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Surgery or Not

Hi my name is Amanda. I am 26 years old. On June 15, 2012 (out of nowhere) I woke up and could barely walk. Since 2005 I had been getting "flare ups" of my sciatic nerve, which would usually leave me nearly immobile for weeks until it would simmer down and go away. This time however the pain would not go away. I am a teacher so I had all summer to rest my back but the pain did not subside. It was really affecting my life. Finally in August I saw a specialist and had an MRI done. The MRI showed I had two herniated discs L4 and L5. Since then I have had two cortisone injections, in conjunction with physical therapy, and a round of prolotherapy injections. All of this with little to no relief. Finally in March my doctor told me that after all the things I had tried it would probably be surgery that would give me the relief I was looking for and deserved. My doctor referred me to a surgeon and I set my laminectomy and discectomy for June 25, 2013. (I waited for school to be over so I could take the time I need to heal.)

My dilemma is, besides when I moved into my new apartment on June1, I have been in the least amount of pain I have been in all year. I feel as if, unless I try, I am not in pain and can function almost the way I did before I was "injured." I even went for a little run yesterday and, although my foot went numb in the beginning of the run, I was relatively fine. I don't know if i should still do the surgery or if I should wait until I have another "flare up." My surgery ordered me a new MRI on Monday to see if it had changed from the MRI in august but it still shows a substantial herniation. About 2/3 of my disc (or the fluid i'm not sure) is on my spinal cord.

The reason I am having such a dilemma is because, as I said, I am a teacher. I have the summer to heal. What if I don't get the surgery and then in August or September, it flares up? Then will I be in pain for months again, waiting until summer comes along to do surgery. I have really been trying to do things I would do before I was hurt. (I was doing the Insanity exercise program a week or two before I was hurt!!) I was very inactive all year. I couldn't practice with the basketball and lax teams that I coach, and I had to keep sitting to take the edge off the pain.

Please advise! I think in my heart I want to do the surgery now rather then waiting for a time when it "needs" to be done because of so much pain, but in the back of my mind I think what if it keeps getting better, and it doesn't flare up again?


  • LizLiz Posts: 7,832
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    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • PaulPPaul Posts: 730
    edited 06/13/2013 - 7:57 AM
    The surgery is not a guaranteed fix.

    A disc is like a jelly donut: a tough outer covering called the annulus and the inside "jelly" called the nucleus.
    When the outer covering is compromised for one reason or another, differing degrees of bulging or extrusion of the nuclear material occurs.

    If the herniated material is stuck in the rip or the hole, it can be likened to a towel stuck in the doorway of a bathroom door. You can't close it all the way until the towel is removed. Once the towel is removed you can close the door. However, in the case of our discs, the body attempts to close the hole with scar tissue. Unfortunately, the scar tissue is weaker than disc fibers.

    Thus, if the disc was not strong enough to contain the first extrusion, the scar tissue will be even less capable of handling the same amounts of forces. Therefore, you will have to change your lifestyle so that there are lesser forces being imposed on the disc.

    Now, about the MRI images. If you take 10 people off the street and MRI them, some will show awful looking spines yet are asymptomatic. Conversely, some will show perfect spinal structures, yet be in a ton of pain. Nice, huh?

    I personally experienced what you are going thru now. In one instance, I held off and things got better. It should be noted that waiting may have permanent consequences. For example, my right calf shrank when my right L4-L5 nerve was compressed by the herniated disc. Macrophages ate away the herniated nuclear material; It also retracted some as well. Combined, those two things were enough to keep me off the operating table because it became pain-free. But I did face permanent nerve damage and paralysis. Every case is unique.

    I know one instructor who tore her ACL at a conference in San Fran. It was 6 weeks away from the end of the semester yet she held surgery off till then. I personally witnessed her daily struggle. I, on the other hand, was only 4 weeks into the new semester when I blew out my L5-S1. I had to drop out because there was no way in heck I was going to be able to go. I couldn't even walk.

    I'm sending you a link to some 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
  • optimistooptimist Posts: 546
    edited 06/13/2013 - 8:42 AM
    You have to rely on gut feelings here; when I first saw your post and your (young) age I thought "Oh no, don't go there yet" - have you really done as much conservative therapy as possible? But then I saw the comment about the change in the MRI - and how much cord was being compressed by the disc...I would have to STRONGLY suggest having another surgeon and maybe a physiatrist look at your films for a second opinion before you undergo the knife and be 100% sure in your decision. Hate to say it but with Obamacare around the corner more surgeons may be suggesting surgery. I had a cervical herniation I babied for 4 years without surgery before it improved, and joined here with two lumbar fusions - if I could take back my fusions I would.
    While microsdiscectomies can be wonderful in the results they produce, they may not be a panacea. Good luck with your decision.
  • mommaof4mmommaof4 Posts: 24
    edited 06/13/2013 - 9:05 AM
    Little background...3 years ago, I started having hip pain I'm an avid runner and lifter so I though I was over training for a half. I had a MRI and it showed l4/l5 herniated disk, annular tear and some other stuff. Very hard for me to compute that it was my back with no back pain. Although my herniated disk was not significant, the tear was. I went through PT...nothing, refused the shots then. Last summer, my back finally started to hurt, my right leg became difficult to lift and push and I was falling when I was running. My calf muscle was shrinking, 1/2 of inch difference. I went to a very reputable NS and he didn't think I was a candidate for surgery, but insisted on the shots in conjunction with PT. Nothing with the first two, then after the facet I was never the same. That's when I had the disco gram along with nerve test. The nerve test showed significant nerve damage and the discogram verified that it was indeed my L4/L5. My NS then told me that if I didn't have a fusion I would have permanent nerve damage. I lost it...I asked why not a laminectomy, basically my issues was the Annular Tear. I made my decision to have a minimum invasive fusion the day that I couldn't take my youngest son to the zoo. I'm scheduled for a XLIF 6/21.So, with all that said...consider your quality of life, I'm 36 with 4 kids who loves to run, compete in crazy obstacles and play sports with my kids. Once I got past what I used to do vs what I'm doing now, the decision was made. Good Luck on your decision.
    36 Year old mom of 4 awesome kido's, and married to the love of my life!

    IT Assistant with the Federal Government.

    L4/L5 XLIF 6/21/213 to correct nerve damage to my right leg.

    Each day is a step forward, even if it's baby steps!
  • Hi! First, I'm a teacher.... (well, I had to give up the classroom due to my spine issues, but I am now a STEM specialist, still do some "teaching" and professional development, etc)... I'd certainly get a second opinion first and foremost. Normally I'd suggest trying to put off surgery as long as possible as it is certainly a "life changer" and may not provide pain relief (of course it might give you your life back....) However, someone brought up the new health care reform in America. This is NOT political, this is just something ALL of us need to think about. The entire premise of the new health care reform is that many Americans can't afford health insurance and therefore don't get the medical treatment they need... introducing this new system is suppose to give these people access to health coverage.... which could mean (if it all works as planned) that come January you are going to have lots of people who have had multitudes of issues that they were never able to have medically addressed finally making medical appointments. We can all be certain a lot of these issues will be spine related... so in the matter of months we'll have a HUGE new population of "spine patients" but no "extra" spine surgeons... so spine surgeons could become way over taxed quickly. It could take a lot longer to get a surgery date if you wait till next year. That is something you need to think about when weighing the pros and cons. Best of luck to you. I know this is a very hard decision.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
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