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Slip disc in L4/L5 - confused to go for surgery or not? The pain isnt major but had it for 4 years

Dear All,

Thank you for reading through this firstly. As a newbie, I apologize in advance if i'm missed any of the rules of the forum. I'm gonna shoot straight to the big question - do i need surgery - specifically microdiscectomy (doctors have advised against nucleoplasty as the bulge/protrusion is large and it wont help)?

I have had a slip disc for the last 4 years and the days i exert myself there is shooting pain down my leg. The days i completely rest (bed rest), i could play extreme sports (not that i've tried). I havent been to the gym or played a sport in the fear that things might get worse. Most doctors after looking at my mri have said the disc is out but its not that big a problem, lets try conservative methods. I've tried every possible thing, yoga, physio, accupuncture, chiro etc. I havent been very regular to be honest but i have tried giving each a shot for atleast a month or more. I have finally mentally made up my mind to go for surgery but a lot of people who have had surgery have told me this should be a last resort. Now, i'm not in major pain that i need surgery but my lifestyle is such that we go out alot and my dearest wife has to suffer more than me due to this (we have traveled to over 50 new cities in the last 4 years, we both love traveling and taking holidays and i have the luxury to do so).

Here begins my list of questions, anyone with prior similar experience who can comment on any of them, would be much much appreciated:

1. the pain in the leg will go away 100% and the pain in the back will be reduced tremendously (90-100% less pain than existing) with microdiscectomy?

2. Best case scenario with microdiscectomy - i can go back to play extreme sports, diving etc and may not require any exercises etc to keep the back in correct posture or for relapse.
Worst case scenario there will be 90% less back pain than what i am at right now and i will need to keep strengthening the back? Am i correct?

3. I have been very lazy with exercises and knowing my lifestyle I doubt I will ever get to regular exercises - I just want to make sure post surgery things will not deteriorate because of that.

4. Will the degenerative disc get worse, better or stay same with surgery?

5. someone recommended i take an epidural and try strengthening my back (going to the gym daily for 2 hours) first before going to surgery. if the epi doesnt work then surgery would be the best option - do you agree?

6. If yes to above, currently i am generally in pain (3 or 4 on 10 amount of pain) which reduces my initiative and also doesnt allow me to push for more. not sure if not surgery what else can be done to strengthen the back in this pain.

7. I am generally lazy about exercises - will post care be an issue if this is taken lightly? I have heard the chances of a relapse are high if i dont strengthen the back?

8. if yes to above, is it better to leave it untreated and the chance of a relapse reduces (considering the back is natural and no surgery is done) or is the probability of a relapse the same with or without surgery?

9. I have always had a tight hamstring since high school - i used to play a lot of sports and my instructors always told me about it. even now i have very strong calfs but my hamstrings are very tight - will surgery loosen them? will i need to anyway fix this issue with or without surgery?

10. is there any breakthrough in technology that will specifically help someone as such in my case? Looking for an alternate to microdiscectomy that may be worth considering?

As i mentioned above, any help/feedback/suggestion from someone whose been through something similar will be much appreciated. Age: 30. No kids yet. Weight 150 pounds (not overweight yet). Work - business owner but a technology firm (which means im behind a desk atleast 10 hours a day).


  • If the pain is manageable, then avoiding surgery is the best option. I was in your position 5 yrs back and though the pain was not considerable, i went for the surgery thinking that my back will be perfect but the actual problem is after surgery, it's not. You will have to strengthen the back by exercising even after surgery and so there is no use of going under knife to avoid exercising. In my case, i had MD in 2009 and there was no pain so started to indulge in hard sports and gym. Three months back, had a recurrent with huge pain and undergone revision MD last month. Still, not much reduction in pain but its too early.

    My suggestion will be to avoid surgery and bring a minor change in the lifestyle by regularly doing the exercise atleast 15 mins a day. This will strengthen your back and avoid further issues because when i turnback and see myself, that was the best option i did not choose and regret for.
  • Thank you liz and ratzcare,

    This is the exact same issue i just discussed with my doctor. its a cycle - i cant go to the gym because im currently in some pain and dont want to aggravate it, and unless i go to the gym, i cant strengthen my back. (on top of that i have excessive working hours and social hours and have absolutely no time for myself to fix this). i agree going under the knife should be a last resort but i feel if i will never get around to going to the gym due to the pain, shouldnt i try this route instead?

    (*i just read what i wrote and realized im making excuses about no time whereas making time is def better than going for surgery - this forum is already starting to help).
  • You can try the Epidural injection and look unto restarting physical therapy. PT will provide you with low impact stretches/exercises to help strengthen your core. If you start doing low impact exercises and walking daily, you may be able to slowly build the strength to get back in the Gym. Surgery should be a last option so if the pain is bearable, I would give conservative treatments another shot. It's possible that the symptoms will improve in their own, but it's also possible that the disc bulge could worsen, and if there is nerve compression then surgery would be a viable option. Spinal surgery alters our anatomy to a degree so there is always risk of either no improvement, or even worsening symptoms. Ultimately the choice comes down to you and what your surgeon recommends. Just make sure that you have realistic expectations. Recovering from spinal surgery is not easy, but there are many who have successful outcomes.

    Progressive DDD
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • Another point of view:

    You could have the strongest back muscles that have ever been known but you're still going to have a damaged disc. No amount of exercise could ever fix a bad disc. It's the weak link. They never get better. Further, if you strain during the activity as is the goal for most trainers/therapists, intradiscal pressure goes way up. This pushes the limits of the scar tissue holding the opening closed.

    As far as new tech, medicine is seeking to reverse disc damage on a genetic and cellular level. However, these advancements are still far away.

    M.D. got rid of 100% of my back and 100% leg pain.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
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