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How to decide to stop conservative treatment and have surgery?

bruin94_01bbruin94_01 Posts: 2
Hello everyone! I'm looking for advice on how to decide which route to take, since each option presented has its values and its detractors.

My case history:

July 17, 2013 - I was healthy up til then - played soccer multiple times a week, backpacked, hiked. Then, the freak bike accident - I was mountain biking and hit a root that made the bike come to a complete stop. My lower body stayed put but my upper body went forward and then back onto the seat. Somewhere in this movement I heard and felt a pop in my lower back (the "uh oh moment"). Immediate treatment was vicoden, ibuprofen, flexeril, ice and lots of laying down. The pain eased a bit.

Early Sept 2013 - Pain worsened and started radiating down both legs. MRI showed a broadbased L5-S1 herniation. Started taking gabapentin, still taking ibuprofen and vicoden as needed. Started physical therapy - core stabilization exercises, ergonomics, TENS unit.

December 2013 - Not much change - could work but couldn't drive for more than 30 minutes; limited exercise and social activity. Had first epidural - worked well for about 3 months.

March 2014 - Not much change. Had second epidural - worked well for about 3 months. Tried traction therapy and acupuncture - traction felt good while doing it but no overall change, no change from acupuncture.

April 2014 - had second MRI that showed, if anything, herniation was slightly larger.

May 2014 - had microdisectomy. Felt good for two months, but with the occasional nerve twinge particularly when lengthening (putting shoes on, etc.)

August 2014 - third MRI showed reherniation, most likely through the incision in the disc from the microdisectomy. Still on gabapentin and ibuprofen. Still doing core stabilization exercises. Still working, short driving, and minimal exercise including yoga and pilates.

October 2014 - pain increasing, so had third epidural (or first, depending on how you look at it).

End of November 2014 - pain significantly increased, increased dose of gabapentin from 300 mg to 1800 mg. Pain continued to increase.

Mid December 2014 - pain continuing to increase to the point where I can't eat a full meal while sitting (or standing/wandering), can't work, can't drive. Had forth epidural, no apparent effect. Had forth MRI that showed the herniation is slightly larger. Started taking Norco 6-8 per day. Restarted using the TENS unit. I basically haven't gotten out of bed since Christmas since my pain level averages 5-6 with bouts up to 7-8 (and I have a high pain tolerance) , except for the necessities. On good days I can walk 6 or so blocks or, if someone drives me, go grocery shopping. On bad days I've choked on food because of a pain burst while swallowing, laid down on the floor in restaurants and movie theaters because I was no longer able to tolerate sitting or pacing, crawled around the house since it hurt less than standing.

Early January 2015 - I'm on the books for a fusion at the end of the month, just so it's scheduled if I decide to take that option. I also saw a chiropractor who recommended 6 weeks of spinal manipulations with the expectation that at that time I would be in less pain and could then wait on the healing process and could avoid the surgery.

I have to make a choice - have the surgery at the end of the month or delay the surgery and see if the chiropractic and continued meds & exercises gets me to a point that I can, literally, get out of bed. I've got all the information, but I don't know how to make the decision. Have I "exhausted" my alternatives or have I not tried enough of them or let enough time pass? Advice and shared experiences would be appreciated!



  • maryingram3615mmaryingram3615 Posts: 1
    edited 01/20/2015 - 12:09 PM
    I have my surgery scheduled for the end of the month... here is how I SEE it can you live a somewhat normal life in extreme pain, or take a chance for less pain so you can at least do your needed items without severe pain. i wrote out all the pros and ALL the cons for surgery.. My mother had the surgery with noticeable pain release, while my father had same surgery same doctor and his pain stayed the same. I prayed for release of pain begged dr to remove the nerve kill it or cut off my leg,lol, the pain is to much to take so I plan on going for it. Also, sometimes the alternatives can and do worsen the pain . praying for you
  • I wish I'd had my initial surgery earlier. I had no injury & probably should have gotten a diagnosis sooner. I also spent 18months post diagnosis down the conservative path before surgery. Although not diagnosed as I'm only 5 months post fusion, i wouldn't be at all surprised if I have some permanent nerve damage. I've since read that if the nerve is severely compressed surgery may be the only way to relieve it.

    I feel so much better having had the fusion. I can go out for dinner, travel, sit through an entire movie and am increasing my exercise level as each month passes. It wasn't a magic fix, I still have some pain but I have my life back.

    I have no personal opinion on chiro's as I didn't go down that path but there are many here who would tell you to steer clear.

    18 months of conservative treatment is giving it a good shot. I guess the question is 'can you go on like this?' Just remember a fusion is usually done to stabilise the spine & that pain relief is an added bonus. For me the risk was worth it for the chance to rid me of the crippling nerve pain. It worked & my residual nerve pain is tolerable with medication.

    Microdiscectomy L5S1 January 2014
    Microdiscectomy L5S1 March 2014
    Fusion L5S1 11th August 2014
  • Had my first microdisectomy March 2013 was great for nine months. Went back on Boniva Nd 3 days later sciatica is back. These meds can bring it on. Neurosurgeon and family doctor believe it could have triggered something Had three epidurals, therapy and now having second surgery in 11 days. Surgeon feels it will work .
    Roselyn Reisman
  • dilaurodilauro ConnecticutPosts: 9,862
    When you have exhausted EVERY conservative treatment perhaps more than once

    The only thing that changes this IS IF your doctor says Surgery is the ONLY Option

    So many spinal problems have been taken care of without surgery. I am not saying everyone is in this picture, but so many people have had herniated discs resolve in time

    But the bottom line, besides your doctors input, is your quality of life. That is key to making this so very important decision.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Apart from the cause and disc levels, your timeline is identical to mine. I can't stand up for more than ten minutes without the pain kicking in, even though I'm on 120mgs of morphine a day.

    The bottom line for me is that I need to be able to stand up for longer periods when my new job starts in September. I've been offered fusion surgery on 5th March and I'm taking it.

    I feel better for having made that decision, knowing what to expect in recovery and preparing myself for it practically and emotionally.

    making the decision is the hardest part.
    L5-S1 herniation. Both knee meniscus tear. L4-5 herniation - 2 x nerve block injections. L4-5 discectomy. L1-2 nerve block injection. L4-5 reherniation - TLIF fusion. 2016: L1-2 and L5-S1 retrolistheses and multiple facet joint degeneration.
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