L5S1 reherniation....for the third time!

L5S1 reherniation....for the third time!

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Anonymous (not verified)
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L5S1 reherniation....for the third time!

HI! Last year i had a L5S1 Discectomy to repair a herniated disc. And then again in April to fix a reherniation. Both times the nerve pain in my butt and down my leg was so severe i couldn't get off my floor for about a week prior to surgery. I did PT, Chiro and all that jazz but the nerve pain came back by Aug. Since then, the nerve pain in my butt has increased to the point where I cant sit or stand for long periods of time and being 27 and a personal trainer, the daily pain has really put a cramp in my work and social life. I have had two cortisone shots with little relief. I recently had a new MRI which shows a small disc protrusion as well as a small buldge at L4L5 and degenerative discs. A third surgery to get my disc fused is being discussed. I would love to hear any positive or negitive stories from anyone going through anything similar. What do I do?!?!?! I have wasted away the past year lying on my floor watching tv (thank god for reality tv!) and want to get out in the land of the living again :)
Thanks!!

DNice
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Joined: 10/03/2009 - 6:56pm
Hi DAS23...

Hi Das23...our worlds sound similar.

I herniated my disc L5-S1 in August. Lost feeling in most of my left leg. Massive disc mass sitting on the nerve. They couldn't even see the nerve on the MRI. I also have some loss of feeling in perineum (groin) area.

I was so bad they were afraid I was wasting time with epidural shot b/c size and fear that it would impact bladdar/bowel nerve control.

Had Microdiscectomy. I think I got 2 weeks of relief but that's questionable. By the 6 week post op appt, my doctor was surprised at my slow progress and put me on prednisone in hopes it was just incision inflammation. It didn't work so at week 10, sent me for MRI.

Reherniated the disc.
I was told revision microD but if it herniates again, fusion. I must have gone for 7 opinions and some doctors wanted to fuse and not try revision.

Long story short, I'm due for revision MicroD with the understanding that if it doesn't work, I'm facing a fusion. UGGH.

I'm starting to get right leg pain now too. I'm going for another MRI before the revision to ensure that it's the same mass causing issues and not a new piece.

I'm 40 years old, was very active up until the summer, mostly leg pain but impacting my quality of life. I am not ready for a fusion but I will tell you that if this surgery doesn't work, I will likely give in to the fusion b/c spending 18 hours in bed (working from home flat b/c sitting is just a drain) is not a way to live my life.

First, I always recommend 2nd and/or 3rd opinions.
Second, I have learned a lot in my research (thanks to articles from folks here, esp. Gwennie), and asking lots of questions at the various doctors.

If I fuse, the approach the doctors want to take with me is TLIF. I have found a doctor that does Minimally invasive TLIF but make no mistake the only thing minimally invasive is the scar size and not cutting through muscle. The fusion is still a major surgery as they remove the bad disc, put a spacer in (various thoughts here) and screws/rods for support.

what questions to do you have?
I've asked my doctor how he does the surgery, what happens if he starts with 1 level and find out he needs to fuse 2, recovery, approach to fusion (my own bone, synthetic, combination, etc), how long on hospital stay, recovery time, etc. Everyone's experience is different from what I've been reading.

I know that I would be out of work for 6 weeks minimum if I did a fusion and likely 3 months. Bone doesn't start fusing until week 6. Fusions also can introduce risk of future surgery above or below.

I got good advice...when you can't be talked out of a fusion, you are ready for one.

JulieA
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I am not big on revision

I am not big on revision micro d's. To me it is wasted time and more scar tissue.

One of my GF just went through this and decided on the fusion. The amount of time she spent in PT was longer than me. She took PT for well over a year and it still re-herniated. She is super fit BTW.

I understand the thoughts of adj segments going but they do the same thing with out fusions.

I would really want to be certain that you don't have instabilty issues if you are considering the revision. No sense wasting the recovery if it is going to happen again. Plus consider if you play hard- it is more likely to keep happening.

At the very least get another opinion before you decide.

Good luck,

Julie

DNice
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Last seen: 1 month 4 weeks ago
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Joined: 10/03/2009 - 6:56pm
Julie

Julie - there is a debate on revision microD and fusion.

Statistics state chances of reherniation is 10%. If you reherniate, the change of 3rd hernation increases to 50%. This is why textbook answer is 3 strikes and you are out. Yes, there is a a chance of scar tissue building up but a fusion is permanent and comes with its own risks (ie. domino effect, bones don't fuse, hardware issues, etc).

There are 2 schools of thought.
School 1 says - reherniate (2nd strike) and you go for fusion b/c it resolves the issue at hand.

School 2 says - reherniate, try revision, reherniate again fuse. Why? because the odds of revision being 'successful' are about the same as a fusion being "successful". If I can get 5 years out of the revision, technology will advance to where I may have more options.

A fusion is permanent and MAJOR surgery not to be entered lightly in my opinion.

The flip side is that the nerve may not handle the 3rd 'hit' from herniate and/or the more disc you lose the more chance that disc height can shrink/collapse and 'choke' the nerve resulting in permanent damage.

It's really a matter of opinion, statistics, and what the key symptoms are.

I do appreciate your perspective though. I have considered both sides thoroughly.

As a matter of fact, I waited 1 month to do research, speak to several doctors and have since developed a few new symptoms. I'm going for an MRI to see how much things have changed in 2 months. If I herniated more, it might show I have an inherantly bad disc and I may change my course of action. It's really a personal opinion/decision.

I know people who had microD's 10 years ago and are still in good shape. I know a few people who had revisions and are still good 2 years out.

The one thing I've accepted is that you only try the revision 1X on the same level so if I do revision and it fails or reherniates like Das23, I will go for fusion and have found a surgeon that I'm confident with and have discussed his approach to fusion.

mike 29
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Joined: 11/03/2009 - 4:17pm
I just got had a plif

I just had a plif in late oct.I am also in my late twenty's. I reherniated the same disc for the third time. In eartly august this year.I also had nerve block shot. That caused more pain. I choose a fusion do to the fact that it was the third time. I had all the same symtoms that you have described. Im sorry i know that it is not fun and painful. Now that I had the fusion I feel better since i got the fusion. And getting better everyday. I hope that this helps you. If you have any more questions message me.

DNice
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Joined: 10/03/2009 - 6:56pm
Mike29 how long

Mike29...how long did the revision Microd work for?
I'm just curious.

My initial microdiscectomy failed within the 1st 3 months (probably the 1st month). Can you share insight on your timeline?

Did the 1st one fail right away or did you get a few years from it? Did the 2nd one fail right away?

I'm expecting the worst but hoping for the best.

mike 29
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Your ?

The first one lasted 6 years. I switched job and worked out to built the muscle in my back. the second one only lasted 3 years.if anymore question just message me.

saltzworks
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I have a DH that had a 2

I have a DH that had 2 discs that went out and the same dr. who did my fusion did a double micro-d on him. It's been 8 1/2 years since his surgery - he's never been back and is a very physically active guy. He gets backaches, but never anything he's felt he needed to get medication for.

Micro-d's do work. Just don't know if I'd have opted for one in my case - well, guess that's really a moot point, it wasn't offered to me! Wink

awalker819
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That kind of situation is

That kind of situation is exactly why I passed on microdiscectomy and wnet straight for fusion. I had extensive herniations at L4-5 and L5-S1 and I was in excruciating pain no matter what. After a little over a year of tons of narcotic pain meds, PT, ESI's, etc., and I still couldn't even walk to the bathroom without a cane, and some mental preparation beforehand.

Come August, the Dr gave me 2 options. The first was microdiscectomy which would probably give me relief from my leg pain, but not my back pain, and it wouldn't be a matter of IF I re-herniated, but WHEN. My second option was fusion, which of course would give me significant if not total relief from my leg and back pain as the offending discs and herniations would be completely removed. So even though I am only 30 yrs old, I went for the one big surgery, rather than multiples over time.

And it was the best decision I could've made. Today marks 12 weeks into recovery and feel great! I have ZERO leg pain, and really ZERO back pain. For the first few weeks after surgery, I had a little bit of stiffness at the surgery site, but I couldn't even call it discomfort. I weaned myself almost totally off of all pain meds by week 5.

Ive been back at work since week 4 of recovery (Dr actually released me at week 2 because I have an office job, but I chose to take 2 more weeks so I could get as much of my strength back as possible.) and have been driving since week 3.

At this point I don't even feel like I've had surgery at all. Sure once in a while I can feel my back muscles get tired, but even that is getting better every day.

I'm also walking a minimum of 2 miles a day since week 3, and can truly say I have no pain. My OS was amazed to see me up and around so easily and without pain, at my 10 week follow-up. He told me "People don't do that well after the surgery you had"...but well here I am, feeling great, doing just about anything I want, including hiking now!

Oh and I never had post-surgery PT, OS and I decided it wasn't necessary as I am doing so well and have been kind of doing PT on my own since my first day home. I found a fabulous list of exercises and stretches I could do at home, or in my office, and that's all I have done since I got home from the hospital.

Hope my story helps at least give you another perspective. Best of luck!

DNice
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thank you all

thank you all for the insight on how long your microdiscectomies lasted for. It gives me encouragement. I am optimistic but do know a fusion is probably in my future...I just prefer it to be in the future.

I'm going for re-MRI on Tuesday as a final confirmation that MicroD is the right direction.

MIke23 - in return, from what I've heard your doctor is in line with all the doctors I spoke to that say 3-strikes and you are out. I was told they will only do a revision 1x on the same level. IF it were a different level they'd offer a microD depending on your situation. But if it helps, if I herniated after this next surgery at the same level, I will have 2 choices...(a) live with what I've been living with or (b) try fusion to avoid further nerve damage and try to help with some of the pain.