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L4/5 herniation

I've recently been diagnosed with a 6mm central disc herniation at L4/5 level and a disc bulge at L3/4. I have been suffering with back pain for the last 7 years, but my doctors only ever ordered xrays and said they only see some disc space narrowing and inflammation. I was T-boned by a car while on my bike in February, and had been getting chiropractic and massage therapy for 3x a week for a month. After a month of treatment, the chiropractor did a re-evaluation and ordered an MRI because I have had a sharp, stinging, pinching feeling in my back with radicular pain down my right leg and also some foot tingling. That's when they found the herniation and bulge, and I was referred to a spine center. They gave me only two options: injections or surgery. (I have already done PT and that made the pain worse, massage therapy seems to be helping with the muscle spasms). I was evaluated by an ARNP, who said I could try the injection and if it doesn't work I can do surgery. She didn't explain the surgery at all, but I'm assuming this would be a discectomy? Anyway, I'm just wondering why surgery is an option so early on in this? There is nerve root compression, I can hardly bend over without pain, and my back is so weak that I can't lift my legs on my own when in a sitting or lying position. When it was at it's worst, I'd have to lift my legs into the car with my arms because if I tried to use my back it would just spasm out. I'm 23 so I'm wondering if this surgery is really the only "permanent" solution? Will this get worse over time?

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Comments

  • hi martinr

    welcome to spine-health

    unfortunately there are no medical professional on this site to advise you and only your surgeon can answer some of your questions.

    some herniations compress the nerve more than others and this can determine earlier surgery sometimes.  i cannot say this is the case with you, but has definitely been a case for me with my herniations and problems over the last 5 years.  i had herniations, before but i managed to get myself through those, with non surgical treatments but that changed in april 2013 for me.

    i have added two links below to help new members with information and these also contain the forum rules.  there is lots of material to research on spine-health that will give you the power of knowledge.

    welcome to spine health


    aj 


    AJGormit

    ---------------------------------------------------------------

    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015
    L4-S1 TLIF with decompression June 2017
  • Hi Martinr,

    I don't know the details of your situation, but in my case they offered surgery right after diagnosis from MRI as well. It felt ridiculously rushed (I am only 29), but I guess my herniation was really severe such that it was improbable that more conservative measures would work for more that a few weeks/months. I wanted a more permanent fix given my personal circumstances. In my personal case, I have gradually worsened over time (i'd get totally better, then worse again. Now I am symptomatic pretty often and it affects my functioning).

    The injection will hopefully decrease swelling enough for you to take time out to let your body heal. It will also give you time to think critically about your options. It might not be a bad place to start. Will your symptoms be gone forever and ever? Perhaps, but you would have to do everything possible to never upset your discs (e.g. running, weights, backpacking, obesity, smoking, etc.). From your post, the injection seems like the best option because 1. you are suffering so so much, 2. they didn't even explain what surgery they are offering.

    Start with finding out what surgical options exist for you personally. There are some minimally invasive things out there that may give you time to adjust your lifestyle so that you have fewer and less severe flairs.

    Wishing you all the best.

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  • Hello there! I also started having herniated L4-5 disc in my 20s. I often feel like doctors sometimes rush people into surgery. I went for the shots and they have worked well for me. Just now starting to think about surgery at 31 since I also now have some degeneration. Read all you can and come up with a plan that’s best for you, if you feel like your doctor isn’t listening to you then seek more opinions. Sometimes we have to be our own advocates!

  • I'm opting for the discectomy. After talking more with the doctor and considering my symptoms, I think it is my best option given the circumstances. This has been part of a legal case that has been going for nearly 2 months already. Obviously, if this nerve root compression continues to cause me issues throughout my life, I'm going to be the one footing the bill for pain management and therapy. I'm already doing therapy 3x a week, which I thought was helping with the spasms but they have come back again. The nerve pain is no longer a quick, shooting pain down the leg...it is a slow, painful, pulsing that lasts for several seconds at a time and goes all the way to my foot. This is just excruciating. I also depend on my bike for transportation since I don't drive, and I can't really carry my bike up and down the stairs when I have a herniated disc that is already compressing a nerve root, and another disc that is bulging. I'm scared that I will herniate that one too. I'm also a college student and I work full time, so I really do not have the time to keep doing therapy several times a week.

     

  • Guess I'm no longer looking for advice, some well wishes would be nice. I'm super nervous about this.

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  • L4_L5LL4_L5 Posts: 1,459
    edited 04/16/2018 - 4:00 PM

    Hi Rebecca,

    Hopefully the driver had good bodily injury coverage.

    You also can recoup current and future medical costs (as well as pain and suffering) with a personal injury lawsuit (provided you were “in the clear,” so to speak), which it appears you’ve already initiated.

    You may have to tell your lawyer you can’t continue to work full-time due to your injuries.

    Don’t kill yourself overdoing your daily activities and commitments.

    If you are being offered injections as an option then if I were you, I’d give them a shot (no pun intended).

    If I had 2 or 3 spinal experts telling me injections are NOT an option then I would pass on them and opt for surgery (if that’s the only option).

    This is just my opinion but I tend to err on the side of exhausting all conservative treatment options before I would consider surgery (especially if the doctors are suggesting injections as a possibility to relive the pain).

    As is often stated on this forum results vary greatly person to person so it’s hard to say if they’ll be effective until and unless they’re tried.

    I was seriously injured due to horseplay when I was young and got a lawyer and received a settlement that paid for my entire college education plus $$ left over to invest in the stock market. 

    Hopefully your outcome will be similar (although I have lifelong impairments due to the injury).

    That injury did not involve my head, neck or back.

    Good luck with both your medical and legal matters

    Please do keep us posted if you can.

  • Many specialists are very quick to suggest injections and surgery as they are a quick fix. Things to consider with both or that yes injections will give you muscle relief for a period of time but will not fix the problem on its own, you will then need to rehabilitate the route course while the surrounding muscles have relief and allow you enough pain free mobility to do so.

    Again surgery can eliminate the immediate pain but this really should only be a last resort once all other avenues have been explored. If you have disk surgery the likely hood of developing further pain elsewhere is fairly high.

    A simple but effective way of initial treatment is decompression therapy. Many people revert straight to stretching which will release muscle tissue and prevent spasms for a short time but they will not last, they will also irritate the disk further. Your main focus should be to create length through your lumbar spine.

    I would recommend some manual therapy work to increase blood flood to the muscles allowing you some extra mobility followed by decompression work.

    Hope this helps slightly and wish you well on your recovery. 

  • I had the discectomy and I am now one week post op. I have had significant improvement in my pain. It is no longer constant, but I still have some of that radicular pain intermittently and it is still intense. Interestingly enough, I am getting some of that pain in my left leg as well, even though it was always in the right leg. Is there any reason why I would be having that pain in both legs now? It was never in the left.

    The op note says that the procedure went well without complications. Though the surgeon does note that after evacuating the herniated disc material, there was persistent neuroforaminal narrowing and a foraminotomy was medically necessary. I'm not sure what that means besides that it gives the nerve root more room?

    Based on your experiences, if you have the pain still post op is it indicative of it persisting? I would like all the pain gone, obviously. But the discectomy gave me significant improvement and at least this pain I have now is manageable.

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