microdiscectomy scheduled on May, 2013. With L5/S1 disc herniation. Scared but im going for it!
  • I had my last day of physical therapy round two on Wednesday. Needless to say, I'm in more pain now than I was when I started it. It hurts almost all the time and every time I stand up I limp for a while until the pain goes away. It's almost getting to the point where it's depressing because I can't do some of things I want to do. When I walk for long times, it hurts a lot the next day. Going to school is a chore for me. I am currently a high school student and walking to and from class just makes me dread walking. I just know it will get worse in college. I know surgery is a last resort, but it almost seems to look good if it might help me faster. I don't want to go to a chiropractor because when my back was popped a week ago at physical therapy, it has only increased my pain. I have already had traction and that has not helped. As for the injections, I don't think I can. Just even the thought of needles makes me nauseous. I just don't know what else can be done. Looking for a neurologist in the Dallas/Sherman TX area that has good experience with this and hoping that it won't take forever to get in. Good luck to the people having surgery!
    Brianna Reid
  • jellyhalljjellyhall Posts: 4,373
    edited 03/22/2013 - 5:10 AM
    Welcome to Spine Health Brianna!
    I am sorry to hear that you are in pain and not able to find something that will help you.
    I have had a lumbar fusion 3 years ago and a 2 level neck fusion 4 months ago.

    I would definately say yes, do get another opinion if you can. A different doctor may have other ideas of things you can try to help and may order more tests to try to find out why you are in pain despite nothing showing up on your MRI scan.

    There is no way anyone here can advise you which type of surgery to get or which would be the easiest to recover from.
    We are only patients like you and each of us has a different experience and will recover at different rates. Some have complications that slow down the recovery and even different surgeons have different rules to follow while we are recovering.

    Only a medically trained spinal surgeon can tell you if you should have surgery or not. They are the experts with years and years of training. They have examined your back and seen your scans and test results, so have a much better idea of what your problems are. Even then, they don't always know what is causing the pain and can't promise that surgery will help. If you are afraid of needles (I was too, but less so now I have had two spinal fusions!) then having spinal surgery is not going to be much better than epidural injections.

    If you need surgery and a surgeon thinks he will be able to improve things for you, then one day, when the time is right, you will be prepared to suffer needles and surgery to try to get rid of the pain and get your life back. I wish you luck in finding some way to help with your pain. :-)

  • I have an appointment set up for April 3rd to see a neurologist and go from there. My physical therapist thinks that as the day goes on and more pressure is on my back that it compresses the disc and makes it leak fluid which is causing me a lot of pain. Hoping for the best when I go.
    Brianna Reid
  • PaulPPaul Posts: 730
    edited 03/22/2013 - 9:16 PM
    Still to this day, I don't quite fully understand the physical therapy modality of treatment for a herniated disc.

    To me, (and I am a simpleton) it seems like it makes things worse. When I had to do it, it definitely made things worse. Everyone said "You gotta do PT....you gotta do PT... you gotta do PT..."
    I tried to explain to anyone that would listen, that it was like doing PT on a broken humerus. (that's the upper arm bone) Their argument was that if you build up the muscles around the disc, they will support it better so it can heal. I contend that having a herniated disc is like having a broken bone. But nobody listened and it was exhausting telling everyone that PT hurt more than it helped me. Finally I just gave up and went thru the motions.

    I'm sure it has benefits but I just don't get how they apply to herniated discs. Anyways, sorry for the rant. Your story reminded me of when I went thru what you are going thru right now.

    I know that in Texas somewhere is a famous spine/back facility. I think it is called the Texas Back Institute, not 100% sure. But it is nationally renown for having top notch treatment.

    Also, I am going to send you a link to a site that has helpful info. Look for it in your inbox.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Hey everyone, just a little curious if anyone has ever heard of the neurologist I am going to see, Dr. Mignucci. I was also wondering, what should I expect whenever I go? I've never been to a neurologist and don't really know much about them.
    Brianna Reid
  • Hello forum, My first post. I am a 40yr old healthy, active male. I injured my R ACL skiing May 2012 and had it fixed July 2012. Approx 2 months after I noticed sciatic pain on the same leg as the ACL injury. I tried chiropractic, bi-montly massage, physical therapy; none of which helped. I thought it was piriformis.... in Dec 2012 I had a deep gluteal massage and 4 days later I had horrible sciatic pain all the way down my leg but completely went away 2 days later.

    Although I was left with numbness in my pinky toe. A physical exam also revealed decrease calf raise but NO pain and the physician assistant said my S1 was affected and rec a MRI. I sought a sports medicine MD who placed me on an oral steroid taper with no change in symptoms. He referred me to a neurologist to have a MRI in Feb 2013 which subsequently revealed a herniated disc on L5/S1 and referred me to a ortho-spine surgeon. I have since sought 3 more specialist who essentially said the same thing to get a discectomy.

    None of the surgeons were worried about doing the procedure immediately, though the neurologist rec the sooner vs later as if the nerve is damaged for a prolonged period of time (>3 months) the symptoms could be permanent. Ahhhh...! I thought!! I was able to run mid 6 min pace just a year ago and now can't break a 9:30 pace. I have focused on PT to try and strengthen my calf which has mildly improved and I am at month 3 currently with surgery scheduled in a week.

    Anybody with similar symptoms and treated conservatively?
  • Went to the doctor today. The doctor said that the mri is hard to read but looks like there could be a herniated disc and thinks that my SI joint is causing me pain. Is it possible to both of these things come from the same incident? It just seems really weird. Anyways, he wants me to get a cortisone shot, which I am not looking forward to, on Friday in the SI joint and at the L4/L5 area. Anyone who has had these, can you tell me what it is like and what to expect? I'm seriously really nervous. How did you feel after it?
    Brianna Reid
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