Have you had any experience with herniated disc back surgery? What should I expect?
June 8, 2010 10:24 AM   Subscribe

Hey everybody, I asked about my leg pain/sciatica and got a lot of helpful answers last time. This is a followup on the same topic. I recently got an MRI back that says I have "There is a large extradural mass extending posterior to the L4-5 or L5-S1 intervertebral discs most likely L5-S1. This likely reflects an extruded disc fragment from a disc herniation. There is extensive effacement of the right S-1 nerve root. This extends up to the level of the L4-5 disc. Diffuse central disc bulging is present at L3-4. No compression fractures or other bony abnormalities are identified." My chiropractor said that I have the next to worse kind of herniated disc and that it is "leaking" and putting pressure on the nerve. He was anti-surgery last time, but after seeing the MRI said that is pretty much my only treatment option at this point for relief. I am having horrible leg pain and am on pain killers pretty consistently. I am mildly freaked out about surgery, but I need to get back on track with my life. Please help me get a better understanding if you have any experience. Thank you!

My chiro. said that surgery was the only option (he's very conservative). I'm seeing the spine surgeon tomorrow, but I know he will be pro-surgery. I have horrible pain in my leg and do not want to have surgery. This all started with a car accident. This all gives background to my question/s:

*Has anyone had surgery for this condition in particular? Did it work for you? Do you regret your decision? Why or why not?

*Is there any treatment other than surgery that could be helpful?

*Should I expect the recovery time to be bad or not too bad?

I really don't want to have surgery, but if I have to for this to heal I am going to. I really appreciate any insights or advice that you could share. I'm rather nervous about this and always am comforted by hearing of others who have had the same experience. Thanks again for your time. Have a great day!
posted by gibbsjd77 to Health & Fitness (20 answers total) 6 users marked this as a favorite
I had surgery for a herniated disc in my neck (not back) after suffering for several years with a lot of pain (on and off). Recovery was not bad (but may be very different for the back) and 95% of the pain was gone immediately. The other 5% is almost completely gone now, a couple of years later. I am so glad I had the surgery. My life is completely different.
posted by tamaraster at 10:34 AM on June 8, 2010

I know someone who had this surgery, and was also suffering from severe leg pain due to the pinched nerve from the bulging disc in the lower back. He didn't want surgery either but his doctors agreed that surgery was the only option. He was out of work for a week and then had to go back because of money, but his doc would have preferred 2 weeks of being home. After about 3 months the pain has not disappeared entirely but it's getting there and it's better than it was. Also they're not really sure why the pain is taking this long to go away, so maybe it will be better for you.
posted by amethysts at 10:41 AM on June 8, 2010

I have had pretty much this exact diagnosis for the past 10 years with no surgery and now live pain-free 99.99% of the time (the .01% is when I fall awkwardly which happens more often than I wish it did).

I recommend getting a second opinion from a non-chiropractor (IMO chiros are fine until you have a serious structural back problem and then its time for the big guns) and *not* a surgeon. I see a physiatrist who specializes in the spine. He focuses on fixing problems without surgery, but will recommend operating if its really necessary. If you are in the SFBay area, I'd be happy to send you a recommendation.

After some time off for healing, the key for me was extensive PT with an outstanding therapist. It took several tries to find a good one, but the difference has been night and day. I now move, stand, and sit completely differently. I don't do formal PT anymore, but I do have to stay fit and do the exercises that keep me painfree and moving freely everyday. Its totally worth it to be able to bike, run, rock climb and pretty much anything else I want.

Memail me if you want to talk more.
posted by the_shrike at 10:56 AM on June 8, 2010 [5 favorites]

I have a herniated disc too but most of my (now very mild) pain is strictly in my back. I had sciatic pain too but that is essentially gone since I received three different sets of facet injections. Have you discussed injections/epidurals with your ortho? They tend to work for some people and for others not at all. But they are a lot less invasive than surgery so maybe you could investigate that as an alternative to surgery.

I got a lot of use out of the message boards at Spine Health. You can find a great deal of information about specifics of certain procedures and recovery there.


Hope you get some relief soon. Back pain and sciatica are horrible.
posted by teamnap at 10:59 AM on June 8, 2010

I have had this surgery and 25 years later a spinal fusion at the L4-L5 level.

Heal with steel.

The first surgery worked for about 20+ years. Play ice hockey, basketball, softball, pretty much anything I want. Wife would tease me that the only time my back had an issue was when I needed to take out the garbage. The fusion has been solid for 6 years now. No pain whatsoever. Still play the occasional hockey game although more focused on basketball and softball these days.

The recovery time varies. Recovery to full strength not worry about a thing will take time. Back on my feet and able to go to work after the fusion took 4 weeks which was admittedly longer than I was expecting. I was hoping for 2-3 weeks. I made a 12 hour international flight 7 weeks after the surgery and it was really ok. I was a fiend about the rehab exercises they gave me and I tried to build up my core muscles fighting through the pain before hand to improve recovery time. Part of the recovery is simply getting over the operation. Anesthesia and what not. The wound itself, although much smaller for me the second time, was sore and the stitches were tight.

I only regret that I did not do it sooner. My first surgery was when I was VERY young for this sort of thing and my parents and I wanted to try every alternative known to man. I tried everything from a month of literal bed rest, to muscles relaxers combined with yoga, to regular use of an inversion table coupled with a chiropractor. It was only the operation that stopped the intense burning down my leg and helped the weakness in the core muscles. I did not hesitate to have the fusion 25 years later other than having my best friend who does these surgeries in another state confirm that he would take the same course of action.

Surgery can suck, but the alternative sucked way more. The short dislocation in terms of time proved to be the cheapest cost ever for a pain free life.
posted by JohnnyGunn at 11:04 AM on June 8, 2010 [1 favorite]

I would add that I have a bulging disk in my neck that the pain was significantly helped by a series of three epidurals.
posted by JohnnyGunn at 11:06 AM on June 8, 2010

I had surgery 3 months ago to repair a ruptured disk at L5-S1. Surgeon used minimally invasive microsurgery technique - no fusing, nothing implanted, just the debris from the rupture removed. Recovery went well. I was not allowed to drive for 2 wks because of the pain meds, and off work for 6 wks total due to a 10 lb lifting restriction for that time (my job is fairly physical, and involves frequent bending and twisting). Then for another month I was on (theoretical) light duty at work with a 25 lb lifting restriction. I also had physical therapy for a month, learning exercises to strengthen my core pelvic muscles, to prevent reinjury.

So happy I had the surgery. Before, I was painfully stiff in the mornings, and limping with pain by the end of the day. The pain in my leg and back was completely gone within 3 days of surgery. The numbness in my foot took a few weeks to resolve, but is now gone as well. The first week after surgery, I was glad for the pain meds, but overall had less pain at any point after surgery than I'd had daily before.

I think my experience was just about the best case scenario - I know results don't go that well for everybody. But for me, surgery was the best possible plan. Best wishes for your healing.
posted by dorey_oh at 11:36 AM on June 8, 2010

I had minimally invasive microsurgery for a herniated disc that was pressing on my sciatic nerve. Had surgery on Tuesday afternoon, and left the O.R. at 4:15. At 6pm I was sitting up in bed eating dinner. They kept me overnight and I went home Wednesday afternoon (my ride was delayed - I could have left any time on Wednesday). Was off the pain meds on Friday (just Advil at that point for the swelling), and driving on Saturday (to a friend's house to get the dressing removed). I was back at work on Monday.

There are some flash movies on my surgeon's website that explain the techniques she uses.

The one thing that nobody stressed enough is that healing takes energy. I was pain-free almost immediately after the surgery except for the incision, and that pain faded pretty quickly, but between not exercising much beforehand, and the recovery time, I was running on low energy after the surgery. Nothing horrible, but for the first couple weeks I would come home from a day of sitting at my desk working, have dinner, and go straight to bed. But at 6 weeks after the surgery, I was feeling normal enough to leave on a 5k mile road-trip.

Advice? Talk to your surgeon and get explanations until you're comfortable. Also make sure you're comfortable with your surgeon. For me, this was my first surgery with general anesthesia, and I was very nervous about it. I talked with my surgeon and she spent a lot of time explaining the details, why newer, even less invasive techniques weren't a good idea yet, and gave me an idea of what to expect. If it had been someone with a more brusque bedside manner, I probably would have cancelled the surgery and lived with the pain. And that would have been a big mistake.

Good luck!
posted by DaveP at 12:01 PM on June 8, 2010

Under no circumstances should you be taking the advice of your chiropractor on this. Talk to a doctor. Real doctors will tell you about the full array of options that are available to you, and will not invent diagnoses and/or treatment regimens out of whole cloth. I'm usually not so blunt about this, but chiropractors in the US are charlatans, and if someone screws up treating your leg pain stemming from a disc herniation, it can fuck up your life in ways you cannot fathom.

I've been fighting with two herniated discs for the last few months myself, and I'll nod in commiseration with you about how nasty these are. It's worth mentioning that every time I've spoken to any kind of medical professional (ER doc, GP, spinal surgeon, physical therapist, etc.) the first question out of his/her mouth is "are you having shooting pain down your legs?" This is the determining factor in how treatment is approached. The surgeon you're seeing tomorrow might not be empirically pro-surgery; the one I saw flat-out told me "No way we're doing surgery unless it's screwing with a nerve cluster." Surgery can be nasty business--depending on how severe the herniation is, you might just be looking at what a friend-of-a-friend just had done, which they call "disc shaving," which he was back up and walking around from in a couple of days. More drastic options get really nasty really quickly, but will definitely correct the underlying problem. Just be aware, in this case, that the underlying problem is not "severe back pain," it's nerve damage--surgery might still leave you in a lot of pain.

Let me emphasize once more that a back injury which results in leg pain is a serious medical condition--it hurts because your spinal cord is being pinched by either a bulging disc wall, or by the vertebra itself. Left untreated, that nerve cluster can be severed, which runs the risk of major spinal trauma and paralysis. Your chiropractor is not real treatment. If you're also talking to your regular doctor about this, and he's the one that ordered the MRI and is overseeing your treatment, then disregard my ravings, but based on your last question, I'm guessing the orthopedist you scheduled an appointment with is the surgeon you're seeing tomorrow, and he will be the first person you're seeing in the real medical community. If that's the case, don't stop with him--if he says no to surgery (though I can't fathom how he would with shooting leg pain), your normal family doc can put you in touch with a pain-management clinic, physical therapy, and a host of other resources. Please go see him. It would be an incredibly bad idea to leave treatment of something this dangerous up to someone without a medical degree.
posted by Mayor West at 12:09 PM on June 8, 2010 [4 favorites]

Seconding the_shrike regarding physical therapy. Ask (yourself or a PT) this question: which muscle(s) are pulling your L4-L5 vertebrae in the wrong direction? And why? Only if you are certain this is not muscle related (and it could be something as a short leg being the root cause) I'd consider surgery.
posted by Eltulipan at 12:26 PM on June 8, 2010

Wow, I never cease to be amazed and how helpful the people on this forum are. Thank you very much for sharing all of these first hand experiences. This has helped me a lot! Have a great day!
posted by gibbsjd77 at 12:33 PM on June 8, 2010

Had surgery on L5/S1 to remove a some disk in the way of removing some of the bone around the sciatic nerve itself as my sciatic nerve channel (?) was too small and the bone was pressing on the nerve causing pain/numbness/weakness etc.

surgery: TL;DR = godsend. wish I had done it sooner.

I went from pain that wasn't controlled by daily dose of ~100mg of oxycotin + other pills/patches down to occasional Advil and stretches in less than a month. It just stopped. I was able to quit the pain meds pretty much the day after surgery.

Now there was "pain" - they cut your back open man! But it wasn't the same kind and after a few weeks I was good.

One thing - the wake up after surgery when the pain meds wear off - I don't recall this at all, but the people that were there when I woke up said it was horrible. I was screaming/moaning in horrible agony and they can't give you much to help it so you lie that scream in a drugged out half-asleep trance. The doc said later that amnesia is an effect of the drugs which is why I don't remember it, but you may want to warn any sensitive people that stay with you.

Other treatment - that was a no. PT did nothing to help at first and may have made it worse. Drugs sort of helped but pain was just behind a hazy drug fog. I had one epidural last ~4 months and one that lasted a barely a week. The doc always said surgery is a last resort as they develop new techniques all the time so if you can wait, do so. The pain/drug haze I was was fucking horrible so I didn't wait and wish I had done it sooner.

Heal time: out of the hospital the next day, bed rest for two weeks, light effort and limited standing for another 4 weeks, then a few weeks of physical therapy (snake pose!). Now, 6 years on, I can stand, bend, sit, lift anything and don't even really think about my back as a weak spot. I still do my PT, and will occasionally have 'back soreness', but the only lasting think from my sciatica is some numbness and weakness which I blame in not getting surgery sooner.

Good luck, nerve pain is fucking horrible.
posted by anti social order at 12:50 PM on June 8, 2010

If your disc is leaking then have it fixed surgically sooner rather than later. I've gone through two surgeries now in the past 7 years to fix a herniated disc between L5 and S1. The first surgery was a laminectomy (helped for a short while) and the second a spinal fusion (ended the ongoing random shooting back pains). I waited longer than I should to decide on having the surgery and have hyperaesthesia and constant tingling in my left leg...there is no fix for this anymore and it is something I will endure for the rest of my life.

Visit a spinal surgeon, get a second opinion and then make a solid (and swift) plan of action. Good Luck!
posted by labwench at 1:52 PM on June 8, 2010

I had this exact condition--extrusion at L5-S1, herniation at L4-L5, sciatica, etc. Utter misery. Thanks to the quackery that is chiropractic, it took about a year to get a proper diagnosis, by which time I was losing function in my left leg. I had the surgery and did have rather a long and difficult recovery, with chronic pain for almost two years afterward, but then suddenly it got better, and I've been pain free ever since. Like others above, my only regret is not doing it sooner.
posted by HotToddy at 3:33 PM on June 8, 2010

Nthing the recommendation to see a physiatrist if at all possible. I had a very large herniation at L5S1 last year. Thankfully it wasn't leaking, but it was severe enough to put me in a wheelchair for a while, even with the truckload of opiates I was choking down. Now, after a couple of fluoroscopically-guided epidurals and a bunch of PT, I'm 99% fine and still getting better. Just went camping last weekend, in fact, and was hiking on slippery, uneven ground like a champ. It's fairly astonishing what those epidurals can potentially do for you, especially if you follow up with being serious about your PT.

Your chiro may happen to be right, but as much as you may like and respect your chiropractor, I believe it'd behoove you to talk to a medical specialist in nonsurgical techniques.

Good luck. Herniations can hurt like hell.
posted by sculpin at 4:30 PM on June 8, 2010

IANAD, neither are chiropractors - I encourage you to get advice from a real doctor.

My husband suffers from almost exactly the same problem. After trying what we thought was every available option we went for surgery. In hindsight we think it was a huge mistake. After the operation he was still in a lot of pain, almost worse than before, the surgeon told us that now scar tissue from the operation was pressing on the nerve that the herniated disk had previously been pressing on. Convinced that more surgery was a non starter we decided to simply focus on pain management rather than 'cure'. That approach has been far more successful. We found a doctor that does a great job of controlling the inflammation with a combination of periodic steroid epidural injections and drugs (Nurontin + others). This was not the first doc we had tried steroid injections with but their focus was on a quick cure, while his is more long term and aimed at getting you to a place where you can live as pain free as possible and in good enough shape to do some exercise (my hubby swims - which is pretty low impact). There seems to be a lot of variation in the technique between doctors, in the cocktail of drugs used and the application technique, so personal recommendations might be the way to go.

Of course, your specific situation is not identical and my story is just anecdotal. However, there is perhaps evidence that back pain will often heal on its own given time, so a pain management strategy might be a reasonable alternative to surgery.

PS; I think chiropractic is complete BS. Our pain doc agrees, and strongly advises not to do it as manipulating the spine is likely to irritate the nerve further causing more refered pain rather then provide any lasting relief.
posted by Long Way To Go at 5:50 PM on June 8, 2010 [1 favorite]

I had your exact issue. It took a couple months to work through pre-surgery alternatives: prednisone dose packs, cortisone injection, and they didn't work. I was in agony for the summer, and in terrible pain while waiting for the anesthesia to kick in. When I woke up, I had no pain, or so little pain that in comparison to the six months of agony, it was like nothing.

The one thing? My huge mistake? I didn't follow up with the physical therapy afterwards. DO THE PHYSICAL THERAPY after your surgery, and you have an excellent chance at full recovery. My second surgery was partly do to the lack of follow through. That, and the car accident that threw my Chevy Blazer across an intersection into a corn field.

Look at it this way. Athletes have this kind of surgery, and within months, they're back to their sport. Like football, or basketball. You can have a full recovery and live an entirely normal life after the surgery.

My previous 'Avoid the surgery advice' is for anyone who has any chance at getting their sciatica under control with physical therapy (NOT chiropractory) and medication. It's always best if you can avoid having holes cut into you, but I'd say (and IANAD) you're well past that point now. Get to a doctor. Listen to the doctor. If the doctor says surgery, do it. I mean, think of the volume of pain killers you're taking. They're not good for you, and if you can get the surgery, you'll be much, much better off.
posted by Ghidorah at 6:08 PM on June 8, 2010

I am a physical therapist, (INYPT) and not a surgeon. If you go to see a surgeon, or better yet a couple of surgeons, and they tell you you need surgery, then you should listen to them. But a chiropractor telling you you need surgery? No. Not okay. A competent chiropractor would do what I do if I am unable to help a patient get their symptoms under control: send them back to their doctor, to discuss further options with their doctor. This kind of thing -- people operating outside their scope of practice -- ticks me off.

Anyhow, your issue: If this were my back, I would

a) ask my doctor if she thought I needed surgery;

if yes:

b) ask another doctor if she thought I needed surgery;

if yes:

c) ask if I can delay surgery and pursue a more conservative approach first, like physical therapy;

if yes:

d) go here , click on "Find a PT," and find someone who is an orthopedic certified specialist (OCS) in my area. Alternatively, you might call around clinics in your area and ask if any of their therapists are McKenzie Certified -- this is an approach to PT that has seen some success in this type of issue.

I work with people who have spine surgeries frequently. I have seen good and bad outcomes. If someone I loved were considering spine surgery, I would urge them to get informed, stay on top of it with their MD, but to try everything else first.
posted by jennyjenny at 6:23 PM on June 8, 2010 [1 favorite]

i had a partial discectomy at l4/l5 after 18 or so months of sciatica. i experienced about 6 months of total relief. then the sciatica returned, although it wasn't as debilitating as before. i found that i was mistreating myself, and using heat for relief. icing reduced the inflammation and pain (at times all the way down the calf to the foot). now i'm mostly pain free.

if i had to do it again, i'd put off the surgery until all other options were exhausted. it doesn't sound like i was as bad off as you are tho. good luck!
posted by kimyo at 6:44 PM on June 8, 2010

Well, I saw the Dr. today and scheduled a laminectomy for the 22nd. I'm definitely not looking forward to it, but all of these testimonials and information have helped calm my mind quite a bit. Thank you for posting. I really appreciate it. Have a great day!
posted by gibbsjd77 at 12:09 PM on June 9, 2010

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