Sciatica and surgery.

April 13, 2009 3:23 AM

I've got a herniated (ruptured) L5 disc that is causing sciatica, due to the fluids from the disc sitting on my sciatic nerve. I'm in an enormous amount of constant pain, and am trying to decide whether or not to have surgery.

The surgeon suggests it, of course. The chiro/accupucturist/other docs don't, but none of them have been able to help me get any relief from this pain. Has anyone here had the surgery? What's it like? What's the recovery like? Has anyone found alternative solutions?

And are there any good messageboards online specifically for medical discussions like this one?

posted by Framer to health & fitness (13 comments total)

I had the surgery at L4-L5. First time it lasted 20 years. Second time not as good. Third time, fusion. Best of them yet. Pain free and playing whatever sport I want including hockey. Heal with steel. YMMV

Recovery time was several weeks before could spend full day at office. Several more weeks before I regained all my strength. Much rehab and doing your back exercises daily for the rest of your life.

What operation exactly are they proposing?
posted by JohnnyGunn at 3:50 AM on April 13

Can't remember what it's called. Removing the ligament and a little bit of bone to get in there, and then removing whatever of the disc fluid has gotten out and onto the nerve.
posted by Framer at 3:53 AM on April 13

Surgery can often alleviate back pain, esp. when there's a definite pathology to go after. And in a large fraction of cases, there's a good outcome.

The problem with back surgery, in my experience, is that it sets you up for future back surgery. You'll do fine for a while and then something else will act up, and they'll want to operate again. Each operation, especially if they fuse vertebrae or plate them together, can introduce mechanical anomalies into your spine that lead to further damage.

So a significant minority of people undergoing back surgery come out needing more back surgery, and more after that, until their back is so scarred up there's no more cutting to be done.

Before surgery, have you tried A) Physical therapy? B) meds geared to neuropathic pain, like Lyrica or Neurontin or Nortriptyline? C) a comprehensive pain clinic?

Now, if you're losing sensation in your leg or are having bowel/bladder problems, that changes everything. You need surgery right away.

Oh, and this is given for entertainment purposes only. It is not proven medical advice, and I share no liability.
posted by adoarns at 3:54 AM on April 13 [1 favorite]

I had the same issue back when I was 30. I went the therapy/drug route for over a year. All that did was give me temporary relief, but it did nothing to remedy the situation. Eventually, the pain overwhelmed the drugs.

My ortho doc suggested I undergo a procedure called chemonucleosis. The gist of the procedure is that, instead of cutting you open, they insert needles into the herniation and inject an enzyme that dissolves the leaked fluid and seals the disc. I was up and walking pain-free that afternoon. There are, of course, risks and complications, as there are with any other procedure. But being completely pain-free and walking upright after a couple of years of misery was simply amazing.

I'm not sure if the procedure is done anymore, though. I offer my example only to say that there are, apparently, options out there that don't involve cutting you open, fusing discs, etc.

And never listen to a chiropractor when it come to real, medical issues.
posted by Thorzdad at 4:07 AM on April 13 [3 favorites]

IANAD, but it sounds like you are a perfect candidate for a diskectomy. Well defined problem, small incision, clear out the impinging crap, short recovery time (2 weeks for the tissues to knit together, another 2-6 weeks for complete recovery), done. Do your exercises 3 times a week forever. (maybe repeat in a decade, maybe not. That depends on a whole host of individual things.) It would help if you remembered which surgery your doc was recommending, as there is more than one kind of back surgery -- diskectomy (one variety of which is what it sounds like your doc is recommending) has about a six week recovery time; fusion is much more invasive and has a much longer recovery period, but is usually reserved for major problems.

I am assuming that you've tried PT and other approaches. And gotten a second opinion from an orthopedist, preferably -not- a surgeon. If you're having actual nerve problems other than pain (lack of muscle control, f'rex) there really isn't much of a choice.

(FWIW, I had double spinal fusion three and a half years ago, and while I'm glad I was able to put it off as long as I did, it was time to do it -- the L5-S1 disk had collapsed so badly that the vertebrae were beginning to fuse on their own. I still haven't regained sensation down the outside of my right leg, but as it's been gone for 15 years....)
posted by jlkr at 4:24 AM on April 13

Another option that a good Pain Management physician may offer you: LESI (Lumbar Epidural Steroid Injection). It's an outpatient procedure and takes just a couple of hours. My sciatica was 99% gone after three separate injections, and similar pain in my neck and left arm were taken care of 100% after one. (Chiropractors – stay away from them. My father died at the hands of a chiropractor who couldn't/didn't read an x-ray and "manipulated" a cervical tumor, putting him into a fatal coma.)
posted by davcoo at 5:29 AM on April 13

I had the exact same problem in September '07: ruptured disc at L4-L5 sitting right on my sciatic nerve. The pain shot down all the way to my left foot sometimes, and the toes on that foot were nearly 100% numb. I had a discectomy to remove the offending piece.

Relief lasted a little while, but some of the pain came back and wouldn't go away no matter what was tried. I tried medications, including Lyrica, and had so many injections of various types I lost track of them all. Finally I had a test they called a "discography," which involved injecting fluid into each disc in the lumbar region to try to reproduce the pain sensation, followed by a CT scan.

The discography was almost certainly the most painful test I have ever had in my entire life, but it worked. It was determined that the L4-L5 and L5-S1 discs were damaged and leaking, and that surgery was really the only reasonable option. So I had surgery this past February, which seems to have worked, so far. I'm still recovering from the surgery itself, because I had two discs replaced and a titanium plate bolted to my spine, but the pain I feel now is entirely different from the pre-surgery nerve pain.

If you want a second opinion, get it, but get it from an orthopedist, not a chiropractor. Good luck!
posted by cerebus19 at 5:45 AM on April 13

I currently have the same problem (L4-5 slip and rupture and L3-4 tears), but it seems not as bad as yours. My doctor put me on a corticosteroid (methylpred) and that took care of the pain. (I'd recommend the steroid. It was magic.) I still have some numbness in my toe and a little weakness in my shin, so he referred me to a neurologist, who I'll see in a couple weeks.

But the doctor said these things often take care of themselves with time. Once you take care of the pain, anyway. And it's true, I do feel minor improvement but I'll probably keep my neurologist appt.

He also said that PT wouldn't do anything in my case - though I don't believe that. And he gave me a copy of the MRI report to give to my chiropractor so she can adjust her treatments appropriately. Oh, and I should mention that my leg was cramping terribly when at its worst, so I saw my massage therapist weekly. The leg felt best after those sessions.
posted by booth at 7:12 AM on April 13

I don't know the details, but my mom had back surgery for sciatica about 19 years ago. It cured the pain, and she has not had further surgery since. Recovery time similar to what Johnny Gunn said: she brought in a mother's helper type nanny to help her with all of us kids for the next two to three months.
posted by salvia at 7:20 AM on April 13

Thanks, everyone. I neglected to mention that I had three cortisone shots (two of them epidural) and none helped. Hurt like hell when the fluid was being injected, though, so I know they got the right place.....
posted by Framer at 7:41 AM on April 13

I'm currently recovering from a gumball-sized disc herniation at L5S1 under the care of a physiatrist. If you haven't tried fluoroscopically guided epidural steroid injection, it's worth giving it a go before resorting to surgery. (The fluoroscopic guidance is key, from what I've read.)

I'm finding it shockingly effective. Six weeks ago I couldn't get out of bed without a lot of help, let alone walk; the pain was astounding, even on opiates. Of course, we'll see how things progress, but so far it's like this: the first injection knocked out all but 10% of the pain almost immediately, and the second (just last week) has knocked the grand total down to about 3% with almost no tingling or numbness. I can now stand at my full height, walk perhaps two blocks with care, sit upright, bend and twist gently, lift light objects, and generally engage in light activity without painkillers. It's enough that I can start doing PT with a spine specialist.

I suspect I'm going to get out of this one without having surgery. But even if I weren't so optimistic, I would be glad for even temporary significant pain relief if only because it makes it so much easier to research my options. Constant racking pain makes it difficult to process information and make good decisions. I was having a heck of a time thinking straight. (Not to mention that, wow, am I ever enjoying standing up and walking around again.)

I'm enormously pleased with my physiatrist and would not hesitate to recommend seeing a well-regarded doctor in that specialty. Whatever you do, good luck with it!
posted by sculpin at 7:44 AM on April 13 [1 favorite]

Shoot, and I previewed just before you posted that.
posted by sculpin at 7:45 AM on April 13

I had a ruptured disc at L5 S1 last May. I had the steroid injection, it didn't help. The narcotics didn't help. Finally after nearly 12 weeks lying in bed I had the surgery. Tried to do it under just a local (epidural) and couldn't sit in the position for them to do the injection. I ended up with general anesthesia. Pain in my leg and butt was immediately better but the surgery really made me sore. I spent the next three days in bed. On the fourth day I sat at the dining room table and had dinner. I hadn't been able to sit at all for months, so it was pretty amazing. Not quite a year out yet, my back is feeling great. I did therapy for about 8 weeks and have been working with a trainer after that. I do stretches and core strengthening nearly every day, which definitely has helped me recover. I still have nerve damage in my foot and calf and tightness in my back, but I am very happy with the process. Feel free to contact me with questions if you want.
posted by sulaine at 8:42 AM on April 13 [1 favorite]