Opinions wanted - microdiscectomy or not

[chrismck]

What a great site - thank you all for sharing your experience and knowledge.
I recently had an MRI which revealed a large l4 l5 herniation.
I suspect this has been there a while, however I never had sciatica until January.
PT since then, have done back exercises the last 10 years and inversion.
Since then the pain level has dropped to a 4 from a 9 and although I still have numbness and tingling in my foot it is less than it was in January.
My Dr. recommends a microdiscectomy.
Is it possible for this to simply improve on it's own?
After having a microdiscectomy wont the vertebrae be closer together making me more at risk for a future fusion?
Thank you all for your help.

[rhatzy]

Hi,

It's possible you can get better, but it is more likely it will get worse. There are many remedies for a herniated disc. One is the so called "microdiscectomy" that will give you about a 1 inch scar and take out some bone. They also have one where they make a small incision and stick a tube into your back and lase the herniation. There is a procedure that is the least invasive that I have seen and that is where they insert a tine tube into your spinal canal thru a natural opening at the base of your spine with a tiny camera on it. They can then see all your lumbar levels without removing any bone. If they find a problem, they use a laser to shrink or other tools to solve the problem. This is outpatient and you are left with a small bandaid. Most people as they age will lose disc height because your discs will shrink. As long is there is no pressure on your nerves, there will probably be no pain.

If it comes down to where nothing works, your choice then will be either fusion or ADR. L4-5 is a very common problem area and ADR works well here.

I had L4-5 and L3-4 herniations with "microdiscectomies" at both sites. One worked for a while but the other didn't and then they both gave me problems. I got 2 ADRs and I have been pain free for 3 years.

The choice is yours, choose wisely,


Mark

[Justin]

Hi chrismck,

Welcome to the Spine Patient Society.

Is it possible for this to simply improve on it's own?

Your condition sounds like it has been longstanding (> 10 years). Thus, the degenerative cascade continues over time so that your condition is unfortunately no longer amenable to "improving on its own."

After having a microdiscectomy wont the vertebrae be closer together making me more at risk for a future fusion?

With a microdiscectomy, they take out the least amount of disc protrusion ("bulge") as possible. If they took out a lot of your disc, then they would be creating gross instability of your spine which is a very bad thing. The mircodiscectomies have really advanced over the last 10 years and they are truly minimally invasive (unless a Spine Patient presents with a gross herniation that requires more drastic measures).

Are you doing any physical therapy (at home or in a guided program)? Have you tried any other conservative therapy such as injections?

Once again, welcome--we are glad to have you.

[chrismck]

I have read up on the minimally evasive procedures (endoscopic - I think) (laser, water, needle suction) and after reviewing the bonati information it seems more hype than results, and the fact that my insurance wouldn't cover but 68% of the surgery leaves a lot of distrust in my mind.
Is this really a viable alternative?
It does seem like a much quicker recovery time.
I am self employed and already pay $5k a year for a $10k deductible health insurance policy.
Is the removal of a small amount of bone significant?
Will it cause instability problems in the future?
I currently do home physical therapy 4 times a week for about an hour at a time and have for years, after reading a book on backs years ago. I only use the inversion table twice a week though. I did go to professional PT after the MRI but my with my large deductible I felt as though I was paying for a service I can do at home for free, I almost think that they work on commission after I told them I wasn't coming anymore.

[Hooch]

Nerve symptoms due to a bulge or herniation may resolve over time. Talk to your specialist about the risks of declining the surgery at this point re. permanent nerve damage and your prognosis. There are many people who put up with sciatica for 6 months-1 year and it resolves. If your pt is: core strength, ta\multifidus\pelvic floor activation, neutral spine, gluteal dominance etc you are doing all you can to stabilise your spine.

You are correct in that a discectomy has the potential to weaken the disc further.

Good luck.

[Hooch]

Just saw your 2nd post, u are clearly motivated. Try this book for pt

Amazon.com: Spinal Stabilization: The New Science of Back Pain, 2nd Edition (9780968871515): Rick Jemmett: Books

Nice and cheap and sums up the latest rehab science nicely.

[KBear]

Preaching to the choir here.... My husband is also self employed, so we pay outrageous money for insurance that isn't that great either. I ended up spending the money to buy therapy equipment for my house. I found a great work out set with weights on Craigslist for a few hundred bucks, bought an elliptical, stretch bands, big ball and a Wii Fit. I probably spent around $700-800 for all of it. It easily paid for itself though, as I was paying $100 a visit for physical therapy because my insurance only paid $30 a visit and only for 12 visits a year. As long as you have the discipline to do it, it's a great way to save money (and time since you don't have to drive to and from therapy and then wait for a therapist and such.) I think I did better with it at home too, since I could go at my own pace.

[Justin]

I have read up on the minimally evasive procedures (endoscopic - I think) (laser, water, needle suction) and after reviewing the bonati information it seems more hype than results, and the fact that my insurance wouldn't cover but 68% of the surgery leaves a lot of distrust in my mind.
Is this really a viable alternative?
It does seem like a much quicker recovery time.

In my opinion, the endoscopic / laser procedures are merely bandaids. Will they help? Most of these procedures do, but for the very short-term (2-3 years). Now, the disc is greatly compromised from the first operation; thus, requiring further intervention. Ultimately, they only delay the inevitable. Just my .

If you can avoid surgery via conservative care, by all means exhaust that avenue first. Basic physical therapy techniques like in Hooch's recommendation above go a long way. As you know, it's a daily commitment and not just when's convenient (I know it sucks! ).

Anyway, there is a very fine line between waiting for your symptoms to calm down ("less perceivable") and having permanent nerve damage ensure (all while you don't perceive the ongoing degenerative process).

Good luck.