Baby got (a bad) back. What next?
May 10, 2013 4:31 AM   Subscribe

I've been diagnosed with a moderate to large disc extrusion of the L4-L5 disc. It's been causing me pain for nearly a year so I'm glad to finally get a reason. Next step treatment but I'm nervous.

I've been offered a nerve root injection for the pain, and to be put on a waiting list for an operation to remove the extruding part of the disc. As someone who avoids paracetamol unless I'm dying, I'm really nervous about both these things. YANMD but have you personally had any experience with either of these? I'm worried about the side effects of the injection. Did you have any? Did they work? I'll be paying a few hundred pounds for it so I don't want to go ahead if its better avoided. And if you had the operation was it successful? And how big was the incision? I have a large tattoo on my lower back that I love and stupid though it sounds I'm loathe to have a big scar across it! Basically I'm interested in any personal experience of this, or experience of effectively managing the pain in a non-medicinal way. Thanks.
posted by billiebee to Health & Fitness (19 answers total) 4 users marked this as a favorite
IANAD, but I've had a diskectomy, about the same spot. The scar was about three inches long, and thin. I woke up from the surgery totally symptom free for the first time in over a year.

Then I had surgery again about two years later. The scar is much larger now, almost a centimeter wide and about four inches long. If your doctor is recommending surgery, it might actually be necessary, since most doctors I've known have been hesitant to go forward with surgery without at least trying several other options, from oral steroid courses to cortisone injections. Get a second opinion. If you can deal with this through stretching and strengthening, long term you'll be better off.

Then again, if its been causing pain for a full year, it migh have progressed to the pong where surgery is the only way to relieve the symptoms. If that's the case, you should follow the recovery plan like its you're only chance at having a pan-free life, because, well, it kind of is.
posted by Ghidorah at 4:41 AM on May 10, 2013

I had a similar condition a few years back, and while I'm happy to share my experience with you, it's obvious that my experience may mot match yours.

I had numbness down one leg, and couldn't walk more than 15 minutes without sitting down to relieve the symptoms. Went to the doctor. Diagnosed same bulging disks at L4 and L5. I took a series of pills that were ineffectual. Then I did the cortisone shots, which also did absolutely nothing. Then the surgery, which gave me relief.

At first it seemed like a total fix; no numbness whatsoever, but now I find I occasionally experience that tingling, but nowhere near as much as before. I can regularly walk 5 miles or more without numbness. The scar is, I suppose, 3 inches or so, but since its in the middle of my back, I really don't have any idea.

Obviously YMMV, and it also depends on your surgeon, I'd imagine.
posted by jpburns at 4:50 AM on May 10, 2013

A very common course of treatments is as follows. If one does not work, the doctor proceeds to the next.

Physical therapy.
Systemic steroids (short dose, not long-term)
Injected steroids (often only a temporary fix)
Surgery - removal of disc tissue.

In a small number of cases, after removal of disc tissue, more will protrude after a time, and a second surgery may be recommended.
posted by megatherium at 4:59 AM on May 10, 2013

I had a L4-L5 lamenectomy that cured the pain down my leg as well as the loss of strength. That operation lasted 25 years. During that time, I played ice hockey, played basketball, lifted weights, bungee jumped off a bridge several times, etc. I had no restrictions from a back standpoint. After 27 years and the return of pain and numbness, I had a fusion about 9 years ago. I again am playing hockey, golf, softball, etc. I think the operations were a resounding success. I would do them over again without hesitation.

Having said that, I did try many different options first including an epidural, steroid injections, prolonged bed rest, physical therapy, and ignoring it hoping it would get better. While I believe in heal with steel (surgery), I would try other less invasive options first. Also, know there is a recovery period from surgery.

As for the scar, my first operation was done when Jimmy Carter was President fighting off a bunny with a canoe paddle while lusting in his heart or something. So, technique was much different back then and I have a 5 inch scar. The 2nd operation has about an 1.5 inch incision. I would simply ask your surgeon about the placement of the scar vis a vis your tattoo. She may be able to avoid it or minimize the affect.
posted by JohnnyGunn at 5:27 AM on May 10, 2013 [1 favorite]

Umpteen lifetimes ago, I had a similar issue with a disc in my lumbar region. I was popping hydrocodone like M&Ms daily. I just happened across a doc who performed a type of surgery called chemonucleolysis.

I had the procedure and the results were fantastic. I was walking without pain that afternoon. Since there is no surgery (i.e. cutting) involved, there really is no recovery necessary beyond taking it easy for a couple of days.
posted by Thorzdad at 5:28 AM on May 10, 2013

Best answer: The nerve injection is a total non-issue. It's not painless, but it sounds MUCH worse than it actually is. I also have a bulging L4-L5, and I've had maybe half a dozen shots in there over the years. None compares with the unpleasantness of (say) a spinal tap, and I've been back on my feet the next day every time. Mind that they're not guaranteed to work (I had minimal results from the epidural injections, and much more relief from sacro-iliac joint injections), but in the great hierarchy of things you can have done to backs, it's really low-impact.

I would be a little more cautious with the disc operation. I spoke with a couple of surgeons after my injury, and while one was gung-ho to go in and remove bulging disc tissue, the other one told me that the success rate (where "success" = "significantly less pain two years later") is hovering around 50%. A friend-of-a-friend had the surgery, felt great for 18 months, and is now worse off than he was before he went under the knife. A coworker's wife had it and still can't walk unassisted a year later. Obviously I'm not your doctor and I haven't seen your MRI, but you are committing yourself to major surgery with a long and painful recovery period; I would at least get a second opinion before going through with it.
posted by Mayor West at 5:35 AM on May 10, 2013 [1 favorite]

I had the disks between L4-L5 and L5-S1 rupture, then it was followed by two years of excruciating sciatica. I went to a chiropractor for TENS treatment and adjustments, three times a week during that time. It didn't help. I was stubborn.

Then I got inter-caudal injections of cortisone in my back. I had to be admitted into the hospital (out-patient). They threaded a tube into my back and pumped in the cortisone. Then I had to lay flat for 24 hours.

I had to do this twice in a 3 week period, but I got my life back. I don't have any pain. It's been nearly 20 years.

Sure, I may be able to predict rain by the aches I have, and last year I had some muscle spasms that were unpleasant, but the difference in the quality of my life....Amazing.
posted by Ruthless Bunny at 5:49 AM on May 10, 2013 [1 favorite]

My L4-5 diskectomy 12 years ago was the best thing ever. I'd lost muscle control in my toes by then so it was very necessary. Scar was maybe 2 inches long, and is totally invisible now. Pain/numbness was gone on waking for surgery. Since then, I take core strengthening seriously and haven't needed anything else.
I'm anti-cortisone shots, but smart people have differing opinions on the topic.
posted by atomicstone at 5:49 AM on May 10, 2013

Best answer: I have a bulging L4-L5 disc, unless it has miraculously unbulged in the six years that I've been symptom-free. It started off with an occasional twinge in my lower back in the mornings, then it was a constant dull pain, and eventually it began pressing on my sciatic nerve which caused plenty of agonizing, sleepless nights and sometimes kept me from being able to get out of bed at all.

I had heard horror stories about the surgery so I decided that that would be a last resort for me, and I chose to try stretching and strengthening (and lots of painkillers) instead. It took a while but it eventually worked for me. The two biggest things I credit for my recovery are losing a bunch of weight and taking my wallet out of my back pocket. I am convinced that sitting on that damned wallet every day was the main contributing factor to the problem in the first place.
posted by Balonious Assault at 6:07 AM on May 10, 2013 [1 favorite]

A few years ago I had three such (or similar, anyway) injections to help with back and leg pain caused by disc protrusion at L5-S1. The first one helped minimally but the next two completely removed my pain. I had no adverse side effects either from the injections or the anesthesia but I know some do.

I don't credit just the epidural injections with all my improvement though. I also went through physical therapy and committed myself to strengthening my back, legs and core.

I've been essentially pain free since 2009. Something to keep in mind is that a portion of protruded discs do actually reabsorb as well. Not sure if that is what happened to me as I haven't had a repeat MRI but I am glad I got those injections and was able to avoid surgery.
posted by teamnap at 6:10 AM on May 10, 2013 [1 favorite]

If your doctor thinks you need surgery, that's one thing, but my wife has experienced a very severe herniated disc (it's hereditary) and she was prescribed bed rest for 3 months. It got better, but there was a cycle of relapses (with decreasing severity) for the next year.

She's taken up weight training, swimming and walking, and 2 years later she has just completed the first 10k fun run in her life.

The doctors explained to us that removing the extrusion would immediately solve the issue of pain, but it's an extreme thing to do, because the scarring would inevitably cause further pain down the road.

They also said they only perform an operation if there is serious risk to the spinal column and resulting loss of mobility.

But two years later she has been largely pain free, but the first year recovering with bed rest was very long and difficult.
posted by KokuRyu at 7:54 AM on May 10, 2013 [1 favorite]

I had a herniated disc repaired by microdiscectomy fifteen years ago after months of insane pain and useless chiropractic. I haven't had problems since the operation. I, um, can't see the scar but no one's complained about it.

And everyone may be interested in this Guardian article reporting that antibiotics could cure 40% of chronic back pain patients.

I hope you get relief whatever course you choose.
posted by firstdrop at 9:14 AM on May 10, 2013

I had a laminectomy of L5-S1 in 1996. 2" scar that is almost invisible today. The bulging disc had given me a numb spot on one calf which persisted but is now almost normal again. I was out of the hospital on the second day after surgery and I went on a 60 mile bike ride three weeks after the surgery.

My back occasionally aches, but I attribute that to my poor ergonomics when I'm working on the computer. The more active I am, the better it is. I am more fastidious about proper lifting technique and I have a standing desk which is great. I have no limitations imposed by the original disc problem. I bike, I help friends move, I work out (Olympic-style lifting and kettlebells), I bike etc. etc. etc.

I don't have any experience with the type of injection you mentioned.

The worst part of the surgical experience was that the hospital and insurance messed up the recordkeeping. My claim was denied after the surgery and sent to collections without me ever having received a bill, but some persistent and stern phone calling eventually got that straightened out.
posted by under_petticoat_rule at 9:18 AM on May 10, 2013

Best answer: Everyone I have ever know who had back surgery was worse off afterwords. As someone who's had more back pain than Altas, here's what I'd do.
Take one aspirin a day,everyday. Relieves inflammation.
Soak in a hot tub of water for an hour at a time-three days a week. If you can, and I found it was best with my back pain, to get myself in a position in the tub where from the waist up I was floating in the water (not touching the bottom of the tub).
I would also very very highly recommend massage. This is the tricky part. There are A LOT of massage therapist out there, and many many different skill levels, styles, and techniques, so it may take you some time to find a therapist that is right for you and your problem. When it comes to massage and back pain, for me, it's better to have the therapist put pressure on the spot and hold it for as long as I can stand it. I may be wrong, as IANAMT, but I believe you what someone skilled in Reflexology/Nerve damage. Look around. But when you find one that works-go weekly for 6 to 8 weeks. Stretching also helps.
Hope you get to feeling better.
posted by QueerAngel28 at 9:43 AM on May 10, 2013 [1 favorite]

I had a herniated L5/S1 disc two years ago and every type of treatment failed (the epidural steroid injections made it worse, lucky me) and finally had a microdiscectomy with laminectomy. My pain was relieved immediately, and for the first time in four months. (The four longest months of my life.)

I would unhesitatingly recommend it, if nothing else works.
posted by pyjammy at 12:45 PM on May 10, 2013

Best answer: Oh, and I totally missed the tattoo part of your question. I also have a large tattoo on my lower back, and the scar is totally hidden in it. Frankly, I think the tattoo helped my surgeon line everything back up afterwards. :)
posted by pyjammy at 12:47 PM on May 10, 2013 [1 favorite]

Best answer: I just had a discectomy at L4/L5 just last month. The incision is about two inches long running vertically in the center of my lower back. At first it was kinda like an innie belly button, but has flattened out and I'm not worried about it being too obvious once it's fully healed. Unfortunately, I don't have any tattoos, so I can't speak to how the incision might affect yours. I'm honestly nervous how well the surgery worked for me but my surgeon is confident. I do have some relief from the pain, but probably won't know the full effect for another month or two. I was home from work (desk job) for a month and will be doing physical therapy for at least six weeks.

I had a series of various cortisone injections over the course of about eight or nine months. They weren't that big of a deal really, even though I got sedated each time (the thought of needle that close to my spinal cord squicked me out). I needed someone to take me to and from each appointment and spent the rest of the day relaxing, but they were super easy to handle. That being said, I should have tried another pain management doctor sooner, as the shots weren't helping me all that much - they work very well for some and not so well for others.

The surgery was a last resort after nearly two years of lower back and leg pain. It strikes me as odd that surgery would be suggested right away unless you have a great loss of strength or muscle control in your legs and feet or bladder control issues. Absent these symptoms, I'd go for a second opinion on surgery - at least for the moment.

My treatments scaled up to the surgery: chiropractor, acupuncture, yoga, physical therapy, steroid injections, pain medications, nerve medicine and muscle relaxants, and then the surgery. Although it took me a long time to get here, I'm glad I waited for the surgery. I would have hated to go through the surgery without having tried everything else possible. Physical therapy and the nerve medicine were the two things that helped me the most. You should at least ask about PT and non-narcotic medication as options before surgery.

I hope you can find the relief you're looking for. And feel free to memail me if you have any more specific questions I could help with.
posted by youngergirl44 at 11:07 PM on May 10, 2013 [1 favorite]

I had an L5 bulge diagnosed through MRI about 6 years ago. Pain comes and goes -- mostly gone, with flareups once or twice a year -- but I've kept it under control through exercises targetted at strengthening core and back muscles. Apparently I'm lucky in that along with the rest of my skeletal structure, my spine (or, more specifically, the channel inside it that the spinal cord runs through) is apparently enormous and so the bulge doesn't result in as much pressure as it might, or so the gobsmacked Korean doctors told me when they got a look at the MRI.
posted by stavrosthewonderchicken at 6:55 PM on May 12, 2013 [1 favorite]

Response by poster: Thanks all. I've started physiotherapy and she is also referring me for accupunture for the pain. I'm going to try to lose some weight and work on strengthening my back and core, before I move to the injections. I appreciate the feedback on the surgery (particularly the idea that the tattoo might actually help align the scar!) but think I will definitely try to leave that as a very last resort. Wishing you all good health :)
posted by billiebee at 3:19 AM on June 12, 2013 [1 favorite]

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