as the title states, i have a herniated disc in the L-5. In hopes to avoid surgery, i did a month and a half of PT, had 3 ESI shots and have started at a chiropractor. To be concise, i have not experienced pain relief and am now considering surgery to help relieve the perpetual pain in my left leg. This was onset from a wakeboarding accident.

Has anyone had back surgery to address this herniated disc-induced pain?

If so, would you care to share your experiences of surgery and recovery? i have been very active outdoors and want nothing more than to be active again, which hasnt happened since September.

Thanks in advance.

How big is the herniation?

MRI readout is:

"mild to moderate broad-based left paracentral posterior disc protrusion displacing the left S1 nerve root sleeve and moderately effacing the left lateral recess."

So moderate?

Everyone has their own interpretation of the size of the herniated disk. Ultimately, if you have a herniated disk at a certain level on a certain side, then you correlate the findings on the MRI with how you are doing. If you have a herniated disk at L5-S1, you are looking for leg pain... in particular in the back of your legs. You may have some weakness in "pushing down on the gas pedal" or numbness in the bottom of your feet.

Usually back surgery for leg pain yields great results. Back surgery for back pain is different and the reason there are so many bad things you hear about this. For a herniated disk with leg pain, all you would need is a diskectomy. In this case, the surgeon does not take out the whole disk, just a small portion that is pinching the nerve. This can be a 30 minute to one hour operation and can be done through a small tube (METRx tube) that is 18 mm in diameter. The surgery is done throughout a instrument and everything can be done through the tubes. If the surgery is done for pain, the results are excellent. If you have weakness, there is a good chance that the weakness will improve but you may not get back everything. Numbness is harder to treat.

Usually, I put patients through 6 weeks of physical therapy and I recommend 3 epidural steroid injections. If the pain is still unbearable or there is weakness, then I recommend surgery.

thank you shihite, very helpful. You have described my situation pretty accurately. No back pain, just down the left leg.

I put that little laughing emoji in the wrong thread. Sorry.

Where are you? I work in a PT clinic in Bellaire and the Therapist is nationally known and saves most patients from surgery. I've witnessed people come in on canes/walkers and forget them on the way out. No shots.

Your situation is pretty similar to mine. I had an L5-S1 herniation with pain down the back of my left leg. No relief with therapy and one ESI. I had laminectomy-discectomy surgery in March of last year (Dr. Guyer in Plano). I was up walking the same day and went home the next. Like the doctor said it would, the pain returned a few days post-op due to swelling, but it subsided within a week or so. I'm a firefighter and was able to return to full duty in June without problems (fingers crossed). Back to normal as far as exercise too. I was back up to running 3 miles in a couple months. I'll do squats or dead lifts, but with light weight now. I get the occasional irritation down my leg, but it's nothing compared to the pain before. I still get nervous about a relapse when the irritation starts, but overall it's been quite the success.

I'm up in DC.

Had the injury in August of 2015 and am about tired of the pain. Going in for another follow up with the orthopedist in a couple of weeks, I believe he will be referring me to the surgeon after.

The two neurosurgeons I would recommend in DC are both from Georgetown University.

Jean-Marc Voyadzis
Faheem Akram Sandhu

They both are fellowship trained in minimally invasive surgery and probably practice that exclusively.

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as the title states, i have a herniated disc in the L-5. In hopes to avoid surgery, i did a month and a half of PT, had 3 ESI shots and have started at a chiropractor. To be concise, i have not experienced pain relief and am now considering surgery to help relieve the perpetual pain in my left leg. This was onset from a wakeboarding accident.

Has anyone had back surgery to address this herniated disc-induced pain?

If so, would you care to share your experiences of surgery and recovery? i have been very active outdoors and want nothing more than to be active again, which hasnt happened since September.

Thanks in advance.

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My wife herniated a disc dead lifting in November 2011 (Crossfit ). Her symptoms were radicular pain down the left leg, no back pain. We tried rest, physical therapy, chiropractors, and nerve root injections from a pain doc. Unfortunately, the injury was re aggravated several times over the next 4 years and she never had sustained relief. Because of the morphology of the disc bulge/herniation, she wasn't a candidate for microdiscectomy. After nearly 4 years of waiting and hoping to avoid surgery we gave up. In August 2015, she underwent L5-S1 complete discectomy and fusion. Her recovery has been pretty terrible so far. Now she has low back pain at the surgical site as well as radicular pain/numbness in her left leg and foot. She is still on Lyrica for neurogenic pain and has gotten 3-4 nerve root injections since surgery. In retrospect, we are both wishing she didn't go to surgery.

OP, I hope you find healing without surgery. If you elect to have surgery, I hope it is successful.

One thing you need to figure out it if there is a medial breach of one of the screws. If the screw is in the canal and rubbing on the nerve, then it needs to be replaced. A lot depends on what your instrumentation looks like after the surgery. A CAT scan will show all of this.

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One thing you need to figure out it if there is a medial breach of one of the screws. If the screw is in the canal and rubbing on the nerve, then it needs to be replaced. A lot depends on what your instrumentation looks like after the surgery. A CAT scan will show all of this.

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She had a myelogram in December and I just looked over the CT images again (I'm a radiologist). Pedicle screws seem to be contained within the bone. They are close one on slice, but I think it's ok. Thanks for the advice though, it was one more thing to consider.

This is my experience. Seven years ago, I has lots of pain that shot down the left leg. The neurodoc diagnosed the cause as herniated disc L5/S1. He gave me some options, including surgery. Having heard lots of negatives about back surgery, I asked him to explain. His words were, "This is back surgery 101." I said, "Lets do it." A week later it was one night in the hospital and soon back on the streets. I'm quite active--usually walk three to four miles a day on sidewalks or on t treadmill. I do not recommend surgery or anything else--just telling my story.

Surgery should be your last choice and you and only you can tell if you're at that point based upon pain

I had a l5s1 lam/microfiscetomy too. It went well. About ten years later I reruptuted the disc and I used some injections to keep me from having surgery two. The doc said that doing the same procedure on the same disc increases the risk by over 10x. The first procedure is about a 1ish percent chance of issues.

A fusion isn't in the same ballpark as what we have. If you want to talk or have more detailed questions feel free to pm me.

16 years ago, I had a severely herniated disc that caused issues for years. Had the surgery after it turned and where it had previously caused pain in my right leg it was now causing immense pain in my left leg.

Did PT for a month and while the pain went away so did the feeling in the bottom of my left foot. Had an MRI and surgery the next week. WISHED I WOULD HAVE HAD SURGERY 5-10 YEARS BEFORE THAT.

Now fast forward 16 years and that disc is basically gone and two above it are in bad shape, but that would have probably just happened faster if I had not done it.

If it is one day microdiscetimy (sp?) like I had (in and out same day), I advise it but I advise working out and strengthening your core afterward - something I failed to do for a few years afterward.

Good Luck.

Voyadzis and Sandhu were both unavailable until Mid April for an initial appt.... Going to meet with a Dr. Robert Mason from their practice (Medstar Georgetown) next Friday.

Hoping i'm a candidate for microdisectomy and can get on the road to feeling 'normal' again.

Thanks everyone else for sharing.

I herniated my L5 when I was 11. Maybe age is a factor but I've had no major issues with it. Sometimes I feel a little stiff if I've been standing real long but that's about it. I can tell you though that I've always been a weight lifter and I truly believe the strength I built up in my core and back has helped immensely.

Surgery was never really brought up as an option. I was not allowed to run for about 6 months and in the early stages I took significant amounts of ibuprofen. No PT or anything else was done and it turned out fine.

I had an L5=S1 Hemilaminectomy/Microdiscectomy in May '14. PT and healing went great. Unfortunately, it re-ruptured 6 months later. I dealt with it for about 6 more months until the nerve issues started affecting my movement. Had a second hemi/micro last June. Prior to that, i had exhausted all options over 5 years. Multiple ESIs, several rounds of PT, meds, ice/heat, etc.

It's taken almost a year to get back to normal. Biggest issues are inflammation and aches because i have so little disc material. I just have to take it easy, ice down, etc. My mobility at that fulcrum point is much less, so i had to give up golf. But, i can do just about anything else.

Surgery sucks, recovering is not fun. But, for me, it was much better than the alternative.

Not sure what therapy you've tried, but I highly recommend looking into Mckenzie method physical therapist...Worked for me and several other people I know first hand.

Memorial Hermann PT site

I have a L5/S1 herniation and dealt with sciatica for about a year and a half. Went to regular physical therapy (core strength mainly), several ESIs and was looking for a way to avoid surgery. For me, back surgery is a last resort.

My pain management doctor suggested a Mckenzie method physical therapist (Lots of memorial Hermann PT locations in Houston are certified). The actually therapy visits are usually short, 1/2 hour-twice a week as long as you do your part at home. I saw slow improvement over the first 4 weeks or so and wasn't all that encouraged. Then over the next 2 weeks it went really fast. Stopped going to PT at 6 weeks. Was pretty much pain free by 8 weeks.

Most of the work you can do on your own, but having some guidance, evaluations and tweeks to the method are pretty important because you'll hit some plateaus.

I still do the exercises/stretches daily as a preventive measure, but that is less than 5 minutes a day.

Brad, can you elaborate on the exercises/stretches? Thanks

The primary at home stuff, outside of core exercises, is Back Extensions. Early on, I was doing 3 sets of 10 of those every couple hours or even more often. I'd only see very minor relief, and it really wasn't lasting, but it got better with time. It is absolutely not a fast method. There are some other things that PT may recommend. I still do a set or 2 first thing in the morning and 1 before bed, along with some hamstring stretches at night to maintain flexibility.

I think it is a good idea to start with a physical therapist because Mckenzie method is as much about evaluation as it is doing different movements. Small tweaks to how you are doing extensions can make major differences. L5/S1 takes more pressure to get to and PT can teach you how to get that.

I realize this sounds like its too simply to work, but it did wonders for me after over a year of pain, PT, ESIs etc. Every time I talk about it, I kinda laugh at myself because I think I must sound like a new age treatment person or something, but this is from actual physical therapists which I do trust.

The guidance from PT was invaluable for me and doing back extensions without having gone to PT probably would not have really helped me. I definitely recommend finding a certified Mckenzie physical therapist.

Another big preventive measure is to sit with good posture, which is really hard to do starting out and takes constant attention until you really get used to it.

I was diagnosed today with a "major herniation L4/L5, medium herniation L3/L4 and minor herniation L5/S1." Basically I kept injuring my back and going to a chiropractor to bandaid it and now it's hurting pretty good. Doctor says injections may work for some period of time, but with multiple herniations surgery would probably be the best option.

Any thoughts?

Have they expounded on the type of surgery? Are you looking at a discectomy, fusion? One thing to note, is that typically a surgery to remove part of the disc means more pressure at the vertebra above and below. If you've got multiple herniations along 3 areas, they'll probably recommend a fusion.
I could be wrong, but that's what my surgeon mentioned to me, as something I'll have to deal with down the road, after my two surgeries at L5/S1. I went the road of trying every non-invasive treatment before deciding on surgery. I did multiple rounds of PT, injections & chiropractic care. Got to the point that surgery was my only option. I felt a lot better about proceeding with it, after I'd tried, and exhausted, all my other options.

I am meeting with the neurosurgeon next Monday. My appt. today was with his attending I guess (I know nothing of the medical field). I am hoping to avoid surgery if at all possible, but I am also the type of person to fix things and be done with it. I'm not really sure what the best course of action is.

I went round and round on the surgery decision. Very rarely do you hear people talking about how amazing it was. Seems you're inundated with horror stories.

I decided it was the best course of action for me, after weighing all the options. I had fought through back issues for 5 years, and it wasn't going to get better (i finally had a 1cm rupture at L5/S1), so even though the injections worked ok, they only masked the pain, which came back quicker and quicker after each round of ESI's. I started to have a lot of numbness in my calf and foot, and the doctors told me that it could start to lead to more permanant nerve damage.

The first surgery went great, i had no problems, and was able to work through a good PT program, get back to normal etc. Unfortunately, i just have a genetic disposition for disc problems. It re-ruptured at 6-7 months, and I had to think through the ramifications of a second surgery. I ultimately came back to the same result. Doing nothing (other than PT, pain meds, etc) was only going to prolong the fact that i had to get it fixed. I'm about 9 months removed from my second micro/laminectomy, and while there are daily pains/aches, changes in life routine, I'm happy that i can walk and pick up the kids.

Point is, surgery is a big decision, but it all comes down to quality of life. If it's starting to affect your daily routine, your sleep, your general attitude (pain does funny things to personality), then you should consider it. Don't be afraid to ask a lot of demanding questions of your surgeon. How many of these has he/she performed, what is the percentage of success rates for pain relief, how many have had reoccurrences, spinal leaks.

Good luck, and I'm happy to share any information, as are plenty of people on this board dealing with the same problems.

My wife just had this procedure done yesterday. Anybody have some best practices for the first week to get her back and moving as such as possible. It's been 24 hrs since they operated and the stiffness is setting in but I'm afraid getting her to walk to much might stress the incision to much.

To clarify - it was her L5. Dr said her nerve was pressed and looked like a ribbon instead of a cylinder. The pain in her foot/calf/leg is now gone.

Walking is the best thing for her, but limit it initially, and start to build up more and more over the week. For me, it was starting with a slow circuit around the house, and alternating it with laying back down on the bed. After 4 or 5 days, i was taking short walks outside (to the mailbox, etc).

A major herniation at L4-L5 is going to cause pain in the outside of the leg to the big toe? I would figure if you have mainly leg pain or back pain. Also, if the herniation is really that big at that level, you may have a foot drop and may be dragging your foot.

I would agree with Prophet00 in that walking around to avoid getting a clot in the leg. For the first month, you can get muscle spasms from the trauma of the paraspinal muscles. I typically start patients on physical therapy if they are still sore at 6 weeks.

Finally got the actual MRI dictation. Any thoughts based on the findings?


FINDINGS:
Five lumbar type vertebra are visualized. Alignment is unremarkable. Marrow signal is normal without geographic bone lesion or fracture. The paraspinal soft tissues and retroperitoneum are unremarkable. Conus medullaris terminates at the lower T12 level
and is morphologically normal. There is congenital stenosis of the lumbar spinal canal.

L5/S1: Mild loss of disc space height and signal. Mild disc bulge with superimposed left central disc protrusion and associated annular fissure. There is minimal indentation on the thecal sac. Mild bilateral facet degeneration. No significant spinal
canal or neuroforaminal stenosis.

L4/5: Mild loss of disc space height and signal with mild bilateral facet degeneration. Broad-based disc bulge is present with superimposed central disc protrusion. Severe spinal canal stenosis. No significant neuroforaminal stenosis.

L3/4: Mild disc bulge with superimposed disc extrusion and annular fissure. There is severe spinal canal stenosis without significant neuroforaminal stenosis.

L2/3: No significant abnormality.

L1/2: Mild loss of disc space height and signal. Minimal disc bulge is present with a small left subarticular disc protrusion which minimally indents the thecal sac. Mild spinal canal stenosis without significant neuroforaminal stenosis..

T12/L1: No significant abnormality.Impression


IMPRESSION:

1. Severe spinal canal stenosis at L3-L4 and L4-L5 secondary to disc herniations and superimposed congenital canal stenosis.

2. Additional mild multilevel degenerative changes in the lumbar spine as above.

If you have mainly leg pain when you stand and can't walk for any long period of time before You have to sit then surgical decompression (and not a fusion) would be an option. This can be done through a 18 mm incision. I would try PT and epidural steroid injection first if you haven't already done so.

That is exactly what I am experiencing. It's worse when standing in one place. It hurts to walk, but I can tough it out enough to get around. Standing for longer than 3-5 minutes kicks my rear.

I am going to try an injection first and any PT they recommend. I don't go back until April 4th unfortunately. Would going back to my chiropractor in the meantime do any good?

I'm not quite sure chiropractic manipulations are the way to go. I would do the physical therapy for 6 weeks/3x a week. You can get the steroid injections - up to three a year. If you are in Houston, I can tell you who we send patients to for steroid injections that does a good job. Also the physical therapist we refer patients to does a good job as well. Ultimately, you may need surgery. If I were you, if that point comes, I think you would be better off with a two level decompression through a minimally invasive tube called the METRx tube.