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L5/S1 herniation & microdiscectomy - going forward but confused

First and foremost this looks to be an excellent community after reading through a bunch of forum threads. I really wish I had found this much sooner. For those that want the quick version of my battle with sciatica:

L5/S1 disc herniation -> 5 months of progressively worse sciatic pain -> microdiscectomy -> success -> 2 months later re-herniation - > mild pain, becomes moderate if I try energetic activities.

I am a 29 year old male dealing with an L5/S1 disc herniation. Last summer I injured my back twice in two weeks, I initially injured it on an amusement park ride (it was very sore for a week) and then severely injured it weight lifted a week afterwards. I could barely walk after the weight lifting injury and went to the ER. An MRI revealed I herniated my L5/S1 disc. Pain was only in my lower left back. I was pretty much given a conservative treatment plan: PT, medication, injections and chiropractor care did little to help.

Over time the pain started to become intense and localized on the back and side of my left leg. It reached a point that it hurt to walk and stand longer than 5 minutes. The pain was very intense, It became a struggle to do anything, life became miserable. After much debate, I saw a well-respected neurosurgeon and had a microdiscectomy. The surgery was 5 months after my initial injury.

After the surgery the pain was gone, it was amazing! I felt like I had gotten my life back. I began to walk and do light PT a few weeks after the surgery. I noticed stiffness and low pain in my back 5 weeks after surgery, but it was low level stuff that was more of an annoyance than anything else at first. Unfortunately it has worsened over the course of 3 months after the surgery and I started to get occasional pain in the upper portion of left leg. The neurosurgeon wanted an MRI and sure enough I had another herniation in the L5/S1 disc, it was much less severe than my initial herniation but it seems to be the source of my current pain.

I am back in PT and have been using lioderm patches. I feel I am in a touch spot, as the pain is not frequent or strong enough to prevent me from doing my daily tasks, but I cannot do anything active as it will act up and I will be sore next few days. I used to be super active prior to this injury, playing sports, hiking etc. Post injury all I really do is read, walk, and non-energetic type stuff. I am somewhat depressed about this condition and I fear this is going to worsen again overtime.

I know many people are dealing with much worse sciatic/back conditions and my heart goes out to them, I can only begin to imagine what you have gone through up to this point. Any feedback, advice or even a story of your battle with sciatica/microdiscectomy would be much appreciated!


  • it seems like the general course of surgical treatment is microdisectomy and then disectomy/fusion. How many microdisectomy's typical does one have before they move on to the disectomy stage? Also is it common for a person to have more than one microdisectomy?

  • i've had 2 surgeons over the last few years. i also had a microdisectomy and then re-herniated. i had 2 microdisectomies (which is not unusual). but i herniated for the 3rd time. both of my surgeons considered a 3rd microdisectomy, which is not that common, but not unheard of either. it depends on how conservative the doctor is. Also how much disc material you still have left, what else might be going on. in my case, both docs suggested the 3rd, but when i finally agreed to have a 3rd surgery, a ner MRI and CT scan also showed a significant bone spur that was impinging the nerve root. the only way to get rid of it, was the fusion because they had to cut away bone to get in there.
    Microdisectomy / hemi-laminectomy 6/2010 and revision 10/2010
    Cervical fusion C4-5 and C5-6 9/2011
    Lumbar Fusion L5-S1 6/2012
  • PaulPPaul Posts: 730
    edited 03/19/2013 - 7:56 PM
    Sorry to hear of your troubles.

    Discectomy and microdiscectomy are essentially the same kind of surgery with the difference being the approach. In the first version, they make a long incision above the vertebrate and cut thru muscles, tendons, and ligaments. Once at the bone, they cut a window thru the lamina to finally access the disc itself. They can directly see everything with their own unaided eyes. After pulling the nerve aside, they grasp out the herniated nucleus material. They then close with a lot of sutures.

    In the micro version, they only make a small incision of about an inch or two at most and use dilators with microscopes and cameras to get to the bone. Then they cut thru it to get at the herniation grasp at it as above. They close with a few sutures.There are videos of this on youtube.

    In another version, they only make 2 small perforations on your side. Then, with flexible instrumentation flexible cameras, flouroscopy and CT scan mapping, they fish it thru the foramins and work on the herniation. No sutures needed; only two band-aids. This is the version I had. When I had L5-S1 worked on, they touched up L4-L5 a little bit while they were in there. I would venture that a transforaminal microdiscectomy could be done a number of times on the same disc. Each case is different of course.

    The next kind of procedure would involve leaving the natural disc in there, but they install an x-stop device in the pars proccesses. This reduces motion in that segment.

    Others are experimenting with injectable synthetic nucleus material to augment what's left of the natural nucleus.

    Stem cell regenerative treatments are being worked on. Maybe in the future those will be a viable alternative. For now, the ones they have attempted have not produced appreciable benefits.

    Next is the Artificial Disc Replacement. This is a device that is a man-made version of a disc. The natural disc is completely removed and the device is installed. It is a big surgery with high possibility of permanent considerations. This technology is abundant in Germany, but here in the States, we are a little bit shy. Some have reported great results, others not so much.

    Finally, is the fusion. The massive surgery. Here, they make a large incision, cut thru muscles, ligaments, tendons, and set aside the internal organs, then remove the natural disc and install something in its place. That something can be a cage filled with cadaver bone or synthetic material. They also install hardware (titanium rods and screws) to immobilize the segment while the bone grows and fuses the vertebrates together. You lose the problem causing disc but you also lose mobility of that segment and it sets off a chain reaction in the adjacent discs since they now have to carry the load once carried by the now missing disc. Lotta people do ok, lotta people do not.

    Once a disc's outer covering (called the annulus) is breached, scar tissue attempts to close it back up. However, the scar tissue is not as strong as the annulus tissue. So, if the annulus material did not hold, the scar tissue will have a greater probability of letting go under the same kinds of stresses.
    Alright.... now I am going to be very candid with you. These things I am going to tell you might be tough to take. From now on, that disc is going to be the weakest link. You might have to live with this new limitation from now on. This means that if you want to stay out of pain and out of surgery places, you are going to think about not doing anymore deadlifts, bent over rows, good mornings, shoulder presses, standing calf raises, military presses, french presses.

    All of those movements transfer massive amount of weight thru the lumbar discs. Compressive forces, Like from the roller coaster, also put g-forces thru the lumbar discs.

    Shearing forces, like from a golf swing, are bad too. Running/jogging puts shock forces thru the lumbar discs.

    Yes, it can be very depressing. I know, I have lived it. All those things I listed? I used to do them and more. Kickboxing, Jiu-jitsu, golfing, running, carrying girls on my shoulders, etc etc.

    OK, I gave you the bad part. But the good is that you can still do many things within an active healthy happy life. I am living it! It is an adjustment that takes time. My back problems got really bad in 2007. That's when I essentially had to change my life with the new limitations.

    Do I miss all those things? Sure. I miss golf so bad. Jiu jitsu and kickboxing too.
    It was real bad at first, but I have accepted it and moved on. There are lots of things to do. I ride my bike just about every day and it's great. I get out in the sun, fresh air, I get a cardio workout, I see different places, people, and I even run errands all over town now too. I have gone back to school. At work, when I have to move something heavy, I ask for help. THAT was a tuff one because I am someone that wants to everything himself and hates asking for help. LOL

    I am going to send you a pm with a link to some good info. Check 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
  • ChrisM: 3 is usual magic number. But each case is unique.
  • Especially for the candid part.
    Microdiscectomy L5-S1; Jan. 28, 2013
  • ChrisMCChrisM Posts: 5
    edited 03/22/2013 - 5:32 AM
    Paul, that was very nice of you to take the time to post detailed explanation on microdisectomy, disectomy, fusion with the general progression. To be honest, that has been the most informative thing I have read on this topic since I started seeking information on my herniated disc issue. Also the advise, realistic expectations, and how you have adapted dealing with this issue is MUCH appreciated. I know that post had to take some time to write and I can not thank you enough for spending that time to write that!

    Dave and tran92, thank you for your feedback as well.

    I think the 3 things that are always on my mind constantly.

    The first is the state i am in, soreness & pain, not enough to prevent me from working and daily tasks but prevents me from anything outside of that. The second is the prospective of another microdisectomy and the path i will go down if this has to happen. Paul, you post has made me feel better about both of these things.

    The third is the degenerative nature of disc injuries and the resulting prognosis. Eventually I'll accept that I can't do some of the things I did prior to this injury, but I can't break from the mindset this will never get better, it will only continue to bother me and get worse as time passes. This is tough to deal with.

    I will keep at PT and lioderm patches, I have a follow up appointment with my neurosurgeon's PA next month. I will try to stay positive and follow the instructions of the medical professionals I am seeing for treatment.

  • DaveFusionDDaveFusion Posts: 476
    edited 03/22/2013 - 3:39 PM

    Suggest you discuss the value of swimming with your surgeon. It was strongly suggested to me by mine after the microdiscectomy, to prevent and soften the internal scar tissue adjacent to the nerve root. Note: use snorkel and goggles to reduce twisting motion to breathe.

    Swimming was helping a lot but I had other issues that caused nerve damage and the subsequent spinal fusion has improved things. I am now about to recommended swimming as PT.

    Good luck.
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