L4-L5 Bulged disc right side and Micro-discectomy surgery

If you have already decided on a surgery, commit and accept. Think the Rock Warrior’s way. I don’t want to change anyone’s mind who has fully accepted and committed to a surgery. Kingsmountain, that you say you are ‘petrified about the procedure’ indicates you have not truly accepted it and also that, perhaps, you have not gotten the education I believe is 100% necessary before undergoing spinal (or any) surgery. If I knew that and I were your surgeon, I would likely refuse to operate.

I VERY STRONGLY recommend reading Adriaan Louw’s Your Nerves are Having Back Surgery before going through any spinal surgical procedure. I think it should be required reading for anyone having spinal surgery and am currently working on a similar book for patients undergoing any orthopaedic surgery.

As a physical therapist, I treat people just like those who posted here every week, non-operatively, pre-operatively, and post-operatively. First, I would say that if there are no TRUE red flags that surgery is necessary (eg. bowel and bladder changes, numbness or tingling in the genitals or ‘saddle’ region, rapidly progressing symptoms down the limbs) you need to try conservative care first from a good physical therapist (likely involving manual therapy). I believe that the statement that you may be paralyzed or suffer permanent nerve damage is, for most patients, fear mongering. In fact, you may be surprised to discover that things like disc bulges and other imaging findings are common place, even in those with no symptoms whatsoever. See the link:

ncbi.nlm.nih.gov/pubmed/231…

As a personal example, I have 4 bulging discs in my neck and have never experienced any pain or symptoms down either arm.

You should be encouraged to know that most of the time, disc bulges resolve by themselves regardless of treatment. Conservative care, then, is actually often as or more effective than surgery for such conditions. I have helped many patients become pain free and fully functional within 6-12 weeks with conservative care, even though their imaging showed very significant disc bulges/herniations. You may have slightly faster relief (though clinically in my patients, I may disagree) 1-2 year outcomes seem to be no different surgically vs non-surgically. Another study supports this (and there are more out there too):

ncbi.nlm.nih.gov/pmc/articl…

If you decide on a surgery, my personal experience suggests microdiscectomies are usually more effective in the long run than surgeries involving fusions. This is probably because microdiscectomies are used to treat more specific patterns of symptoms, versus fusions, which have often been used to treat non-specific low back pain. Again, though, I think EVERY PATIENT should read Adriaan Louw’s book, mentioned above.

Of course, all decisions you make should be based on exam findings, provider expertise, and THE PATIENT’S VALUES AND BELIEFS (this is evidence based practice). I have not examined anyone who is reading this post and this should not be taken as medical advice. See your physical therapist!

I had the same thing 35 years ago (I'm 65). My doctor said it was one of the worst he'd seen. I refused surgery, spent 3 months in traction in hospital, then 2 years wearing a brace until it fell apart. I gradually started more and more core exercise. I work out my core for an hour daily, in addition to another hour's workout including lots on flexibility. I now have no pain and can now once again touch the floor with my palms with knees straight.
The key was a very old book "Good Bye Backache" (or something like that), written by an ex doctor on the Changi railway. He pointed out that in all the terrible illness he treated, there was no backache, despite men carrying incredibly heavy loads. He claims that back problems are a sedentary disease.
Take it easy though. Don't push through the pain.

I feel your pain. (Except mine's on the left.) I have a triple perspective on it: I'm a doctor, a professor teaching evidence-based medicine, and the owner of a seriously blown-out disc. It was so bad early on that I couldn't ride in a car for more than 10 minutes. I flew from Detroit to San Diego and back standing up in the back of the plane, except for actual takeoff and landing, because I couldn't sit. It took almost 3 months to settle down enough that I was back to more-or-less usual activities, but it's never really "gone", and sometimes it'll be pretty rough for a few days. Usually for no apparent reason, too, not from activity. I can't say if I've gotten back to where I would have been for climbing, because I herniated the disk some years before I took up climbing, but I find that climbing doesn't really bother it. Strangely, if anything it seems to help.

You have a tough decision. Back surgery is one of the most commonly unnecessary surgeries in the US. I know the data, and based on that I've chosen to avoid surgery, managing pretty well with strengthening and flexibility exercises done religiously. However, the fact that many - quite possibly the majority of - back surgeries are unnecessary doesn't mean that all are. It can be advantageous for carefully selected patients. And the tendency of back surgery to have disappointing long-term outcomes is at least in part due to the fact that many people who undergo it are sedentary, obese, and deconditioned, and go right back to that lifestyle post-op. You're not in that category.

Just be sure that your surgeon is doing proper selection, based on real data and knowledge of the literature, not on their subjective opinion. It may be useful to get a second opinion from a physiatrist (aka PMR doc), who will not be biased toward surgery, before committing to surgery. If surgery is the right choice for you, the minimally-invasive approach is advantageous: the less scar tissue you create, the better.

Either way, I hope you recover well!

I want to thank everyone for their input. I definitely have an aversion to surgery, but I know several people at work who have had Micros years ago and swear by them. My Ortho isn't pushy but doesn't believe that this herniation will resolve itself without surgery. I think the most recent ESI may be giving me a false sense of healing. this is very confusing.

Burt,

I was diagnosed with SI joint dysfunction based on a few tests. The simplest being lying flat on your back and lift your affected leg about 12" and try to resist someone pushing down. In my affected leg I had zero strength. I injured it originally doing clean and presses. My hamstring was also so tight it was pulling my pelvis and my iliac crest on the left side was about 1" lower than the right. This was all treated and corrected with dry needling. Also I had pain solely over the SI joint for a while. I feel like the area has so much going on it's impossible to say exactly what's going on maybe without an MRI. I had paresthesia in my left calf and foot for about a week until I got dry needled (piriformis, hamstring muscles, and the lumbar area). That was two months ago and it hasn't returned. I should also add we're assuming my SI joint was screwed up for 2 months before it was treated so it probably damaged some ligaments. At this time I was still mountain biking 50 miles a week, etc etc. I was also told when your SI joint is out of place you cannot activate your glutes on that side, so my hamstrings were redlining. I haven't had pain over the SI joint in over 3 weeks until this weekend. Oddly enough at the PT on thursday we started assuming it was more disc related and I've been doing some core exercises… Now the pain is back over my SI joint.

So far in two months the only thing I feel the PT has positively treated is the tight muscle groups with dry needling, which I don't believe is the underlying cause. I'm going back to the doctor tomorrow for the first time in over two months and I'm going to request an MRI. I'm sick of dealing with this. From what I understand a majority of the active population has bulging discs that are asymptomatic. I'm hoping to rule out a disc issue so we can focus more closely on the SI joint and maybe do a fluoroscopy guided injection. Although I think there not being something on the MRI that shows disc is wishful thinking.

My next option is to switch PTs. I have a friend who bulged l4/l5 and was back at it within 6 weeks and he attributes it to his PT. This was after he dealt with pain for 6 months. The difference being he had classic disc symptoms- pain while sitting, burning, paresthesia, etc. down his leg. The only pain I have is infrequent aching directly over the SI joint, and always a dull ache in my ass cheek. My pain is never worse than a 3/4 out of 10 though.

Good luck to you! I'll post back MRI results when I hear them. hoping to get in early this week.

Read "Healing Back Pain" by Dr. John Sarno before you do anything.

Met with Doc this morning. He thinks I'm having a disc issue and the SI joint has flared up again. Waiting for my insurance to approve an MRI and then I'm going back in to get a guided injection in the SI joint. Doc sounds confident that will eliminate all SI problems and we can focus on PT for the disc issue when we see how bad it is.

SlowTrad wrote:I had the microdiscectomy in 2008 on L4-L5. Best thing that ever happened to me.

Curious as to how your surgery plays out. I've got a bulging disc in my l4 l5 since 98. Seems as I get older it gets worse. I've got all sorts of issues. Sciatica, weakness in my left side from the point of injury down. It sucks Accupuncture helped alleviate the restless leg, chiropractic helps little. I'm ready to be done. Hoping that after all these years I haven't done too much more damge.

I appreciate all the support. I'm having the Micro tomorrow morning. Kirby, i'll be in your neck of the woods at Sinai Hosp.

Kingsmountain wrote:I appreciate all the support. I'm having the Micro tomorrow morning. Kirby, i'll be in your neck of the woods at Sinai Hosp.

Kingsmountain wrote:I appreciate all the support. I'm having the Micro tomorrow morning. Kirby, i'll be in your neck of the woods at Sinai Hosp.

Burt, sorry to hear about your lower back issues. I have had serious back problems since I was 21. The years of bouldering have definitely taken their toll on me. I have had times where I could not walk for weeks as well and suffered from severe siatica and nerve issues. I was slated for surgery as well until I went to the physical therapy center at my university. I now do approx. 100 crunch-type activities opposite elbow to opposite knee and the big activity is the plank pose for 2 min durations. The plank is essential to my every day activity. Not sure if you do this but for me when I feel my back starting to go, I do that activity and I can feel my back aligning immediately..I do a modified version of the yoga plank where I am on my forearms and toes. Just hold that position for 2 min, do 50-100 crunches(bicycle style) and back to the plank. I try to do 2 cycles a day...since I started 5 years ago I have had only very minor flair ups and its almost always due to being a slacker with my exercises...

Get well and hopefully we can share a rope one day!

It's 2pm and I just got home from a 7:15 am Micro surgery. The surgeon said everything went fine. He said that he was surprised that the herniation was larger than he thought. The disc was buried against nerve and was never going to heal on it's own no matter how much PT or other conservative measures it took. Interestingly, the 3rd injection I had 3 weeks ago made me feel better, but that was just a temporary Band-Aid. I guess I fell into that small % that needs to have the surgery. Right now I feel soreness from the surgery site but my leg feels pretty good (knock on wood). I plan on doing as much walking as I can and PT. The doc is pretty confident that any residual pain or tingling from the nerve being pressured should subside over the next few weeks. I'll keep you guys posted.

Wow! Great responces and it is comforting to know that one person I do know - hey EB - has been able to work through major back issue similar to the one I am currently in the middle of. Thanks for the advice for specific excercize that has worked for you. I KNOW we will share a rope in the future.

Kingsmountain.... your real time report of success so far after your just recieved Micro is a big boost to my own state of mind. I am very happy to hear your having luck so far.

NickinCO.... Yup... knock one issue down at a time I guess so you don't get overwhelmed... although it looks like you are mostly in control and also getting good advice/help.

SlowTrad... super glad to hear of your success with having a Micro and it is good to hear there is no pain but also a very sobering thing to hear your not 100% but I am not myself trying to over shoot my expectations of having a Micro and what it will get me.

"H"... it's been a solid miserable 5 months for me and I am super ready to have this over but I know a long road to recovery is still out there for me.... You says years? I can't imagine....

Others... I have already Google searched the variuous suggestions for informative books on the subject at hand and am going to give them reads ASAP.

I have my second MRI and pre-op physical and consult with the Neuro surgeon next week on the 4th of March. My surgery is scheduled for March 18th.

Great to hear that you're doing well. My wife is nervous for me to have any surgery done on my back. I've done just about everything else and i've been sucking it up far too long.

H - I'm glad the surgery confirmed that there was nothing more I could have done to heal my issue. I think that you have to be satisfied that all measures have been taken, then it is much easier to make a decision. My brother has the same back issues I have and he deals with by medicating himself (Percocet throughout the day). I know I didn't want that to be my life.

I wasn't told to do any PT. I asked the doctor when I could go bike riding and told him about a trip to Whistler eight weeks after surgery. He replied that it would be fine to ride bike paths. I laughed and showed him whistlerblackcomb.com. His reaction was I dont need to go to PT. He said I must live an active life to wanna do that stuff eight weeks after surgery.

I've had two micro-discectomies, (l5 s1) darnit. The best thing I've found for my back since then is to stay hydrated. Disks shrink and tighten up a bit when you're dehydrated. When my back starts hurting, I drink water, it definitely helps.

Since my own back and shoulder issues I have become a true believer in Rolfing and Structural Integration. The terms are synonymous. Find a practitioner and see what they have to say. The 10 series is a bit of investment but it changed my life. No more pain! Sure, at our age there may be a need for a session here and there on down the road. The therapy works with the connective tissue of the body allowing free movement of muscle tissue so that our skeletal system can stay properly aligned in gravity.