Broadbased posterior disc bulging at L4/5, anyone?

Broadbased posterior disc bulging at L4/5, anyone?

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kflee0
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Broadbased posterior disc bulging at L4/5, anyone?

Hi,

I have moderate broadbased posterior disc bulging at L4/5, indenting the anterior aspect of the thecal sac, causing bilateral lateral recess stenosis and mild to moderate canal stenosis. There's also a super-imposed annular tear on the disc.

My question is;

1. Am I a good candidate for microdiscectomy?

2. If microdiscectomy applies to my case, will there usually be one incision or two? If one incision, could the surgeon remove the other side from the same incision

3. Will shaving off a portion of the disc make it herniate later since there's already tear/crack on disc?

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kflee0
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I had went to 4 surgeons, 2

I had went to 4 surgeons, 2 of them recommend fusion and the other two said micro-discectomy. I have sciatic pain on both legs for 6 months now. Does anyone here with broadbased protrusion went through microdiscectomy and turn out all right? Please shed some light..

Thanks
Kflee0

DNice
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Hi there...

Hi there...no one here is a doctor. And, as you can imagine, you'll get varying opinions just like you did from your doctor.

I think they key here is to consider you situation, your pain, what else you've tried, and your goals in relation to medical care.

I can give you some things to think about based on how I approached my situation...

1) What alternatives to surgery do I have? (PT, steroid, Anti-inflammatory, ESI (epidural injection)
2) How much pain was I in? For how long?
I had sciatic pain for 17 years but one morning stretched wrong and felt/heard a pop. I couldn't get out of bed despite trying 3 times for 10 hours with various meds called in my my PCP. I ended up in the ER with pain of 9-10. After leaving, my pain was about 6-8 but I lost significant feeling and strength in my leg and other areas. I opted for surgery after trying Medrol Steroid pack for 2 weeks b/c I was at risk for losing bladder control due to numbness in my groin.
3) Who else could I consult?
4) What did each surgery mean both short & long term?

It's a personal decision but you are wise to do your research and ask questions here.

Microdiscectomy can be successful. There are 5% failure rate and it generally occurs within the first 3 months either due to re-herniation or a piece left behind. It is minimally invasive so the scar is small, they do cut away the lamina to dock the equipment. There are minimal risks associated with the surgery. If the surgery fails (e.g. you reherniate), you can be a candidate for a revision microdiscectomy.

Fusions can also be successful but are very invasive, especially at the lumbar level. The Lumbar is carrying most of the body's load. There are different approaches to Fusion (front, side, back, minimally invasive from back) but they all involve removing the disc, adding screws/plates and waiting for the bones to fuse. The satisfaction rate is ~80% I think but that's satisfaction of slightly better to better. The other challenge is once a fusion is done, there's no going back. It's permanent. It also can impact the discs above/below b/c they carry extra load.

I'm just listing my insights on the surgical options, however, I'm not that familiar with your diagnosis and what's right in relation to it.

I just had a annular tear at L5-S1 with DDD.

kflee0
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Thank you for your advice n

Thank you for your advice n reply, Dnice.

Medical hisory: No loss of motor/sensory skills on both legs, functionality is good, no foot drop.

My pain(heavy leg) on both legs happen randomly, when it comes, I have to take 2 ibuprofen for the pain to subside. But for the last two weeks, it happens more frequently and more intense, I have to take 2-6 pills daily to control my pain. Usually, there's no pain if I just sit and lay on bed but as soon as I become more active, move around my house, the pain will attack me. I won't be able to stand/walk more than 30 min without pain, pop in 2 pain killers, can continue walk a lot longer provided I can rest on chair between interval.

Those 2 surgeon who recommend spinal fusion said I am not a good candidate for micro-d. I am so desperate to get rid of my pain but also scared that if I make a wrong surgical decision would end up with more chronic pain on my leg.

If anyone here had broad-based protrusion and went to micro-d, please share some of your experince?

Thanks
kflee0

Ming
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just a suggestion

Have you researched artificial disc replacement or is this something the surgeon mentioned at all? You could research that as well. Sorry to be so short. Getting ready to sign off for the night and go to bed but wanted to send this to you first.

Michele

kflee0
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Hi, Ming Yes, I have looked

Hi, Ming

Yes, I have looked into artificial disc replacement, but the results(based on my research) are controversial. I would prefer conservative way to approach my case if's possible.

Kflee0

Ming
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I agree

I agree that the conservative treatment is the way to go. Avoid surgery at all costs. I just happened to think of the ADR and wanted to throw it out there. I did over 6yrs conservative treatment before surgery and then had more conservative treatments for another almost 2yrs and just had to have another surgery. Hopefully this is the last.

Do as much research as you can and by coming here you've got a wealth of information as well as people who understand what you are going through and can support you.

DNice
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I'm back...

I'm back (no pun intended).

I'm not sure why they would say you aren't a good candidate for MicroD but that's because I really don't have experience with some of the stuff that's in your MRI. I do know MicroD's try to remove the herniated disc (which is like crabmeat) from the nerve and it is generally good for reducing Leg Pain. However, I assume there are other factors.

The choice for surgery is clearly very personal. I would only recommend that you do your research on the risks. For me, I am trying to avoid a fusion at all costs. Why? well, I'm 41 and I consider myself young. The recovery is long on the lumbar. In addition, the lumbar area is carrying most of the body's load so I just didn't want to mess with the mechanics until I had no choice because I knew in fusing my L5-S1, I would put additional stress on L4-L5 and risk needing another fusion in the future.

My thought (and I'm not saying it's right) is if I could buy time until ADR is an option or technology advances, I would have more options that might be better for me.

I've herniated the same disc twice (I have an annular tear and lost 2 large pieces which hit the nerve pretty hard). The first time I lost feeling in my leg, buttocks, Foot...and they still gave me 10 days of Steroids in hopes the disc material would shrink enough to come off the nerve.

Again, not that familiar with all your symptoms but if you are taking ibuprofin and it's working, you have some time to do your research and try PT, etc.

Good luck. I wish I could give you more insight on your MRI but just not familiar enough.

kflee0
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5th surgeon visit

Hi,

I just came back from my 5th surgeon visit and had injection cortison on L4/5. He said my case is in the grey zone between nonsurgical and surgical approach; if surgery will actually do more good than bad at this point. He checked both legs; functionality is good, motor & sensory is ok, no numbness, no foot drop (which I already knew a while ago.)

I am SCARED to death of surgery but I am also sick and tired of my leg pain, I just want to get my life back and get over my fear. I basically walk in the doctor office this morning readily hoping he will opted me a surgery. ( I just need to find one that I feel most comfortable with and have confidence in, which I think he is after many surgeon shopping).

He said the reason I am not the BEST candidate of micro-d is my broadbased protrusion, u can't go in there and trim the disc circumference, micro-d is only apply to candidate with one spot bulge/herniation.

having said all that, there's no other option other than micro-d. if surgery is needed down the road, he will do bilateral laminotomy, micro-d the portion that press on my nerves at lateral recess, spinal cord and leave the rest.

At the end of the visit, I frankly mentioned about the fusion opted from my 1st n 2nd surgeon, and he thought I have not get to that stage yet. fusion is very invasive n take decade to heal.

Right now, I don't know if I should be happy or sad. The first two surgeon's visit hoping surgery is optional, but opted fusion. By the time I get to my 5th surgeon, I am SO READY to let them cut me open but he wanted me to "wait and see" approach, totally, surprisingly out of my prediction.

I asked him if my bulge disc will shrink given over time, he said no. He said if it's a herniation, it will resolve over time.

So, it will not shrink on its own, continue to press on my nerve.....then WHY WAIT??????!!!!! Isn't 7 months enough time. I will ask him this question on my next visit.

By the way, I am 33 years old
kflee0

Ming
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it can be so....

It can be so frustrating. I'm glad that you are taking the time to get several opinions and not rushing into any decision. I also know how you feel that in a way you just want to have the surgery and get it over with and be on the recovery end instead.

I'm 32 so I know what's it's like to be younger and dealing with chronic pain. It definitely has put a damper on my social life know that I can't keep up with my friends. I'm very thankful to have found this site as I get so much support, encouragement and helpful hints and information from everyone here.

buckeyeback
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I initially had an MRI that

I initially had an MRI that stated "broadbased protrusion" at L4/5 and I had a micro-d (which I regret) There is NOTHING micro about it BTW, and then I had a laser scope (accurascope) for the resultant scar tissue from the "micro-d" and they messed with the disc also. Now I believe I have more lateral protrusions bilaterally at L4/5 and will need more fixing. Looks like fusion or ADR to finally stop the pain... hopefully that is. There are no guarantees.

Broadbased protrusions are very difficult to treat due to the disc wall being "bowed out" if you will, over a large area of the disc as opposed to just a small area. Not sure if it could heal on its own, every case is different. Mine sucked.

GL, there is an abundance of great info on here to help.

~BB

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