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L5-S1 Herniation...At a Fork in the Road!

Hello everyone. :) I've been lurking on this site for months now, so I figured I should just sign up and join in the fray. I'm a 35-year old female, super active, and I've been somewhat down for the count since December 15, 2014, with days of varying dysfunction.

I had a car accident in 2002 which was the start of my back problems. I've generally just had stiffness, occasional pain, and sciatica here and there, though rarely. MRIs over the years show DDD, though nothing too major, and I've had bulging discs from L3 to S1. Well, now L5-S1 is herniated, or else I probably wouldn't be here. ;)

Anyway, I've always had relief through massage and chiropractic care, so when this whole thing happened recently I was surprised that I couldn't get it under control. Basically, I'd been having pain in my right buttock since November 2014. I really thought I had piriformis syndrome, so I was doing a lot of stretching and massage. After a particularly strenuous personal training session on December 13, I woke up on the 15th in the worst pain I've ever had in my life. Completely searing pain from my right buttock to my 4th and 5th toes on the right foot. I happen to be a physician, and so I knew immediately that I'd herniated my disc. Sure enough, an MRI confirmed a 10 mm x 14 mm x 13 mm right parcentral herniation. And so here I am.

I've done three courses of oral steroids, two cortisone injections (one in my hip, one in my piriformis muscle...these were both pre-MRI and I had no relief), seven sessions of acupuncture (great for temporary relief but nothing lasting), multiple massages, multiple appointments with my chiropractor (again, temporary relief), several sessions of PT plus daily home stretching (which led me to get substantially worse), and one ESI at the beginning of February that helped tremendously ...three days for the sciatica, lasting relief thus far for my back stiffness. However, as most of us know, the sciatica is the real problem.

I'm at an interesting point now. I am able, for the most part, to walk with less pain and to be generally more able-bodied in my daily life. I have slept through the night more in the last week than I have in the last two and a half months. I consider that progress...though lately I've been having a lot of trouble getting comfortable while seated. There are times when it gets so bad that I have to lay on the floor of my office at work. (I have not missed any work except for a half day last week...physical therapy was VERY rough on me.) But yet I consider the fact that I'm sleeping and having relatively less pain as progress...but what do I know? My symptoms could just be changing and not actually improving. I really don't know.

I trust my orthopedic surgeon implicitly. He has not pushed surgery and has actually encouraged me to do conservative treatments first. He cited a study for me about how people who opt for surgery and people who opt for conservative treatment generally report the same level of recovery at 5 and 10 years down the road...but he said it really depends on how much pain you can tolerate and how much it's interrupting your daily life when it comes to choosing surgery. I have my second ESI scheduled for this coming Tuesday, and if I don't have lasting relief, I probably am going to need to make a decision. He's recommending microdisdectomy, which doesn't particularly worry me...but it's amazing what you'll accept after you've been in pain for so long!

Driving my decisions is the fact that I am a kayaker, mountain climber, and skier. I simply cannot imagine a life without those things, and so I am having an incredibly difficult time deciding what road I should choose. I know that everyone's path and everyone's recovery is different, so I guess I'm not necessarily looking for advice... I think I'm just looking to be among people who understand what I'm going through and who have been in my position. I have a lot of support in "real life", but it's limited by the fact that no one really gets how frustrating and awful this is for me.

So...hello, everyone. And thanks for reading my little novel. ;) I'm typing as I sit on my tennis ball, which has been my constant companion since this all started!

(Of note, I'm currently in the middle of a ski vacation. For reasons unknown to me AND my orthopedic surgeon, skiing gives me no pain and actually relieves my symptoms for several hours. I wish I knew why!)


  • LizLiz Posts: 7,832
    Welcome to Spine-Health

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    If there are any questions, you can always post them here, send Liz or myself a private message or contact Ron rdilauro@veritashealth.com

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Hello
    I'm feeling the same way also. My L5 S1with DDD is not as big though but I've done the injections and other things you have stated above. I feel a little better but It's been just a little over 6 months. My problem is I'm in construction and drive and haul heavy construction equipment. I'm unable to work due to sciatica pain but I have tried with little success. The doctor's keep pushing for the injection which last 2 months. I just do not know what to do anymore. Best of luck to you.
  • Thank you, and best of luck to you as well!

    This pain sure does have a way of getting a person down... It's funny, I'm going back and reading my post and am amazed at how lighthearted I sound. It's remarkable what we adapt to. Meanwhile, I'm forced to sit on the floor of the tub while I shower most days, I come home from work and have to lay on my stomach for the remainder of the evening just to decrease the inflammation in my back, and I'm gritting my teeth through every day. I hope that by going for my second ESI that I'm not postponing the inevitable (surgery) and just dealing with the pain for longer than I actually have to. My ortho says I have a "better than 50-50" chance of recovering without surgery...but how long will it take? How much of my life will pass by me in the meantime? I wonder how people make peace with this.

    Thank you all for listening. :)

  • Do you have obvious nerve compression? Is the nerve pain worse than your back pain? The first question I would ask your surgeon is if you're at any risk for nerve damage by putting off the surgery. Secondly, chiropractic adjustments can make herniations worse. It really comes down to if you can live with the pain you're in. If it's affecting your quality of life, that's when you have to make the tough decision. If you're not at risk for nerve damage and you can handle the pain, surgery should be the last option. There are potential risks with having surgery so it's a tough decision to make. However, you may just be putting off the inevitable. It may be a good idea to get a second opinion before making the decision to have surgery. Did your surgeon say what your chances are of pain relief if you do have the surgery?
    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
  • Thanks for chiming in. :) The radicular pain is what's killing me, and it has been since day one. I have very little back pain...I would go so far as to say no more than the average person. But the pain in my buttock, hip, back of the thigh, and the ankle are enough to take the breath out of me sometimes. Thankfully my strength is 5/5, but I have weak ankle reflexes, tingling during a good moment, and searing pain during a bad moment.

    My quality of life has been completely affected by this. While I'm still able to work, everything else has taken a hit. I feel like all I do all day is think about my pain and how to avoid it. I'm coming up on three months and I'm awfully tired of it.

    My surgeon thinks that I'm a very good candidate for surgery and believes I have a better than 95% chance of getting pain relief with the microdiscectomy. He also thinks I may be able to improve without it, though he has always said that he is open to changing the course of my treatment whenever we need to. I think that this injection will be my decision-maker; if it works, great...but if it doesn't, I need to do something. I hate that it's come down to that for me, but I can't stand the pain. I know there are people here who are dealing with MUCH worse, and I'm sure I sound like a whiner! But this has been consuming me since December. I feel like life is going on without me.
  • Well, I think the biggest question you need to answer is, how much is your nerve being compressed? I had zero pain but lots of intermittent tingling for a few months before the horrible radiculopathy down my left leg literally brought me to my knees. By the time I got done fighting with my insurance company just to get an MRI, the damage to my nerve root was done. I had two microdiscectomies and then ruptured the disc a third time, which led to an l5/s1 fusion, all within a 4 month time span. My left foot and leg will most likely never function properly again. I know walk with a limp and a cane at age 36.

    If I had known how serious the nerve damage was and difficult, if not impossible, it could be to fix....I would have moved heaven and earth to be treated much faster. I can't go back and undo what has happened, but I hope that someone will read this and at least take the risks seriously. I tried everything conservative as well, even though I was in terrible pain for months. I begged different doctors to take me seriously, but no one would listen until it finally too late. I hope that you will be able to get the relief that you need with no lasting impairments. Best wishes!
    Left leg radiculopathy/sciatic pain
    L5/S1 microdiscectomy - May 30, 2014
    L5/S1 microdiscectomy - Aug 14, 2014
    L5/S1 TLIF - Sept. 24, 2014
    Left-side screws/rod removed along with bone fragment Dec. 29, 2014
  • Thanks so much for commenting. I'm sorry to hear about what you went through. :( It's so hard to look back on less-than-stellar decisions we made when our hindsight is 20/20!

    I don't know how much the nerve is compressed, but I know it's enough to cause a lot of pain. I've had random tingling in my ankle ever since I was involved in the car accident that I mentioned above, and an MRI done several years ago showed bulging at all lumbar levels except for L1-L2. But the major impingement of the nerve just started in December, I would think...though we all know that the length of time doesn't always make a difference.

    So...hard to say. I had my second ESI today and the experience was VERY different from my first. The first time around it was so easy! I couldn't figure out what the fuss was. This time it was a little more painful, and I actually had to wait a while afterward for the weakness in my right leg to subside. On the way home, I was feeling pretty pessimistic because the pain wasn't 100% gone like it was the first time...however, I'm feeling a little more relief now, three hours later. I'm also experiencing side effects I didn't get the first time (general lightheaded feeling, flushing, but nothing too crazy), so I wonder if he used a higher dose this time. I'm glad I did it and certainly don't think it went "wrong" somehow, but I couldn't help but notice the differences.

    In any case, I suppose we'll see. I told my surgeon that if this didn't work, I want to start discussing surgery more seriously. I thank everyone for their input thus far! :)
  • I am in the same position. with a big Hernia & medula espinal compression that affects my siatic nerve. But i am not going into surgery, no way!
    Message for LC84
  • Well, I met with my doctor today and scheduled surgery for April 30. He was amazing - he really let me make the decision on my own and even played devil's advocate, which helped me a lot. I appreciated his honesty and his opinion, which he gave only after I'd become set on mine.

    The second epidural didn't give me any significant relief, and both of us agree that a third would likely not be helpful at this point. He believes I'm a good candidate for surgery and anticipates a full recovery, though he would never guarantee it to anyone. He has done this procedure countless times; he likened it to a general surgeon taking out a gall bladder. ;) He feels very confident in going forward, and that makes ME feel confident in turn.

    Wish me luck. I'm nervous...but I'm looking forward to it. Weirdly. ;)
  • You're detailed description of your situation sounds very much like my own. Back in April of 2014, I had an MRI which revealed an L5/S1 herniation. I'm a kickboxing/bootcamp instructor, who's entire life revolves around fitness. My pain was mainly in my back - occasional leg pain. I went to several different neurosurgeons, trying to get the best advice, so I could make the right decision. At that time, 1/2 said surgery, the other half said physical therapy. Geeez, what the heck am I supposed to do right?

    After 6 months of trying everything in the book (2 rounds of shots, Chiro adjustments, acupuncture, inversion, physical therapy, etc ...) I found that water therapy gradually got me back to feeling about 99%. That lasted 3 months. I then decided to start teaching my bootcamp classes again. Bad idea. That lasted 1 month. I moved the wrong way, and I'm right back where I started with the addition of severe butt pain. Not really leg or foot, just butt (to be blunt!). So I don't know if it's sciatica or maybe an SI joint. I literally spend hours some nights trying to figure out what the heck is actually wrong with my back. It's frustrating, but now I'm leaning towards a microdiscectomy, like you.

    I share this story so you know you're not alone. I also have a very good support network at home, but as you mentioned, nobody has experienced this pain, both physically and emotionally, so it's good to talk with those that understand it and live it.

    I meet with 2 more doctors this week. Probably make my decision on surgery soon after that.

    My advice is just try and stay positive ... Reach out on this network anytime to get support and feedback, and hang in there.
    Best of luck with your surgery and keep us posted on progress:)
    Scott Giles
  • I have pain in my left hip, with tightness in the back of my thigh and knee, throbbing in my calf and stabbing pain in my heels. the only thing that shows up on my Mris are inflamed bones on the sacrum. The lumber Mri shown stenosis are L4 and L5, so after many shots not working, I opted for a Laminectomy. The operation was straight forward and I was back to work within two weeks, but unfortunately, it did nothing for my pain.
  • Is amazing how good is this history of every one telling their own stories, gives me a lot of relieves ans scaries me also.
    Wohhh finally you are going for the knife, you are very courageous! Please, please keep us inform of every thing!!! I need all the information to try to take the right decision.
    Thank you also too Scoot. I am in the same boat :-(
    Hernia in L4-L5 1,2 cm i was doing my recovery and everything was going smooth, and i screw up big time, they let me use my bike for 20-30 min. And because i was feeling like a champ i stayed with my kid 2,5 hours (what and idiot)
    Now i started every thing again :-( but the pain is bigger and the sleeping hours are less every day
    I stop taking any medicins and i am doing lots of water exercices, also a new fisio (woman) also yoggie is doing me a lot of good! But my left leg is not mine, it seems is from the neibourg. My butt gets really cramb like and iron steel that i cant hardly walk. And is really hard to massage must be a muscle really deep.
    My toos with cramps and munb, my tight also with crams... Is horrible! :-((((
    BUT i do not want cirjury, my father had 3 my mon 2 and they are not ok.
    I went last wensday to the doctor (traumatologist) and told me for the second time that i should go for the knife! NO WAY!
    I will keep lamping and my wife is searching a (neurocirujist) lets see what happens.
    Good luck for the brave mountain girl and for Scoot! Please keep us inform....
    Ps. Would be good to learn what type of operation you shall be taking.
    All the best
  • ScottGK said:
    You're detailed description of your situation sounds very much like my own. Back in April of 2014...
    Scott, thanks so much for sharing your very similar story! It's not nice that you have pain, but it's always nice to know that someone gets what you're going through.

    I told my surgeon on Friday that if my life was just about going to work and coming home, I could probably deal with the pain. I'm pretty sure that I could deal with it long enough for the disc to heal on its own. But I want to get back to life! And even if I do allow it time to heal on its own, there's no guarantee that it will. It's too big of a gamble for me to wait months and months, only to be in the same place I am now. That's unacceptable to me. Life is moving on even when I'm not, and that kills me!

    The butt pain is what's getting me the most lately. I totally understand what you're going through. In the beginning I considered SI joint dysfunction as well, but after multiple chiropractic adjustments and acupuncture, PLUS seeing my MRI, I figured the culprit had to be the disc. The heaviness/tingling in my foot is still happening if I'm on my feet too long, but that seems to be improving a little bit. But the butt pain...that's enough to make me want to tear my hair out. Not to mention that my piriformis is constantly spasming also, and that's always a good time.

    I'm interested in hearing how your next two appointments go. Please do keep us updated! :) And thanks so much for the positive words and support, its all much appreciated!
  • skipper, sorry to hear about your pain. :( Have you tried therapy or anything else to decrease the inflammation around your sacrum?

    Ernesto, I am not that brave...just desperate! ;) Sounds like you're fighting the good fight. I hope you find relief without surgery, it seems like you're nervous about that. I understand. Isn't that butt muscle a real annoyance??? Sounds like it could be your piriformis, it's a pretty deep muscle. That is SO painful when it gets tight!
  • I just put some ice in my muscle butt, but it did not work. I am going to read and learn every thing regarding "periformis" i think i over did the exercices today and that he is not happy ( my butt, periformis) :-)
    I am going to play a little bit with the internet and try to get some sleep! Amazing for me gives great confort, been seated in a hard chair.
    Well good night, and many thanks for your kind messages.

  • Ernesto martinEErnesto martin Posts: 14
    edited 03/23/2015 - 7:12 PM
    Hi, thank you for your kind message, here i am 2 oclock in the moring,
    My butt is killing me, i am going to read and learn every thing regarding "periformis" thanks. It hurts soo much, i just speend about 30 min. With ice but it did not work.
    One thing that relax me a lot is been seated in a hard chair, it relaxes and i do not feel any pain. But is not fun to sleep in a chair :-(
    I think i over did the exercises today at the pool and the muscle is angry at me.
    All the best, i am looking forward for your cirrugy .
  • Well, I wanted to update because things have been sucessful so far. :) I had my microdiscectomy on April 30. The surgeon kept me in the hospital overnight as is his protocol, and I'm glad he did. It just felt safer somehow.

    He said that my disc was herniated directly into the S1 nerve root. It hadn't broken through the annulus yet...he said it looked like a pearl, which is gross. What's even grosser is that he said it looked like a lump of crabmeat when he cut into it. LOL I don't think I'll be able to eat that for quite some time. Because the herniation was directly into the nerve root, he had to manipulate the nerve quite a bit to get to the disc. Because of that, he said I'd probably experience some nerve pain once the anesthesia wore off.

    I felt great after surgery! I could lie down in any position I wanted to without leg pain, which was amazing. That night, I walked a mile and a half in the hospital and felt so good. I didn't sleep very well because of all of the interruptions, but I was having no problem getting up to use the restroom or anything else. I did have some surgical site discomfort, obviously, but I didn't require any pain meds.

    I came home yesterday. The ride home from the hospital was 30 minutes...that was a bit uncomfortable, but it righted itself quickly once I got out of the car. I did a lot of resting on my stomach, but I also did a lot of walking around in the house and outside in the driveway. I did notice that I still had a tiny bit of buttock pain and some tingling in my foot, but it was nothing too drastic. I started taking Ultracet when I got home to help with the discomfort around the surgical site. No sense in powering through it and making the muscles tense.

    Today I feel loads better. I woke up and took a shower, which felt great. I had to rest a bit after that because I did some slight bending forward to clean my feet. ;) After resting I felt perfectly fine. I walked outside for about 20 minutes and noticed that my nerve pain had decreased a good deal. I still have some tingling in the outside of my right foot when I walk, but I imagine that will be around for some time. I went to the gym this afternoon and walked a mile, then I went to Target, I went to the liquor store for some wine... ;) ...and I brushed my dog and clipped his nails. After all of that, the surgical site felt a little tender, but nothing bad at all. The whole point is to get that area mobile anyway to decrease the scar tissue formation, so it's all good.

    I wanted to share how I was feeling because there aren't a lot of success stories on the Internet! So far I'm doing well. I know I'm not out of the woods, and I know nerve pain returns for people after surgery, but I'm happy with the improvement I've had thus far. I'll keep updating as I go. This is post-op day three. :)
  • I suspect that we don't read that many good reports on these forums because people out of pain are out being active, not up in the middle of the night typing reports here. It seems as if you, Mountaineering Gal, like to write, are good at expressing yourself, and may be have good reports as you heal from surgery. So, before you leave for the mountains, please consider keeping us up to date on your progress after your recent surgery. That might help some of us make decisions about our own ordeals. As for me, I've got a bulge at L5/S1 and barely was living due to #8 to #10 pain until I got the second ESI shot. Now I'm coping so much better and have decreased meds but still can't do all the things I'd like. (It's been 10 weeks since MRI) Skiing is now just a dream for next winter or maybe even after that. Thank you in advanced for keeping us posted.
    L5 S1 disk bulge starting Feb 2015. Hemilaminctomy July 2015 to relieve left leg nerve pain. In patient 24 hours. Neurosurgeon performed surgery.
  • wannabeactive said:
    I suspect that we don't read that many good reports on these forums because people out of pain are out being active, not up in the middle of the night typing reports here...
    I'm so glad to hear that you've had good results from your second ESI! Hopefully it gets you through so that you can continue to heal a bit more. :)

    As for me, I'm post-op day 5. I drove myself to the gym and went a little farther and slightly faster than I did yesterday with no ill effects. I'm using muscles I haven't used consistently for quite some time, so there's a little bit of aching going on, but it's just muscular and very mild. I came home and showered and changed, and I noticed that I'm getting some more range of motion in my right hip. That had been extremely tight due to my piriformis being in spasm all the time.

    I forgot to take my pain meds yesterday, so I guess that's a good thing! My surgical site hurts much less than it did in the beginning, though it's sometimes a little sore after working out. I know that we have to keep that area mobile, so I'm just listening to my body and resting when I need to, but I'm doing my best to keep things moving.

    Fingers crossed and I don't want to jinx myself, but I feel great so far!
  • SavageSavage United StatesPosts: 5,476
    Very happy to hear you are doing so well!
    So nice to share in successful outcomes!

    Thanks for sharing your story!
    And continued good luck!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • Nice to hear your fantastic improvement! Congratulations.
    Ps. Please keep us updated.
  • Thank you!

    Still feeling great today. Slight pain in my piriformis because I sat for two hours yesterday...little bit too much for post-op day 6. However, it's extremely mild and improving as the day goes on. Heading out to the gym in about 30 minutes to get my body moving!

    Very happy thus far!
  • Hi everyone. I wanted to provide an update just to hopefully spread some good news here when I can. :) I'm post-op day 9 and feeling great. Today I went shopping with my sister, the first REAL shopping I've been able to do since before Christmas. I drove us 30 minutes to the mall, we shopped for an hour and a half, sat down and had lunch for about an hour, and then I drove us the 30 minutes back to my house. I had no problems at all, which I was so happy about. Driving was so much easier than it was three days ago when I had to make an hour round-trip drive. I feel tired, but I haven't walked around for an hour and a half since December! But I have no numbness, tingling, or lasting pain.

    I still get a little twinge of nerve pain in my right buttock from time to time. Part of me wants to freak out, but the bigger part of me knows that it's totally normal to feel some random weirdness and pain every once in a while. It doesn't last...it just reminds me that it used to give me hell. I absolutely cannot complain!
  • HI all! I wanted to come back around post-op week 6 but I'm a couple of days late.

    I'm still doing great and am so happy I had the surgery. I was cleared by my surgeon about 2 weeks ago to start running again, so I've been hitting the treadmill for about 30-40 minutes most days a week. When I ran the very first time, I was convinced I'd experience pain again. I kept waiting for it and it never came. What hurt the worst were my legs, as I hadn't run since the middle of December! ;) All I could think about for days was the pain in my quads!

    I'm still getting a bit of nerve pain every once in a while, but it comes and goes very quickly. That typically happens on days where I've been a little lazy...I've noticed that keeping up with exercise and movement makes everything feel SO much better. I follow up with my surgeon on the 29th and should be starting PT then.

    I just wanted to share my experience because it's nice for people to read a good story every once in a while. When I was gearing up for surgery, I was always so grateful to see a success story. No regrets here! (So far!)
  • SavageSavage United StatesPosts: 5,476
    You so right! It's so good to read about a good story!

    So happy for you!
    Spine-Health Moderator
    Please read my medical history at: Medical History

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