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L5-S1 surgery options - 17mm! help!

I know you are not medical doctors, but i need help i knowing what i should do.

I ruptured L5-S1 on 11/22/18.  I have severe numbness on left leg and fear that longer i wait for surgery that nerve damage will set in.

below are my MRI results:  i understand 17 mm to be massive and i have to make a decision on surgery which is schedule on Dec 17. (which is way too far out, I want to operate tomorrow!)

is this urgent for me? should i got to ER? should i get a fusion or try a discectomy first?



At L5/S1, there is a circumferential disc bulge with maximal thickness of up

to 5 mm. In addition, there is a bilobed lesion adjacent to the posterior disc

annulus to the left of midline at this level, likely reflecting extruded, and

possibly sequestered disc material, with craniocaudal dimension of 17 mm, and

anteroposterior dimension of 13 mm, and transverse dimension of 14 mm. This

causes mass effect upon and posterior displacement of the left S1 nerve root,

with mass effect upon the left ventral thecal sac and blunting of the left

lateral recess. There is moderate transverse dimensional narrowing of the

thecal sac at this level, with short axis thecal sac dimension of 8 to 9 mm.

Mild lower lumbar neural foraminal narrowing at this level bilaterally.


IMPRESSION:


1. At L5/S1 there is moderate sized circumferential disc bulge with an

associated posterior annular fissure and posterior disc space narrowing.


2. Directly adjacent to the posterior disc bulge at L5/S1, there is extradural

material to the left of midline and overlying the left lateral recess measuring

17 x 13 x 14 mm, most likely representing extruded and potentially sequestered

disc material, with associated blunting of the left lateral recess, moderate

narrowing of the caliber of the thecal sac, and suspected mass effect upon and

posterior displacement of the left S1 nerve root.


3. Posterior disc bulge at L4/L5 without central canal stenosis.


4. Mild lower lumbar neural foraminal narrowing at L4/L5 and L5/S1. Mild

degenerative lower lumbar facet hypertrophy, most prominent L4/L5 on the left


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Comments

  • LizLiz Posts: 9,518
    edited 12/01/2018 - 11:34 AM

    Hello kcferguson1

    Welcome to Spine-Health 

    No one on the Spine-Health patient forums is medically qualified or permitted to provide any advice or recommendations on any diagnostic test. However, the following key words can always be applied.

     

    MILD Treated with conservative measures such as Physical Therapy and mild medications. Many times these situations can be cleared up and the condition can be resolved.

     

    MODERATE Some more treatments may be needed, ie Spinal Injections, Ultra sound and stronger medications. Always a possibility of more aggressive treatment if the conservative measures don't help 


    SEVERE Need for stronger medications. The requirement for surgery may be necessary  


    https://www.spine-health.com/forum/categories/new-member-introductions



    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • hvillshhvills Suzhou, ChinaPosts: 971

    Hello...

    I assume your doctor set the Dec 17th surgery date... if he/she felt your spinal issues were more urgent I'm sure he/she would have ordered an earlier surgery date.   I assume he/she also has determined what type of surgery(microdiscectomy, fusion, or otherwise) is best for your particular circumstances.   People here on the forum are not doctors...  so we cannot read your MRI and give advice.  A lot of us however have been in your shoes... so for sure we can relate to your horrible horrible pain and numbness and the desire to fix things NOW... trust me I know that feeling all to well... but you need to trust your doctor.  If you have any doubts seek a second or even a third opinion.  

    Once you do have surgery don't expect immediate pain relief... recovery from spinal surgery and nerve healing is a slowwwww process... slower than snails.   So don't panic and use this forum to help you understand and deal with the recovery process... it's actually the hardest and most important part of getting your life back.

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
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  • That is a pretty big herniation.

    Were it me I would not do surgery unless the disc ruptured, because once they cut you are technically vulnerable for all years forward. 

    Stay the heck away from the ER, unless you enjoy paying above "retail". 

  • I would not stay away from the ER.  If you feel you need to go-then go.  But  I don't think going to the ER would get you surgery any faster if that was your thinking process unless something changes with your condition.  Why were you thinking of going?

    You could get other opinions but an appointment for one may go far beyond your surgery date.  There is usually a waiting period of 6 weeks to 3 months.

    I would get surgery, lol, and did.  But I am not a medical professional, this is a decision between you and your doctor.  If you read the discussions, you will see that doctors don't rush into doing surgery on spines.  I agree with hvills.  Of course, I had surgery on L4L5 as recommended by my doctor.

  • ER will charge you through the nose and at best will write you a 3-day script for pain meds. The whole waste of time will cost you or your plan $2,000. There is literally nothing they can do that calling your surgeon couldn't do in a more direct and informative way.

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  • Kcfergerson1,

    Androo and I obviously disagree about the ER.

    It is your decision.  Let us know how you are and what you decide.  I know waiting while scared and in pain is hard.  Keep in close touch with your doctor.

  • dilaurodilauro ConnecticutPosts: 12,771

    My personal view is that the Emergency Room is just for that Emergencies.  This may be different in smaller towns or rural areas, but in the larger metropolitan areas, the ER is already being taxed.  Long waiting lines, endless hours worked by the emergency room staff.

    And most of the time, unless its an emergency situation, there are not many things they can do for you.  Many will tell you to contact your doctor for further treatments.  It is a problem when people run to the emergency room for everything.

    Got a sniffle, lets go the emergency room, cant wait for a doctors appointment
    I have a splinter and cant take it out, lets go to the emergency room

    That is one of the major reasons Immediate Care Centers are cropping up all over the place.  They take the workload burden off of emergency rooms.  They may not be able to handle everything, but they can make the situation more comfortable

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • We call them instant cares here.

  • Hi. Just my own experience: I had a “l4/l5 disc herniation of 17mm and was ranked a level 3 (severe). The surgeon I saw was able to work me into surgery within 3 days. However, I could have waited until 12/17. I had been struggling w symptoms of a disc herniation since July 2018 and just had surgery 5 days ago. I know it’s scary to hear those results. I freaked out a bit. (I had also been told by multiple doctors that saw the MRI that they were surprised I was walking....also scary to hear).

    Also, following my surgery I was told that I still have 95% of my disc intact! Much better news then I was anticipating.

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