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HELP! Herniated disk @ L3-L4. Far lateral compressing nerve. TLIF vs Far Lateral microdiscectomy?

gescoggesco Posts: 1
edited 01/07/2016 - 4:25 AM in Back Surgery and Neck Surgery
Hello folks.
Nov 2, 2015 I experienced a painful, throbbing and cramping pain on my right thigh. For most of November I had very limited movement due to extreme pain on right thigh. After Thanksgiving numbness, cramping and tightness on right thigh muscle ceased. Early December my right quadriceps and medial thigh are significantly atrophied compared to my left side. In addition that area had significant numbness/tingling and weakness. Since then I have done X-rays and a MRI and the results are:

L3-L4 Facet hypertrophy. Small right extraforaminal disc profusion with abutment of the exiting right L3 nerve root. No canal or foraminal stenosis.

My Orthopedic doctor recommended MIS/TLIF (minimally invasive transforaminal lumbar interbody fusion) as well 4 weeks of physical therapy.
My Neurosurgeon recommended a far lateral microdiscectomy.

After my 4 weeks of physical therapy (2x a week) my right quadriceps gained 2cm of muscle mass. Some improvement but muscle weakness continued.

At the Medstar spine center both doctors are very helpful and I feel confident with them. The neurosurgeon who I met referred me to another team member in neurosurgery. He is not available to see me until mid Feb, who knows when surgery can be scheduled. The Orthopedic doctor who recommended the MIS/TLIF discussed with the neurosurgeon and shared with me that he is a qualified spine specialist and can also do the far lateral microdisectomy. We have surgery scheduled for January 14th 2016.

The Orthopedic doctor shared his opinion that far lateral microdisectomy can be successful but there is a probability that it may not resolve the issue or that the remaining disk can re-herniate which would require additional surgery (possibly TLIF to correct it).

He also gave his opinion that the TLIF will be the best choice to alleviate the nerve compression and reduce the risk of re-herniation.

I don't like either option.

If I could use alternative methods (physical therapy/yoga/core strengthening etc) I would however my major concern is the compressed nerve. I do not want to risk permanent damage to my right quadriceps and medial thigh. Time is of the essence as I was advised that if I wait too long more than 3-6 months my nerve root can be permanently damaged. This episode happened in early November who knows how long my nerve root was being affected throughout the year without me knowing.

By the way, lower back pain is sporadic. I would feel pressure if I walked the mall for quite sometime. Doing yoga stretches and exercises doesn't trigger any pain response.

Anyway thats my situation. I'd appreciate any advise on the best option. TLIF vs Far Lateral microdiscectomy? Which is less of two evils?


Please remember that no one at Spine-Health is a formally trained medical professional so not permitted to give medical advice. Everything that is posted here is based on personal experiences and perhaps additional research



  • LizLiz Posts: 8,835
    edited 01/07/2016 - 4:25 AM
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    Liz -Spine-health Moderator

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
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