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Update: 6 months with a HUGE disc herniation... should I still be thinking surgery?

AnonymousUserAAnonymousUser Posts: 49,322
Hi everyone,
I have been absent from the boards since my first post, but I do lurk/read your stories and hope you are all doing well with your recovery and pain managment.

Here is an update on my story, hope it's not too long winded...
It has beenn about 6 months + since my original injury.
Originally had what I think was a disc bulge at L5-S1 w/horrible sciatica in my right leg for two months- at that time I was still working and was seeing a chiro/acupuncturists with minimal improvement.

Then (thanks to a cough and chiropractic treatment) it completly BLEW OUT and I was unable to move/stand/walk/sit without exrutiating pain in my back and right leg. I was in a total panic since I was without insurance and unable to work. I quickly got into see a GP and requested an MRI (Discount center- $400 o.o.p) which showed an absolutley HUGE disc extrusion at S1-L5 (2.7 x 1.4 x 1.0 cm!) impinging on the S1 nerve root, and also a small bulge at L5-6 with annular fissure.

Then saw two nuero-surgeons (one at the county hospital) who both recommended a microD. One said it would NOT resolve without surgery and the other was more optimistic- saying anything could happen - even huge extrusions have been known to resolve without surgery and resorb into the body over time. I was not too comfortable with the NS at the county hospital who would be the one doing the surgery, and I seemed to be gradually improving day by day (only with walking, walking, walking and taking it easy during a flare up), so I decided to postpone surgery (twice!).

Amazingly, after recovering from the second "blow out" the sciatic/back pain improved each week- much less pain than when it was a "bulge". Eventually I was taking no pain meds, just fish oil and glucosamin. The last month I also began egosque exersizes and posture therapy with some improvement.

I'm at the 6 month point and progress seems to have leveled off a bit.
My activities are still limited but pain is manageable- If I overdo it, sciatic pain ranges from 1-3. I still have persistent numbness in my small toes/right side of my foot and burning in the ankle and calf if I sit/stand too long. No muscle weakness or foot drop, bowel symptoms, etc.

Lately, I have been second-guessing my decision to forego surgery. I know the window of opportunity is 3-6 months and I am already past that point, but I am worried that the nerve numbness/symptoms will be permanent and that huge extrusion might DO something to me again down the road-
The thought of ending up where I was 4 months ago is horrifying!!!
And I do have one new symptom that worries me- my right leg has "patches" of numbness/tingling now.

Has anyone out there recovered from a large lumbar disc "extrusion" without surgery? with what treatment?

Would surgery even be advisable at this point?

My last MRI was 4 months ago, would it be ness to get one to see what has changed?

I appreciate any advise or stories you can share. Thanks much!



  • I've read your post a couple times without responding, but will make an attempt today...and in no particular order to your questions.

    It is possible to recover from a large herniation...and the larger the herniation, it usually is longer to recover. I don't think anyone could give you a timeline. However, increasingly the newer literature is saying that after six months, there are far fewer chances for recovery.

    Regarding the nerve, as long as you do not have bladder or bowel issues or foot drop, you probably are not doing permanent damage.

    I had terrible sciatic pain for over three years before finally deciding to have a fusion. (I kept hoping technology would catch up and there would be some new procedure that would replace fusion!) During that time, I consulted with 8 different spinal specialists, both neurosurgeons and ortho spinal surgeons. Every time I would ask if I was risking permanent nerve damage, and was always told NO. Of course we all know of patients who have permanent damage after only a few months of compression, so there are no absolutes when it comes to the human body.

    If it helps any with your decision, there is no guarantee that you will be painfree and back to all your old activities even if you have a successful surgery. Patients who enter into surgery thinking they will be returned to the condition they were in prior to the onset of injury or pain are almost always disappointed, blame their surgeon, etc. But in realty it is their expectations that are out of kilter. Of course, some surgeons are not very accurate in their descriptions of surgery or recovery either.

    You are very smart to be working with posture therapy. That will help prevent other wear and tear on other parts of your spine, neck and knees. Alignment all begins with the feet.

    It seems to me that you are doing fairly well. If you continue on with your exercises, using good body mechanics, avoiding activities that involve twisting, bending, pushing, pulling and reaching overhead, you should hopefully continue on with your progress. If not, you will know who to go to for surgery and can probably get it done quickly. If you develop any bladder, bowel or genital problems you will want to go get medical attention immediately.

    Good luck.
  • I know these are a lot of difficult questions- At the end of each month I seem to go through this re-evaluation and second guessing things all over again. It's been a huge emotional strain to go through this sciatica thing as I am sure many of you know.

    I am doing fairly well, but probably only 65-75% back to pre-injury status.
    Beyond getting out of pain, I do hope one day I can get back to doing the things I love- mountain hiking, biking, backpack travel, moving ahead in teaching career, etc. It's so devastating to think those things might be over, as I'm only 40. It has been hard on my son too as I can't do the things we used to do together.

    If I had had insurance, I would have had the operation months ago. The NS at the county hospital wanted to cut out a signifigant portion of the disc (he said 1/3) as well as the extrusion. I was weary of this since the other doctor i consulted (at a well respected spine pogram) said he would preserve as much of the disc as possible and only remove the extrusion. (Of course I didn't have the $50.000!!!)

    One question-
    [However, increasingly the newer literature is saying that after six months, there are far fewer chances for recovery.] Did you mean with surgery or without surgery? Is the 6 month condition more likely to be where you will remain?

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  • Newer reports are indicating that if the symptoms aren't better within six months, it is likely the disc will not heal on its own...and they are now saying that after six weeks of trying conservative measures, it is time to seek professional help, whereas before, they used to say more like three months.

    However, I do think that there is still time for things to heal and move off the nerve. It can take up to two years after surgery for things to heal and for the impacted nerve to quiet down...so I wouldn't give up yet.

    I understand your desire to get back to the things you love. I haven't been able to walk more than a block or two for about five years now, but I am optimistic that I am on the right path to getting my nerve compression resolved soon.
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