Would like educated opinions on this - back surgery

[KillahBee]

Quick background for those that don't know:

I tweaked my back about 14 months ago (squatting) and ended up with an extruding disc (L5). Did the PT thing (hit it REAL hard) and had 3 epidural injections over the span of about 10 months. FYI - I am 26

A lot of the symptoms went away with the first injection, some with the 2nd and none with the third. PT and the gym helped, but eventually I just plateaud. There is not a DAY that I do not have extreme discomfort / numbness running all the way down my left leg and there feels like a constant knot is being pulled in my left glute. I am very limited in the exercises I can do and my left hammy is tighter than a virgin on prom night.

Went to see a specialist in the city today. His summation of my issues:

- degenerated disc (it is blatantly darker than the others in the MRI)
- L5 is fused to my sacrum (rendering it pretty much useless)
- L4 is rubbing up against my nerve

My corrective options:
- keep on going the way I am - basically, "deal with it"
OR
- surgery. he would do a procedure called a "lateral decompression" where he would basically remove two ligament by the disc which would hopefully relieve the tension on my nerve (which is the major issue I have been experiencing). I would be in the hospital overnight, followed by 2 weeks out of work, followed by a month of no lifting or major movements/exercise.


My heart is saying surgery - actually, my head is too. Just wanted to see if anyone has any thoughts on this, cause I know some of you have experienced it and have been a great help to me throughout this cocked up experience.

Cheers

 

[Scotsman]

IMO- if you feel it's what's best for you than do it. No surgery no matter how simple or routine should be taken lightly especially near the spine. Given your case where your rehab isn't helping that much and you continuously are having relapses along with the ensuing injection, surgery is a viable option. If I were you I'd take a couple of days to really think about it. The real unfortuneate part is that there isn't a guarantee that things will be better afterwards. Best of luck with your decision and its outcome.

Cheers,
Scotsman

 

[KillahBee]

IMO- if you feel it's what's best for you than do it. No surgery no matter how simple or routine should be taken lightly especially near the spine. Given your case where your rehab isn't helping that much and you continuously are having relapses along with the ensuing injection, surgery is a viable option. If I were you I'd take a couple of days to really think about it. The real unfortuneate part is that there isn't a guarantee that things will be better afterwards. Best of luck with your decision and its outcome.

Cheers,
Scotsman

Thank you scots - sound advice. I'm going to take plenty of time. I won't be able to do the surgery til mid Sept anyway cause of a major 3 week long event at work I am managing.

It almost feels like a lose-lose situation. But I have to be positive and believe that the surgery will work out, if that's the route I go with. But I just can't imagine living the rest of my life like I have been the last year.

Also - um, can I get a 1 year extension on the contest?

 

[Scotsman]

Thank you scots - sound advice. I'm going to take plenty of time. I won't be able to do the surgery til mid Sept anyway cause of a major 3 week long event at work I am managing.

It almost feels like a lose-lose situation. But I have to be positive and believe that the surgery will work out, if that's the route I go with. But I just can't imagine living the rest of my life like I have been the last year.

Also - um, can I get a 1 year extension on the contest?

I'd probably go with the surgery in your place, but I just wanted you to put some serious thought into it.

Another year, I thought you weren't going to use your back as an excuse you gaping muff.

I suppose I can wait till '08.

Cheers,
Scotsman

 

[hammer110]

KillahBee:

I can perhaps offer some advice/guidance. I am not a surgeon, but work with neuro and ortho spine surgeons on a daily basis in my business of providing spinal implants.(15 years) From your brief description of your visit to the "specialist" it sounds like you have a sacralized L5 vertebra which is often congenital. If it is autofused than that level is basically sound. Your left sided symptoms are apparantly from a stenosis at the L4-5 level resulting in redicular pain shooting down your leg and perhaps some sciatica as well based on your glute pain. At that level the exiting nerve root often gets impinged or constained due to either a bulging disc at that level or from heterotopic bone formation in your foraman at that side and level. (extra bone closing down the bony hole the nerve exits through.
Often times a simple laminectomy decompression will alleviate the pain issues, but this surgery also to some extent destabalizes that motion segment of your spine which over time will more than likely become problamatic again. Keep in mind that this is the gold standard procedure with a fairly high success rate 80% +. If the plan is to go with a micro disc procedure than there is no removal of bone and hence no destabilization. There is a new devise on the market called the X-stop. I do not personally have any first hand experience with the devise, but I do know surgeons that either use it or have interest in using it. The reason I mention this is that it is a minimally invasive procedure (outpatient) that does not burn any bridges in the surgical continuam of care if for some reason it does not work. The devise essentially goes between your spinous process at that L4-5 level and then has the ability to crank open that space that used to be there prior to degenerative changes. By doing this you basically restore proper disc height and proper foramanal opening. I do not know if you are a candidate for this procedure, but I would do some research. You can find more information under that devise name and the company St. Francis medical. Univ. of Wisconsin madison reports approximately a 70% success rate when used in the right patient.
Lastly I would recommend that you get a second opinion and that you make sure you are either seeing a neuro surgeon or orthopedic spine surgeon that is fellowship trained.

Hammer110

 

[Tweakle]

You've had my opinion on the matter, although it does sound like your pain is worse than mine was. Ultimately it's can you stand the pain? If not then you have to do what you have to do.

3 things to remember -

docs like to cut, period. their definition of a 'success' is very different from ours. And lastly, surgery cannot be undone.

 

[Illuminati]

Killah....

I think we had the same back problem around the same time. (I slipped my L5-S1 in March of last year). My MRI showed that I had a very large protrusion in the disk. I know you pain, and I know that it is no fun to deal with. Much like you, I went through months of PT. I was on electrical stimulation (due to pulling muscles at the same time) for 1.5 months 20 minutes a day, and then Traction for for 2 months also 20 minutes a day. Each session, I had to heat my back for 20mins before and after (both the electrical stimulation and traction). They put me on 1000mgs of Robaxin (muscle relaxer) per day (I refused pain killers b/c I didn't not want to run the chance of becoming addicted to them). Ultimately I ended up not being able to re-enlist in the military b/c of it (my time was up as the injury happenend, so they just wouldn't let me re-enlist). In the end, I ended up taking care of my disk in my own way, and things are a lot better now. I rarely get pain.

But back to your question...Surgery sounds like a good option for you. With the degenerated disk, it will only continue to get worse over time. Did you have problems with your L4 when the injury happened? Assuming that you didn't, and I'm sure your doc has told you this, but the weakening of your L5, may have cause the problems with your L4.

I wish you the best of luck

 

[KillahBee]

Killah....

I think we had the same back problem around the same time. (I slipped my L5-S1 in March of last year). My MRI showed that I had a very large protrusion in the disk. I know you pain, and I know that it is no fun to deal with. Much like you, I went through months of PT. I was on electrical stimulation (due to pulling muscles at the same time) for 1.5 months 20 minutes a day, and then Traction for for 2 months also 20 minutes a day. Each session, I had to heat my back for 20mins before and after (both the electrical stimulation and traction). They put me on 1000mgs of Robaxin (muscle relaxer) per day (I refused pain killers b/c I didn't not want to run the chance of becoming addicted to them). Ultimately I ended up not being able to re-enlist in the military b/c of it (my time was up as the injury happenend, so they just wouldn't let me re-enlist). In the end, I ended up taking care of my disk in my own way, and things are a lot better now. I rarely get pain.

But back to your question...Surgery sounds like a good option for you. With the degenerated disk, it will only continue to get worse over time. Did you have problems with your L4 when the injury happened? Assuming that you didn't, and I'm sure your doc has told you this, but the weakening of your L5, may have cause the problems with your L4.

I wish you the best of luck

Do you mind if I ask what your own way was?

I did not have problems with L4 before the injury. The L4 and L5 issues are definitely because of each other.

Appreciate the thoughts. Same with everyone else. Thanks for taking the time to post that, hammer. I did see and Ortho Spine specialist. And I am seeking out a second opinion.

What it comes down to is this - I simply cannot live day to day with this injury. At night I CRINGE when gettin up off the couch or chair. I limp for 5 seconds, sometimes completely hunched over, until the issues subside. That is not living, not living at all. I completely realize that there are no guarantees with surgery and that no matter what, my back will likely get worse as time goes on or other problems may arise down the road. But is that a reason to just deal with the current pain/discomfort I am in? I don't think so....

 

[Illuminati]

Do you mind if I ask what your own way was?

I did not have problems with L4 before the injury. The L4 and L5 issues are definitely because of each other.

Appreciate the thoughts. Same with everyone else. Thanks for taking the time to post that, hammer. I did see and Ortho Spine specialist. And I am seeking out a second opinion.

What it comes down to is this - I simply cannot live day to day with this injury. At night I CRINGE when gettin up off the couch or chair. I limp for 5 seconds, sometimes completely hunched over, until the issues subside. That is not living, not living at all. I completely realize that there are no guarantees with surgery and that no matter what, my back will likely get worse as time goes on or other problems may arise down the road. But is that a reason to just deal with the current pain/discomfort I am in? I don't think so....

I'll send you a PM>

 

[jerol]

Quick background for those that don't know:

I tweaked my back about 14 months ago (squatting) and ended up with an extruding disc (L5). Did the PT thing (hit it REAL hard) and had 3 epidural injections over the span of about 10 months. FYI - I am 26

A lot of the symptoms went away with the first injection, some with the 2nd and none with the third. PT and the gym helped, but eventually I just plateaud. There is not a DAY that I do not have extreme discomfort / numbness running all the way down my left leg and there feels like a constant knot is being pulled in my left glute. I am very limited in the exercises I can do and my left hammy is tighter than a virgin on prom night.

Went to see a specialist in the city today. His summation of my issues:

- degenerated disc (it is blatantly darker than the others in the MRI)
- L5 is fused to my sacrum (rendering it pretty much useless)
- L4 is rubbing up against my nerve

My corrective options:
- keep on going the way I am - basically, "deal with it"
OR
- surgery. he would do a procedure called a "lateral decompression" where he would basically remove two ligament by the disc which would hopefully relieve the tension on my nerve (which is the major issue I have been experiencing). I would be in the hospital overnight, followed by 2 weeks out of work, followed by a month of no lifting or major movements/exercise.


My heart is saying surgery - actually, my head is too. Just wanted to see if anyone has any thoughts on this, cause I know some of you have experienced it and have been a great help to me throughout this cocked up experience.

Cheers

I'll preface my remarks by telling you two things: First, I am a surgeon. Second, I've performed over 1000 anterior spine approaches for various spine surgeons in my area over the last 10 years. I am not a spine surgeon myself, I am a vascular surgeon that is asked to provide exposure of the spine from the front.

The symptoms you describe sound clearly to be related to an anatomical abnormality (i.e. a bulging disc or a degenerative neural foramen). This is the type of pain that can (and really should) be completely relieved with surgery. I say these things for a reason. There are many individuals (I'd say roughly 50% of the patients) that have back pain without clear anatomic reasons and some get surgery and they usually don't do as well as people in your situation. There are a large number of folks out there that use chronic back pain as an excuse for not living their lives and that is clearly not you... which is good.

Now for the bad news. I say you can get better (and not that you will) because back surgeons vary widely in their approach and skill. I've worked with a few that weren't competent. If it sounds scary, then I've succeeded.

Check out your doctor. Get a second opinion (or a third). And for god's sake DON'T LIFT (doesn't sound like you can right now). Also, ask around for how other patients have done with the doctor you're going with. And remember, that this surgery will permanently affect your mobility at this spinal level and will affect the vertebrae next to it as well.

Good luck to you,

Jerol

 

[Plutto]

I had a microdecompression at L5 S1 just over two years ago.
My left leg was going numb when standing for about 10 minutes. No brainer for me to have surgery. The site below helped me alot with what to expect, detailed animations, what questions to ask. etc ...

http://www.spine-health.com/topics/surg/overview/s01.html

 

[KillahBee]

I'll preface my remarks by telling you two things: First, I am a surgeon. Second, I've performed over 1000 anterior spine approaches for various spine surgeons in my area over the last 10 years. I am not a spine surgeon myself, I am a vascular surgeon that is asked to provide exposure of the spine from the front.

The symptoms you describe sound clearly to be related to an anatomical abnormality (i.e. a bulging disc or a degenerative neural foramen). This is the type of pain that can (and really should) be completely relieved with surgery. I say these things for a reason. There are many individuals (I'd say roughly 50% of the patients) that have back pain without clear anatomic reasons and some get surgery and they usually don't do as well as people in your situation. There are a large number of folks out there that use chronic back pain as an excuse for not living their lives and that is clearly not you... which is good.

Now for the bad news. I say you can get better (and not that you will) because back surgeons vary widely in their approach and skill. I've worked with a few that weren't competent. If it sounds scary, then I've succeeded.

Check out your doctor. Get a second opinion (or a third). And for god's sake DON'T LIFT (doesn't sound like you can right now). Also, ask around for how other patients have done with the doctor you're going with. And remember, that this surgery will permanently affect your mobility at this spinal level and will affect the vertebrae next to it as well.

Good luck to you,

Jerol

Thank you for the insight, very very helpful. I agree on all points and if it's one thing I am figuring out, it's that I really need to do my research on this surgeon. I am actually going to get a second opinion next week.

 

[KillahBee]

I had a microdecompression at L5 S1 just over two years ago.
My left leg was going numb when standing for about 10 minutes. No brainer for me to have surgery. The site below helped me alot with what to expect, detailed animations, what questions to ask. etc ...

http://www.spine-health.com/topics/surg/overview/s01.html

How was the surgery and post-surgery recovery?

 

[Plutto]

I'm new here, I'm still looking around so I didn't want to say too much. I could write a book on the subject but I'm gonna try and keep it short.

First of all I'm not really in the same situation as you. My back was injured in a work accident in 1988 so it's a real old injury. It was a disc bulge. I didn't need surgery until it herniated 16 years later.

The surgery went well. They took about 40% of the disc out. I was walking the same day and the numbness was gone. There was alot of pain at the surgery site but that was expected (it's surgery - they cut you!) Pain went away in few weeks.

The following info/exercises really, really helped PT and I still do the McGill exercises as part of my warmup.
Physical Therapy Corner: Low Back Pain and Lumbar Stabilization Exercises
http://www.nismat.org/ptcor/lbp/

Dr. Stuart McGill exercises (click "Next Article" to see exercises)
http://imprint.uwaterloo.ca/issues/110300/5Sports/sports18.shtml

I'm in my 40's so I don't heal as fast as I used to. I started squating again at about 18 months post-op. No-where near the weight that I used to do, though I'm not really pushing it.

Feel free to ask any questions I'll do my best to answer them.
Hope that helps...

 

[win19]

Arch Phys Med Rehabil 1999 Jan;80(1):20-5.
Can spinal surgery be prevented by aggressive strengthening exercises? A prospective study of cervical and lumbar patients.
Nelson BW, Carpenter DM, Dreisinger TE, Mitchell M, Kelly CE, Wegner JA.

OBJECTIVE: To determine if patients recommended for spinal surgery can avoid the surgery through an aggressive strengthening program. SETTING: A privately owned clinic, staffed by physicians and physical therapists, that provides treatment for patients with neck and/or back pain. METHODS: Over a period of 2 1/2 years, consecutive patients referred to the clinic for evaluation and treatment were enrolled in the study if they (1) had a physician's recommendation for lumbar or cervical surgery, (2) had no medical condition preventing exercise, and (3) were willing to participate in the approximately 10-week outpatient program. Treatment consisted mainly of intensive, progressive resistance exercise of the isolated lumbar or cervical spine. Exercise was continued to failure, and patients were encouraged to work through their pain. Third-party payors in Minneapolis were surveyed for average costs. Average follow-up occurred 16 months after discharge. RESULTS: Forty-six of the 60 participants completed the program; 38 were available for follow-up and three required surgery after completing the program. DISCUSSION/CONCLUSIONS: Despite methodologic limitations, the results are intriguing. A large number of patients who had been told they needed surgery were able to avoid surgery in the short term by aggressive strengthening exercise. This study suggests the need to define precisely what constitutes "adequate conservative care."

The program basically consisted of isometric strengthening of: including the lumbar extensors, cervical extensors and rotators, and thoracic rotators. Full study at: http://www.backbuilder.com/archphys.htm


I'm not a spine expert (although based on the casese suggested for surgery it seems somewhat similar to yours), so I don't know how this would apply to your situation. I'd highly suggest that to form an inquiry and try emailing two of the researchers about your situation here: http://www.ncbi.nlm.nih.gov/entrez/...t_uids=8726348&query_hl=6&itool=pubmed_docsum But be professional and hope they check their email, and if you do decide to email them let us know what they said.

 

[KillahBee]

Interesting, thanks for the info. FYI - I was in the gym and PT running a pretty intense strengthening program for probably 4-5 months. Made some good progress with strength gains, but flexibility progress was very minimal. And the SAME stretch/movement was the issue - hammy stretching with my left leg. When I am sitting on the doc's table and I try to hold my left leg out straight the pain gets bad. No improvement there.

Maybe I will try emailing these cats, once I do some research.

And as far as being professional - yeah, I manage multi-million dollar sponsorships for blue-chip international clients daily. So I definitely understand that

 

[win19]

Interesting, thanks for the info. FYI - I was in the gym and PT running a pretty intense strengthening program for probably 4-5 months. Made some good progress with strength gains, but flexibility progress was very minimal. And the SAME stretch/movement was the issue - hammy stretching with my left leg. When I am sitting on the doc's table and I try to hold my left leg out straight the pain gets bad. No improvement there.

Maybe I will try emailing these cats, once I do some research.

And as far as being professional - yeah, I manage multi-million dollar sponsorships for blue-chip international clients daily. So I definitely understand that

Alright, good deal man. A quick synopsis of the study: In the study, 46 patients basically completed it (though 77% completed the exercise program and 82.6% who completed it were available for follow-up), 38 were thus follow-ups. They mention that 90% of the patients already tried but failed some type of exercise program. They also mention: "... Early attrition is unfortunate because patients undergoing aggressive strengthening exercises often do not begin to feel better until 3 to 4 weeks into the program. Also, some patients are unwilling to devote the time and energy required for aggressive strengthening exercises and elect passive care and/or surgery instead." And out of the 38, they were originally recommended to surgery and of those, lumbar fusion (technique for degenerated disc, 15), lumbar decompression (technique for relieving impinged nerves, 13), cervical fusion (3), cervical decompression (7).After the exercise program completion, 17(44%) had "excellent" results, "good" in 14 (36.8%) and "fair" in 4 (10.5%). And in the end 3 of the 38 needed surgery.

If you have done an intense strength training progam for 4-5 months, I'm not sure how the nature of that program would compare with those of that seen here in this study and how that would affect the results (ie, 90% mentioned they already tried some type of program).But then it seems surgery is certainly an open option.

 

[KillahBee]

FYI - got a second opinion today and, as expected, I got the same feedback. Although, I liked this surgeon much better in terms of personality and information sharing.

Same deal - either you live with it or you get the surgery. He has done hundreds of these and was realistic in explaining everything.

My father is talking to a surgeon in RI (where my parents live) that did his back a few years ago (a Brown University surgeon) to see if he can talk to me and potentially to the surgery. Since I will be out of work for 2 weeks, it makes sense to have the operation at home and stay at my parents' place.

Looks like I'm going for it.