Second Microdisctomy

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Have had another MRI done...injections/another op .... microdisctomy no 2 or fusion ....Thanks Dave

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  • Posted

    Hi Dave

    i guess you are asking which op to go for?

    which segment is it? I can only talk about lower lumbar segments.

    I think it depends on the amount of disc left and your age.

    if you are older and less active, or the disc is very dehydrated and has lost a lot of height, then it might be best to skip to fusion.

    if you are younger and more active, especially if you still have a good amount of the disc left (significantly more than 50%] then it much less invasive to try another microdiscectomy. 

    Fusion is completely irreversible and has a much higher risk of side effects. I have a partial fusion - a dynamic stabilisation- and it has screwed my SI joint and my quality of life has been much worse. I have just recently realised that my legs are different lengths so my pelvis is at an angle when I walk. This was ok for the SI joint when I had a flexible L5S1 and L5L4 disc to deal with that tilt, but with any fixture of the spine, the SI joint is under completely different and dysfunctional loads... Hopefully fixing my leg length discrepancy with a lift etc will correct the angle of the pelvis and it will calm down.

    Bottom line, without knowing anything about you, I would say a revision microdiscectomy is the smarter choice. If it fails, then fusion. But you need to try the least invasive route first.

     

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    • Posted

      Hi Michael.... I’m 55 ... My previous op left me with foot/calf numbness in my right leg... This has gone to pain aswell as my back. My MRI shows compression again.. not as severe as last time...I’m seeing a Neuro/Orthopedic surgeon next week...My Physio thinks either injections or surgery..,My Chiropractor friend thinks traction and injections...... Seeing my GP was a big waste of time...He prescribed naproxen,without looking at my records...I’m allergic to them !!! Thxs for the advice.... I’ll post on here my results....Want to avoid surgery...Every has gone Fusion crazy after Tiger Woods but he’s getting the best money can buy and 24hr medical attention!!!
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    • Posted

      Hi Michael.... Saw the Specialist yesterday...Said I had some scar tissue...The disc is touching my sciatic nerve slightly... He’s recommended nerve block injections first... 
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    • Posted

      Hi Dave

      thats par for the course. They can reduce swelling in the nerve and it can shrink back into the space available for it without touching the disc.

      everyone gets scar tissue after an op but it’s unlnow how many times it causes pain. I was obsessed with scar tissue being my problem after my my first op. It turned out to not be related. When the surgeon actually got a look at the nerve during the second op he said the scar was not attached to the nerve.

      They would normally recommend physio as well (if the injection works reasonably well) as this will build up the muscles around the joint. The muscles then support the joint better and take pressure off the disc. That can allow the disc to shrink back into its proper place slightly. All of these things are small effects but the changes sometimes only need to be a few millimetres.

      Did the doctor say anything about physio for your core or are you already doing this? Else maybe Pilates with a teacher familiar with back injuries might work as well. 

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    • Posted

      Hi Michael...Yes...I got a phone call from a Orthopedic Physio who works with him...Hopefully I”ll find out Friday when I’m having the injection !
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  • Posted

    I had 2nd discectomy and have regretted it ever since.l went back to work as a class 1 lorry driver after the 1st one but the 2nd one l had 12 months later just didn't feel the same.l felt like a puppet that had a couple of it's strings cut.

    Now l suffer terribly back nerve pain and sciatica in my left leg.I am on gabbapentin,diclofenac,zomorph, tramadol and diazapmam for anxieties and depression. I have come close to ending it all a couple of times as l worked hard for 30 years to get to the top of my game and miss work terribly. I have a mobility scooter that fits into the back of my car which l have to use hand controls.l can't even take my wife far because the muscle at the bottom of my back where l am seated swells and goes into spasm.

    She also had to pack her job in to care for me which makes me fell guilty as she spent years training to be in teaching. Now l am been hounded by employment and support allowance to prove l cannot work even after letters from my doctors and neurosurgeons. I wish l had never had that second opinion. Dean.

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    • Posted

      Right. Having spent most of the last year in bed because every time i start walking for more than a few minutes I start to get SI pain and nerve pain in the leg, I can honestly sympathise with the depression. I chose not to go onto lots of painkillers and try to avoid further damage buts is only possible because my wife is looking after me. Btw, if and when you come if Tramadol, don’t be surprised if it makes you even more depressed and anxious for a while. It’s a mild antidepressant. If you are sensitive to that then withdrawal is bad. It took me about 6 weeks to taper off and I felt mentally awful for 2-3 weeks afterwards. Crying every day. I will never touch it again. I was on a low dose of diazepam for sleeping and to avoid spasms but I don’t like it so I wax switched to lexotanil which had less side effects for me. I am on a very low dose of Targin (Oxycodone with Naloxone) which is basically a baseline to ease the background crap.

      Anyway, if I was you, I would be getting the fusion ASAP. You have nothing to lose.

      Which segment went wrong?

      Btw, don’t regret the microdiscectomy. It did not work which is a shame but it was reasonable to try it.

      Oh, do you have any muscle weakness or just spasms?

      Last, if it’s a lumbar segment then check your legs are the same length! If they aren’t then you could run into SI problems after the fusion. It’s easily corrected for.

      BTW, you say you have a mobility scooter. Doesn’t it hurt to sit in it? I hate sitting down unless it’s bolt upright in a back friendly chair and even then not for long.

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    • Posted

      Ps don’t feel guilty. Your wife would not want it. When you get better you can make it up to her.

      I don’t like to try to get all motivational but you are not at the end of the road. 

      I have thought that a lot of times, honestly. I have had some very tough conversations with my wife. I was 41, very sporty and had a great job and lifestyle when this hit me. It’s been completely blown up. But I am not giving up until every last thing has been tried.

      Look at Tiger Woods. He had 2 microdiscectomies. He could barely walk. Now, after L5S1 fusion and a year recovery he can complete an elite golf tournament. This crap can be fixed.

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    • Posted

      Thanks for your support.Its just this damn government rules that are getting me down at the moment. I bought a special gel cushion from somewhere like Denmark through Amazon on offer at £40. It also has a cut out at the back for coycix and 2 to 3 inch thick.Its the best live had yet.It helps when l get back home l need to lay down. I try not to take zomorph unless l have to.My only does 3hrs instead of all day. But apart from that l wouldn't bother getting up if it wasn't for my springer spaniel. He usually shouts me to get up.As for Tiger Woods they can do anything if youve got money.Like fit prosthetic disc.I also have ddd so a spinal cushion is out of the question. I even saw a professor of numerology and he said in his opinion after studying all my mri scans was if the operated again l would be in a wheelchair for the rest of my life.Dean.

      fusion wood be out of t

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    • Posted

      Tiger Woods just had a straight L5S1 fusion. Nothing fancy. The NHS will do one.

      Did the neurosurgeon say why you were not a candidate for fusion? It’s pretty common for disc herniation when other methods have failed. 

      Have you had a second opinion?

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    • Posted

      No he didn't. But even before op l kept telling them for years it's the muscle on the bottom left of my back keeps swelling and causing me pain.Thats why l think it's the nerve running through it.

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    • Posted

      Hi Dean... Thxs for the advice... Seems you have serious problems your self....If you have a current MRI pay private and get a second opinion...I ‘be been lucky and have got a really good Physio who got me in touch with a Orthopedic Surgeon.... It’s took me 6 weeks paying private!!!!! I went to my GP in January......He refereed me in Feb...Still heard nothing....I learnt a lot before during and after my last operation...Dealing with the NHS is a nightmare....some fantastic staff but organization and waiting times !!!!! Got cancelled 3 times waiting to see a specialist last time....Paid private saw one in 2 days.....Cost me £150 2 years ago at the Spire in Hull.

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  • Posted

    I think maybe you need a second opinion. If the surgeon isn’t giving you reasons then maybe he doesn’t have them and is just concerned about taking up scarce resources. The NHS is very squeezed for money and I have heard of several cases of people being fobbed off. 

    The risk of nerve damage from fusion is not major, The whole point of the surgery is to lock the joint and prevent damage to the nerve. Unless the surgeon is clumsy and disturbs the nerve then the typical complications are infection, screw loosening, scar tissue attaching to the nerve (pretty uncommon) and adjacent segment disease (more common, where the fixing of one segment overstresses the next and it eventually herniates). 

    Which segment do you have a problem with because different segments have different chances of causing ASD?

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    • Posted

      Hi Michael,l have found my last MRI scan from 3 years ago .I dont know if you can make any sense of it but here goes.

      MRI Lumbaosacral spine.

      Standard T1 and T2 weighted axial and digital sequences of the lumbar spine. The last axially imaged invertebral disc is counted as L5/S1.

      Vertebral bodies are of normal height and alignment.Normal bone marrow signal.The spinal canal is of small diameter probably congenital.

      L1/L2 High intensities zone is suggestive of an annular fissure.

      L2/L3 No disc germination or foraminal narrowing.

      L4/L5 There is diffused disc bulge and it is seen indenting the theca

      .Disc bulge in combination with the facets hypertrophy and laxity of ligamentum flavum is causing moderate central canal stenosis.

      L5/S1 Diffused disc bulge with indentation of the theca posterity.

      Bilateral mild foranimal narrowing due to facets hypertrophy.

      That's it hope it helps Dean.

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  • Posted

    Hi Dean

    Yes, I can understand most of that.

    Your main problems are at L5S1 and L4L5. The are the 2 lowest disc.

    You have 2 problems. The discs are losing shape and bulging into the spinal column. This puts pressure on the nerves that feed the leg. L5S1 traps the S1 which feeds the back of the thigh and calf. L4L5 feeds L5 nerve which feeds the side of the thigh and front outside of  the lower leg.

    You also have stenosis which is a structural narrowing of the space for the spinal column by the bones themselves. In this car it’s caused by the small joints at the back of the vertebrae being overgrown from wear and the ligaments not holding structure open.

    Last, the gaps on the side of the spinal column to let the individual nerves out of the central spinal cord are reduced in size because the vertebrae are too close together.

    Added to this, but probably not causing symptoms, you have the start of breakdown of the disc at L1L2 - ano T 3 inches  higher up spine. I doubt anyone would do anything to treat that at this stage.

    I am not a surgeon or a medical professional. I have just spent a lot of time trying to diagnose my own problems and had quite a few consults with surgeons.

    I don’t see why a fusion is off the table, although it might have to be a 2 Levels depending on how much degeneration and pain you have at each level. 2 Levels would be a major procedure and does risk later damage to L3L4.

    Fusion stops the joints moving so can avoid pinched by of the nerves when you move. Plus they can re-space the vertebrae properly so the nerves get space to lead the spinal column again (by opening up the “foramens”)

    I don’t know why the surgeon was talking about fusion putting you in a wheelchair though. You don’t have anything unusual here. Just lots of congestion pressing on one or two nerves. Fusion will restrict your motion and lots of sitting will be risky for the rest of the lumbar discs.  But it seems like the pain is the first thing to fix.

    I would ask your GP to line you up with a second opinion. Everything I said above could be missing something vitally important so don’t be surprised if another surgeon tells you that you are not a candidate, but you need to ask exactly why - not just “because you will end up in a wheelchair”. You need to know why that is. 

    If you have not already then go to spine- health.com and read up on the conditions mentioned above so you can visualise what is going on and have a proper conversation with the surgeon.

    HTH

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