L4/L5 Lumbar Disc Protrusion

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Hi, about 3 years ago I was disgnosed with L4 & L5 prolapsed discs which were crushing the Sciatic nerve, causing such pain that I ended up on crutches for about 2 months, finally losing strength in my foot. The specialist eventually decided that I needed injections into the spine, one  a nerve blocker to the Sciatic nerve and then 6 steriod injections to help rebuild the spine area. I was told that this would give my body time to heal naturally. The following morning I awoke without any pain at all, such a relief after 6 months of totally agony. A year and a half later the symptoms came back with a vengeance, on crutches after 3 days of the pain. The specialist has confirmed that the proplasped discs still have not repaired themselves. It took seven months to get the next appointment (all the time in agony, even taking 2 Tramadol 4 times a day), in which I have more steroid injections into the spine. 10 days after the injections I was back on crutches and the pain even worse than before. I have just seen the specialist again 2 days ago and he has said that the last injections must have aggravated the area.

I have been given two options, one is to live with the pain or the second is to have the operation (microdiscectomy).

It is quite frightening reading through the leaflet of risks & complications, but I feel I have no option but to have the surgery as I cannot stand being in constant pain for the rest of my life. (3 years so far and for me it is 3 years too long). I have been given 3 weeks to make my mind up with the specialist.

Can anyone give me positive advice on the success of the operation!

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  • Posted

    Hi

    Wow, what a trial. That sounds awful. I’m really sorry.

    If your disc is herniated and physio is not fixing it then surgery is the only option. If you are losing strength in your muscles that can be permanent if the nerve is damaged. I had this happen after just a few days of compression after my L5S1 disk ruptured. 2 years later I have had the nerve tested and it has permanently lost about 20-25% effectiveness. This is not terrible but it’s noticeable.

    Likewise if you let the nerve get battered by the disc indefinitely, even if you don’t lose motor function, you can develops chronic pain where your brain changes and creates the pain it’s expecting from the nerve.

    So I would have the microdiscectomy. 

    Note that discs never regenerate so the tissue that is cut away is gone. You get scar tissue that seals the part they cut away. This should spare your nerve any further punishment. But in your current condition you have to build up you core muscles to properly support your back when you move. With a weak disc the muscles have more work to do.

    If you stay as you are then you run the risk of permanent damage to the nerve as well losing strength generally from immobility and also depression from the pain.

    Microdiscectomy ops are generally successful. They aren’t a cake walk but they aren’t awful either. You need to do very little except walk a bit for about 6 weeks, then you can slowly start easy light activities over the next 6 weeks-ish. People usually take 3-6 months to fully recover back to full strength.

    I don’t know what they are stating as possible complications, probably infection or maybe nerve damage?

    Infection is very rare. Nerve damage is completely avoidable so long as your surgeon is competent. Other things that can go wrong are scar tissue attaching to the nerve. This can cause ongoing pain and loss of mobility. I don’t know how common it is. I think it’s hard to study. The other possibility is that the disc is past saving and the segment is just weak and unstable. This will cause ongoing irritation to the nerve. This happened to me. You can’t know until you have had the op though. If that is the case then you have to have the disc removed and the segment fused. 

    But microd is pretty safe, not very invasive and usually effective for typical disc herniation. I felt good after mine, for about 6 weeks, then I did more exercise than my back could cope with and it deteriorated. But on the flip side one of the guys in the GB Olympic cycling team returned to training after 6 weeks and won a world champs gold medal about 3 months after his microd!

    HTH 

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    • Posted

      Hi Michael, thanks for that positive reply, it does help my mind and hopefully I will get some sleep now, as I haven't been able to with so much in my head. I can see from what you say that leaving it without intervention will eventually cause more problems, so the op is really the only option.

      The surgeon seems to be very good and many talk very highly of him in the south so fingers crossed that he can do a good job.

      I see from your experience that afterwards the importance is taking things very easy for 6 weeks and not rushing back into sports (as I do play Badminton) until I am really ready.

      Thanks again for giving me some confidence to go through with it.

      Good luck with your recuperation.

      all the best

      Tony

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  • Posted

    Your welcome. Glad I could help. Not having a plan is a recipe for panic and depression.

    if you are sporty, then you have to try extra hard to NOT overdo it afterwards. You are NOT training, you are helping your body to heal. Even if you fix all of the pain, the scar tissue takes months to form and solidify. Your back will be delicate for a lot longer than you feel. So the only activity you should do is work on your core and back muscles. Nothing dynamic for 3 months. I broke myself going hiking up a mountain trail for about 80 minutes. I felt up to it but, while my muscles were ready, my lower back was simply not capable of coping so it got smashed up in the process. 

    If you have a partner or close friend or family member, have them around to remind you over and over that pain is an unambiguous sign to stop the exercise immediately and wait a day or two before trying it again.

    Otherwise, being in good physical condition is great as you are much more likely to recover quickly. But like I say, you will want to program Pilates or other core training into your program for at least a year,  better yet, the rest of your life. 

    The problem with bad discs is that degeneration is a one way street. They generally don’t get better. And if they have been able to degenerate to the point of herniation, then that degeneration will continue if you don’t change the conditions. Building core strength and flexibility are the main tool available to you to avoid future degeneration.

    hth and good luck

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  • Posted

    I wonder why Etanercept injection was not suggested. It shrinks the gelly like tissue that leaks out from the disc on the nerve causing excruciating pain. After the injection 29 minutes after back in recovery room I had zero pain and could touch my shoes. 
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