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Large Central Extrusion, No Sciatica, Surgery Questionable?

iamadpiiamadp Posts: 5
edited 03/20/2014 - 6:02 AM in Back Surgery and Neck Surgery
I hurt my back surfing early October 2013. I did not take the pain lightly and kept doing heavy workouts like running, stair sprints, and surfing. I did not have significant sciatica pain until this January 2014. I had bad sciatica for a month, couldnt lay flat on my back in bed, i would wake up and get spasms in my back and hip. February 2014 the spasms and sciatica pain are non existent. No leg pain now.

I have no pain in my leg so the neurosurgeon says we dont need to operate. Then he looks at my MRI. MRI shows i have a large central extrusion/herniation at L4/L5 directly affecting my Spinal Cord. He says im at risk for cauda equina syndrome. It is strange because my pain is only at a 3 to 5 on the 1-10 scale. The doc asked me to get another neurosurgeons opinion.

I dont want surgery. Surgeon #1 says Id need a fusion. Id really like to conservatively treat the herniation since I dont have too much pain. But since im at risk for Cauda Equina I could go and get the invasive surgery... Need to see another neurosurgeon for consult #2.



  • Id also like to add that im only 25...
  • EscapeFLEEscapeFL Posts: 14
    edited 03/20/2014 - 6:12 AM
    That's great that you don't have sciatica. At your age, you wouldn't want to risk the fallout from the cauda equina. I'd look into that second opinion soon and go from there. Maybe in the meantime, take it a little more easy on the work outs.
  • I'm 2 weeks post op from MIS TLIF and doing great, btw. I think the choice of surgeon is crucial. Skill level can vary a lot.
  • Neurosurgeon #1 says the fusion would not be minimally invasive. So im looking at a full procedure here. Just made an appointment with Neurosurgeon #2 but it isnt till mid April. I guess i will be taking it easy till then and watching out for any bad signs of cauda equina.

    I just feel blessed I have no sciatica. Lots of stretching and mckenzie excersizes help
  • I think you'll find that if you present your case independently to various spine surgeons, you'll get differing degrees of proposed solutions. I interviewed 7 of them when I was looking for a solution. None knew about the others. It ranged from "do nothing" to full blown 360 degree fusion and a few things in between.

    I went with the one that would give me the most benefit with the least amount of detriment (collateral damage to the spine).

    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • can result in paralysis and permanent damage to your bladder, bowels and sexual organs, depending on the level effected if a compression is left too long. Nerves within the canal do NOT recover the same way as ones outside the spinal canal so even thiough you do not have leg ( neuropathic pain) , the dangers of not addressing the compression of your spinal cord nerves can have long lasting effects, especially given your level of physical activity.
    You do not want to wind up in a wheelchair or having to self cath for the rest of your life.........
  • I had a major disc herniation L4. I did not know it, I just thought my hip hurt and I was "off" after I got out of bed and fell to the floor for no reason . Fast forward a few months after every possible thing I could do to stop the discomfort and sciatica I started interviewing surgeons. All 4 said I needed an operation. But 2 of the 4 said 'now" the others ( that I liked best) said that based on my fight and determination and what I had done already( PT, yoga, massage, acupuncture etc.) they felt I should wait to see if I got worse, and that I may even avoid surgery. Well, I got worse and in December 2012 I had the surgery- I am 95-98% most days but still learning my limitations. I just got back from a ski trip and did great. I'm at the gym several days a week and I walk a lot . You are very young. You don't know what the next 25 years will bring. Even if you have to pay out of pocket to get another opinion, do it. Find a good teaching hospital, plead your case, they will negotiate on the cost of a consultation if your insurance does not cover it. Remember, there are good surgeons, and not so good surgeons. Get a list of referrals too. Especially young patients they have treated. Avoid putting any hardware in your body via a fusion at all cost. My disc extrusion was HUGE, but they did a laminectomy/discectomy, basically trimmed off the part that was out of place. No hardware. Sounds like you need to do lighter workouts, hard to do if you are used to strenuous stuff, but you can get the core strength with yoga, Pilates and gentler stuff for a while. Yes, I want to do Crossfit and Ju Jitsu too, but I can't any more. I manage some tough HIIT classes at my gym, modify to low impact and still get the benefits. I'm 57, but work out and train like someone half my age. And, thankful for a good surgeon . Good luck.
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