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L5 S1 extruded disc / Need Help with next steps!

DdahDDdah Posts: 3
Hello - I was in a head-on car accident 1 month ago with a DUI driver. Thankfully nobody was seriously hurt, or so I thought. A few days post accident I had difficulty getting out of bed due to significant inflammation of the lower back. I consulted with an orthopedic, x-rays were taken, and the consensus was that I was likely suffering from a slipped disc. I was prescribed several meds (analgesics, anti-inflammatories) along with physical therapy. After about two weeks without much relief or change in my condition, I awoke with severe shooting pain down my left leg with hyper spasms in my calf muscle. The doc sent me for an MRI revealing a fairly large extrusion at my L5 S1 and protrusion at my L4. He recommended an epidural and it was administered the next day. I did experience some relief, as the shooting pain subsided. However, I have rather severe numbness down the back of my left calf and foot - can't feel a pin prick - and my muscle is fatigued to the point of not being able to walk without shuffling my left leg. I cannot stand on my left toes, but still able to do so on my heel. I can also still rotate my left ankle and move up and down, but it feels as though the weakness is progressing. The pain, on the otherhand, has been reduced to a dull, sore area centralized at the lower back. I've now visited with two orthopedic surgeons, both suggested microdisectomy to remove the nucleus material pressing on the nerves. I'm very reluctant to proceed with this surgery, but the seemingly progressive nature of my leg numbness/weakness does concern me. I am in my mid forties, and (pre-accident) I am very active (water sports, biking, playing with my kids). I've combed through many posts on this forum - and it seems there is a wide variety of opinion re: surgery. My question to the group is - given the progressive numbness / weakness in my left leg am I a prime candidate for surgery? Or should I continue with therapy, light exercise and meds to try to rehabilitate in hopes that the numbness/weakness will subside? The anecdotal advice seems to weigh heavily in favor of the latter. However, I can't help but wonder if the neurological damage will become permanent if I don't undergo surgery. Additionally, my work and personal life is hindered quite a bit - and I don't have the luxury of being sidelined for 6-8+ months to see if my situation improves. I'm getting pressure from my wife to push for surgery - as she wants me back on my feet 100%. But I'm just not certain that is the best route.

Your collective thoughts / feedback are greatly appreciated.


  • LizLiz Posts: 9,745

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    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • My pain from L5 S1 extrusion has subsided to the point of negligible, but the weakness and numbness has increased in my left leg. So much so that I am having trouble walking. This progression has stymied several of the docs that I have seen. The Orthopedic spine surgeon says no problem, the feeling and strength will return - give it time. Another says we need to operate, the longer you wait, you may have permanent damage. And the Neurosurgeon is perplexed, wanting to conduct neurological tests and get a second MRI. He suspects that the herniation has increased significantly, hence the increased weakness/numbness. I am taking his advice. Would be great to hear from someone on this forum who has/is going through the same problem....
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  • Hi Ddah- I too had a significant herniation at level s1-l5 and a herniation at l4-5(occured in my late 30s)for me surgery was a last resort after 6+ years off and on again pain varying from shooting electric shocks and not being able to walk to spasms and soreness. For me, each episode the pain got worse and lasted longer until I was having more painful days than healthy. I also had years of PT off and on and tried epidural shots, steroids, etc. Only you and your doctors can decide whether surgery is a viable option or not.

    When you say you can't be sidelined for 6+ months, the reality is you probably will be to some degree regardless of your course of action. The good news is you find new ways to do what you need to do, but sadly we don't get to choose whether we are incapacitated or not, in my opinion, this is the hardest part to take for everyone, caretakers and patient.

    For what it is worth, I had the surgery (microdiscectomy on both levels)and it was successful at treating my pain. Within a month of surgery we moved and I was house hunting, going to the zoo, sitting and playing with two little ones again while my husband was starting his new job. Each day I was able to do more and more and if I had not had the complication of a ruptured disc at the 6 week mark, I am positive it would have been a success. In hindsight, I probably pushed myself too hard and should have gone a more slow and steady route, but moving to another state did not make it easy to recover. I have also had issues with numbness, severe spasming in calves(if you catch it early, flexing your foot can stop it before the muscle freezes)tingling, nerve symptoms and a host of others. My nerves were almost fully recovered up until this latest setback(took nearly a year, after a bone chip was removed and fusion surgery) so it can recover, nerves are very very slow to recover-but they can, again, everyone's story is different and your doctors can help you determine what is critical. Being healthy and active prior to all of this can help, since you probably have good core strength, which is very important in recovery.

    I hope I have said something to help. The answer is, there is no easy answer, but I wish someone had sat me and my husband down and told me take a deep breath because this is a very slow process and life will be different for at least 6 months and you have more strength in you than you realize.
  • OveritALL - thank you for your response :) Did you experience weakness to the point of no reflex response on ankle and no ability to do calf extension on toes (essentially what the doc referred to as an ankle drop)?

    I've been dealt a bit of bad news today...as the suggested next step is to undergo microdisectomy ASAP. The primary concern is the extreme weakness that has progressed in my left calf and ankle. I can no longer elevate on toes and have no response to reflex test on ankle (achilles tendon). While I value the opinions of the docs - I can't help but think this process is moving way too fast - only 6 weeks out from injury. That said, I fear if I wait I may have permanent nerve damage..
  • When you say you had a complication of a disc rupture at 6 weeks, is that after your microdiscetomy? I'm only asking because I am 4 weeks out from my microdiscetomy and had 2 great weeks-literally no pain, felt great. But then my pain came back and worse than before. The electrical shocks through my leg, the pain when walking, can't walk at any speed faster than a snails pace, hurts to even sit in the recliner, Hurts to stand for longer than a few minutes. So my surgeon is concerned its just a nerve flare or a re-rupture. I'm just worried and very sad/depressed as I thought I wouldn't have this pain anymore.
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  • Yes, it was after my first micro discectomy, definitely felt a pop and surge of electricity followed with painful spasms and sciatic symptoms. They did a contrast dye MRI in the ER and rushed me into surgery the next morning(came in late Saturday evening, in surgery 5am Sunday)
  • Yes, it was after my first micro discectomy, definitely felt a pop and surge of electricity followed with painful spasms and sciatic symptoms. They did a contrast dye MRI in the ER and rushed me into surgery the next morning(came in late Saturday evening, in surgery 5am Sunday). So very sorry, I know exactly the emotions your are experiencing and they suck, gentle hugs!
  • desb63ddesb63 UKPosts: 107
    edited 04/06/2015 - 11:05 AM
    Hi,Not been on here for a while as I am looking up foot pain and spasms after surgery at L5/S1 about 3 years ago,reading the comments here I see it is quite a common problem I had a fusion and decompression with hardware,after surgery my muscle spasms reduced by half or more but never went away this has been a real help for me,however my feet and lower legs have become painful especially my left with foot drop with pain over the top of my foot ankle and outside of my lower leg,I am due to see the orthopaedics later this month,I think my problem was when my surgery was performed they left the disc alone opting for decompressing the joint and fusing it,I am thinking now it may have been better to have removed the disc as it appears to be irritating the nerve still.I have reduced my meds because of being on too many making me feel bad but I'm just about to start some new ones,I can remember a good med was Baclofen for the spasms although I stopped these.To make things worse I have slipped discs in my neck so not sure what to sort out first.
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