After 12 months of nonstop lower back pain I finally got a second opinion. Last doc said "come back and see me when you can't handle the pain anymore". This one pretty much concurred.

Herniated disc L4/5 and level 1 spondy on L5. He said surgery is just a matter of time, fusion of L4/5 and L5/S1.

So my question to AD or anyone that's been down this road, I'm just wondering if there are any treatments to prolong the inevitable. I went for my first round of spinal decompression yesterday just to see if I could tell anything. He said it usually takes a few sessions before any noticeable change. I was actually having a pretty good pain day. As the machine pulled I could feel the discomfort down the nerve, starting in the glute and working down the outer leg. Kinda crazy feeling it work its way down like that.

My pain most days is a 2-3. I can still run 5 miles / bike 30 on a good day with minimal discomfort (oddly enough exercise generally makes it feel better, not worse). I was just optimistic there was a non-surgical way to get it back to 0. The doc basically said "if you have any bucket list items, knock them out now, because training's going to look different after".

I managed through a L4-L5 herniation for roughly three years until I had a microdiscectomy in Aug/Sept 2011. Prior to surgery, I just dealt with pain (max 4 out of 10) and did feel some nerve tingling down my butt/legs. The nerve issues were minor and went away pretty quickly. My treatment was largely using a chiropractor in Houston (I think most chiros are quacks, but this guy does more deep tissue message and traction). Using this treatment i was able to do an Ironman in the summer of 2011.

A few months later, I lost all feeling down one leg while on a bike ride and while the feeling came back within a day, I lost the ability to raise my right toes - I had foot drop. That's what got me to have surgery within a couple weeks.

Post surgery, I was able to get back to normal within a few months and have done another Ironman and numerous 70.3s.

If you are just dealing with pain, and can manage through it, I would recommend holding off on surgery as long as you can. This is just an anecdotal comment, but surgery does guarantee the pain will go away. Hang in there, keep trying non-surgical treatment.

Corleyjr said:

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I managed through a L4-L5 herniation for roughly three years until I had a microdiscectomy in Aug/Sept 2011. Prior to surgery, I just dealt with pain (max 4 out of 10) and did feel some nerve tingling down my butt/legs. The nerve issues were minor and went away pretty quickly. My treatment was largely using a chiropractor in Houston (I think most chiros are quacks, but this guy does more deep tissue message and traction). Using this treatment i was able to do an Ironman in the summer of 2011.

A few months later, I lost all feeling down one leg while on a bike ride and while the feeling came back within a day, I lost the ability to raise my right toes - I had foot drop. That's what got me to have surgery within a couple weeks.

Post surgery, I was able to get back to normal within a few months and have done another Ironman and numerous 70.3s.

If you are just dealing with pain, and can manage through it, I would recommend holding off on surgery as long as you can. This is just an anecdotal comment, but surgery does guarantee the pain will go away. Hang in there, keep trying non-surgical treatment.

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Thanks for the feedback. I think my doc wants to do it all in one big go. I wonder if there would be any upside to dealing with the herniation first. I'm guessing that's where the pain is coming from. Then maybe revisit fusion options down the road.

If you are still that active, I'd look at trying PT before you have surgery.
1. You might be able to avoid surgery all together
2. The things you do the first time will make recovery easier IF you end up doing surgery
3. You can see if you like the PT and know if you would want to see them again in the future.

I would echo going with PT before surgery. A lot of herniated discs never need surgery at all.

For me I had a herniated L4/L5 that floored me one morning. Quickly after I developed numbness in left toe and foot drop in left foot. Both docs I went to recommended surgery because of the foot drop. I went to an orthopedic surgeon and a neurologist (both can do that surgery). I had microdisectomy in April 2019 and have been fine since, but been diligent in keeping my core strong and keeping my hips lose.

I trained for IMTX in April and felt fine before it was cancelled, and now I'm 6 weeks out from IMTX and feeling fine again.

I ended up using Dr. Mark Prasarn. He did JJ Watts microdisectomy so I figured he could handle me. When I went to PT afterwards the PT looked at my chart and said "Oh wow. You got like THE doctor."

Good luck. There's some info in this recent thread too.

http://texags.com/forums/13/topics/2537646/466

So I herniated my L4/L5/S1 discs in college freshman year - at first I did some stuff I saw online to help the pain, and that didn't help, then I went to PT and that didn't help. Took me until senior year to not be able to deal with the pain (walking to/from classes, sitting for prolonged periods of times in uncomfortable chairs and desks) before I had my microdiscectomy in 2016. Everything was relatively normal, until last year when I now have 2 more (way less) herniations. I didn't want to go through surgery again, so I began trying to strengthen my core - and it has helped me in so many ways. I started off relatively slow with weight lifting, and really pushed myself to get back in "shape". Once I lost some initial weight and could feel some strength coming in, I up'd my weight training to what was comfortable to do, while also pushing myself. I still have some bad days, but overall, I feel exponentially better than before. That would be my advice, try and slowly work on your core strength. Since everything you do is based on your core, you can really feel a difference.

Look for a pain management specialist who can inject steroids into the epidural space. This can ease pain, allowing you time to get in better shape for surgery, possibly avoid surgery.

I had herniated L5-S1 playing soccer. Couldn't walk for a week, but the steroids got me in good enough shape that I eventually was able to run. Never had surgery, it's been over ten years.

It was no cake walk, took many treatments over a couple years, still occasionally have burning in feet. Surgery may have immediate results, may not.

If you aren't having leg symptoms an epidural isn't likely to do much. If you are there might be a chance it will help.

"herniated disc" seems to mean many things to many different docs

i hear/see it all the time, the patient will say they have a "L5 slipped disc" but we get a MRI and there is maybe some mild degenerative disc disease w/ flattening

perhaps your neuroimaging is worse given they want to do a fusion instead of microdisectomy -- would ideally see a neurosurgeon, maybe that specializes in spine, and that is up to date on his/her techniques

in your situation w/ pain at 2-3, i would work with PT & get an EMG/NCS at an EMG specialist to see if there is active L4-5 nerve root damage

if the pain is too bothersome to carry out your normal activities, i would also try a lumbar epidural steroid injection -- but know that the evidence for this procedure is scant -- most get short-term to no benefit, however, some get great results

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in your situation w/ pain at 2-3, i would work with PT & get an EMG/NCS at an EMG specialist to see if there is active L4-5 nerve root damage

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They did a shock test on me last week. Basically shocked the nerve from my hip to my toes. For better or worse I felt every one of them. No nerve damage.

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if the pain is too bothersome to carry out your normal activities, i would also try a lumbar epidural steroid injection -- but know that the evidence for this procedure is scant -- most get short-term to no benefit, however, some get great results

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Had that done back in January. Got relief for maybe 2-3 days.

I have a follow up w/ the spine doc tomorrow. Oddly enough I've upped my running mileage lately and it feels like it loosens the lower back / glutes. Pain has been as minimal this past week as any week in the past year. Then I sit down for five minutes, it compresses something and my world goes back to heck.

Same problem in the same spot. And as a bonus, I have two spots in my neck that cause similar pain in one of my arms. Steroid epidural and PT is about all you can do and when that no longer works, surgery is only option. Im still kicking the can down the road but surgery is inevitable for me too.