L4-L5 Disc Herniation: Steroid Injections vs Discectomy

Which should I choose?
2
Steroid Injection - 66.7%
1
Surgery - 33.3%
0
Other - 0.0%

 
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Junebug74
New Member


Date Joined Aug 2009
Total Posts : 3
   Posted 8/24/2009 2:07 AM (GMT -7)   
I've been having sciatic nerve pain down my right leg for 7+ weeks now. In this period, I've found it too painful to continue working, to walk around a grocery store, etc - instead, I've seen my doctor 3x, had an x-ray, an MRI, and been to 3 weeks of physical therapy. The x-ray & MRI confimed that I have a herniated disc and one bulging above it, these being at the L4-L5, with the herniation putting pressure on the sciatic nerve. Of course I've been prescribed medications, which have included:  a non-steroidal anti-inflamatory, followed by a steroidal one; a muscle relaxer; and have tried 3 different pain pills (none of which have succeeded in completely ridding my nerve pain, but never fail to make me sleepy!).
 
At the end of my PT, the therapist said it seems my disc has an "incompetent annulus" and so further therapy won't be of any benefit, as the exercises would decrease my pain at the time of doing them but within a minute of standing the pain would return. 
 
My most recent visit has been to consult with an Orthopedic (Spine Specialist) Surgeon, as referred by my physician. I realize that the next suggested step might be to try a steroid injection, however I'm quite reluctant. I understand that not only are the injections quite painful, but also that a series of 3 may be required, not to mention is typically just a temporary "fix" (without actually fixing) anyway. The surgeon's leaving the decision up to me, and I'm strongly considering the surgery option. I want to not have to deal with this again in 6, 9 months or even a years time, as I'd most likely have to if I choose the injections. 
 
THE QUESTION:
I know that every individual's case is different... Has anyone had a bad experience going the surgical route, or had failed attempts with injections whereby surgery ended up being required in the end anyway?
 
p.s. No suggestions of seeing a chiropractor please. Apart from having my own strong personal opinion that a chiropractor can actually do more harm than good... I have a colleague who was sent to one when she too had an L4-L5 herniation, and the morning after her visit with him, woke with paralysis of her leg. She called the chiropractor, who then told her to call 911. She needed emergency surgery and 2 1/2yrs later has only been able to gain partial function of her leg.          

bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 8/24/2009 4:44 AM (GMT -7)   
June, can't really give you an answer cause this will have to be your decision what is done with your body. I did try the epidural injections when I first started having back problems, mine too was L-4/5, but only completed two cause I saw no relief at all from them. At that time my disc was bulging with an annular tear. I tried the PT also with little success cause my job was very strenuous with alot of lifting, bending, stooping & twisting in a factory. The light exercises they gave me were a joke. I lived with it for another 4 yrs in constant pain, no narcotic pain meds due to working around machinery. I ended up having fusion surgery after the disc herniated which relieved the radiating pain going down the leg but going back to the same job I continued to have lower back pain going into the hips. Tried changing jobs but 3 years later have stopped working and applied for SS disability. I hate giving you such a bad outlook for surgery and everyone is different, I'm sure there are some success stories out there. I should add that I also had cervical fusion and this too comes into play why I can't work anymore.

As far as the meds go. The muscle relaxers (tried 3 different ones) always made me too sleepy and gave me little relief but the narcotic pain meds I can tolerate without the sleepiness. Maybe this is something you can discuss with your physician.
---Jag---
 
DDD, osteoarthritis, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus left knee 2000 & 2002, buldging disc L-2/3


BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 8/24/2009 6:05 AM (GMT -7)   
Another thing to keep in mind is that surgery may not necessarily be the long term cure you're looking for. It's possible you'll find yourself facing the exact same situation again in 6 months to a year, even if you take the surgical route. Once you have a discectomy, you're forever in a class of people that are at a much higher risk of re-herniation of the same disk and/or having discs above and below the altered begin to act up as a result of the change in dynamics within your spine. Once they remove that herniated portion of the disc, you're left with less disc matter at that level, but your body is asking it to perform the same job as a whole disc. For some people, it's not a problem; others (like me) end up in worse shape because compensating for the lack of strength at one level places more strain on other levels of the spine.

As far as the PT proclaiming you have an incompetent annulus - I put about 90% of what PT's "diagnose" in the big round bin. Personally, I've found most PT's will easily win the award for "Most likely to step outside their scope of practice." When I herniated my first disc, I was shocked by the things my PT was able to "diagnose" related to my condition, in spite of my board certified neurosurgeon telling me he was unable to determine those exact same things, even after reviewing all of my radiological/ diagnostic testing and my clinical presentation. eyes

Junebug74
New Member


Date Joined Aug 2009
Total Posts : 3
   Posted 8/28/2009 4:24 AM (GMT -7)   
Thank you both for your replies and thoughts... This is just such a hard call to make.
 
Over the past couple weeks I've done alot of looking into this subject and it just doesn't seem there's a "right" or "wrong" when it comes to this type of thing. Seems more or less like it's all just one big crap-shoot, if you ask me. I know it's pretty much a 50/50 chance of the injections working, but it I still tend to feel that surgery holds the better odds.
 
I'm weighing it out like this:
 
A. I'm not willing to continue in my current pain-ridden state while "trying" the ever painful injections, keeping fingers crossed that I get some relief from just one... and God-willing the pain not return within a few months, and God-willing I won't require another.... basically, the possibility of just dragging it out longer.
 
B. Based on other family members & friends who have long ago had the surgery successfully and without any further re-herniation, complications, or disc above/below damage... even 10, 15yrs later... I am willing to hope and pray for a similar outcome to my story. I realize that there are things that I personally can do to try to achieve this outcome as well -  those being:
           
            1. To lose weight. I'm not obese, but like many, I could stand to come closer to a more healthy weight 
            2. To, by the same token, exercise more... especially focusing on my stomach/ab muscles thereby strengthening my "core"
                so that it might assist in carrying my upper-body load --> hence taking some of the stress off the discs
            3. To try to better my posture & bending/lifting mechanics. I do notice that I tend to slouch quite often, especially while
                sitting, and my ex-husband had constantly been telling me to "bend your knees!" when I would bend or lift
            4. To quit smoking. Since going thru these past 8 weeks, I've heard from every healthcare professional that smoking aids in
                the deterioration of discs, thereby making them weak and suseptible to injury
 
So again, I do thank you both for your thoughts as I had requested. 'Bionic', I'm sorry you ended up in worse shape - I can only hope I won't end up saying "I wish I had listened to her!". And 'Jaguar', I am in awe of stories like yours, of people having this constant pain for YEARS.. I have NO IDEA how you've managed and I really empathize - after just 8wks I'm wishing the pain gone already! However, it does sound like you had a bit more going on than I do at this point, plus the strenuous job surely didn't help your matters. But again, thanks to you both. I'm not an overly religous girl, but I'll definitely be saying my prayers as I take this step. I wish you both better health as well. 
 
 
        

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3344
   Posted 8/28/2009 3:21 PM (GMT -7)   
Junebug

I do hope you will continue to post and let us know how you are doing ans how your surgery comes out if that is what you are deciding to do. Decisions like that are difficult and there is on right or wrong decisions, it is only what you want to do and what is best for you, and only you know that!
I do wish you well and hope that it all works out for you!

Good Luck

White Beard
Moderator Chronic Pain
 
I'm Retired USAF, went back to school and became an RN, and now am on full disalbility!--Degenerative Disc (affecting mostly the thorasic disc but all levels involved), C6/7 laminectomy/diskectomy& fusion, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications: Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV


Junebug74
New Member


Date Joined Aug 2009
Total Posts : 3
   Posted 8/29/2009 7:33 PM (GMT -7)   

Thanks White Beard. I did choose surgery... a micro diskectomy... it's scheduled for Sept 9 (09/09/09 - hope that's the opposite of a 06/06/06! lol)...  Despite some of the negatives I've heard, I am looking quite forward to this, as I know that almost immediately after the surgery, the nerve pain will be gone. At the same time, I am very much a realist and do also know that I may have future back problems from this point forward, but I'm going into it with a very positive attitude and hope that helps me some. I'm young and otherwise quite healthy, so provided I take care of myself well enough in the coming years, my fingers are crossed that I'll get thru this and carry on without any repricutions of the choice I'm making.  

I'll definitely post updates, and hopefully with some positive feedback for the rest of the forum participants. Thanks again for the well wishes.

~ Junebug


fatherjohn
Veteran Member


Date Joined Feb 2009
Total Posts : 999
   Posted 8/30/2009 10:27 AM (GMT -7)   
Junebug, You have received good advise from people that have been there. I do want to remind you that this is a pain forum and people who have had injections and the injections working are not on this site. Also, people who have had sucsessfull surgeries are probably not here. Some find lasting relief and others relief for a period then they are back to the doctor. Some of us have had multiple surgeries and that is what I wanted to stay away from at the start. After 3 surgeries, I am still dealing with pain on a daily basis. Most of us are not even looking for a pain free option anymore just enough relief to keep some level of functioning in our lives. I tell you these things because many of us here have tried all the options and they did not bring a pain free life. In my experience, injuections (I have tried several types) were not as painful as the back, leg and foot pain that I was in. Injections were much easier than mulyilever fusion surgery. That is one reason they try injections before surgery, in the hopes that the injections will give your body time to heal without the need for surgery. It also depends on what kind of surgery you have and who the doctor is. Not all doctors are created equally. I hope the best for you and let us know what you decide and how it goes.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 11656
   Posted 8/31/2009 4:50 PM (GMT -7)   

Hi June,

Welcome to Healing Well. I do hate to hear of the problems you are having, however, we all fully understand what you are talking about.

I do wish you well with your surgery. Many times surgery is helpful to the individual. As you have probably figured out by now pain medication does not work on nerve pain. There are medications available to help with specifically nerve pain. Nerves have to heal on their own and there really is no time limit as to how long it will take a nerve to heal.  Many times if the surgery is done soon enough the nerve damage can reverse itself, but waiting a long time makes the odds much higher of getting any pain relief. As one of the others mentioned the people here on this forum have not had good results from their surgeries for one reason or another. Its a difficult choice to make but not always is a person doomed because they choose surgery.The field I worked in I saw hundreds of back and neck surgeries. I saw more successful surgeries than failed surgeries. So, with that said, its a very individualized thing. I do hope you have an excellent surgeon on board to help you.

The ESI's are really nothing more than a temporary fix if they work at all. I do know of many people that they did not help. In most instances they either ended up in worse pain or they were of no help at all and went through alot in an effort to ease the pain all for nothing. My first pain mgt said they were nothing more than a way for a dr to pad his bill, so that told me alot and helped me decide to never consider it.

I do hope that you will hang out here with us HW and keep us posted on how you are coming along. I do suggest that you talk at length with your dr about what you can xpect after surgery and what limitations you will have post-op and what you can do and not do until you are healed up and recuperated. Many people are not well versed in their post op care and end up in trouble for over doing. Just remember that you have had surgery and need to be kind to your body.

 


Straydog/Susie
Moderator Chronic Pain
 
crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & decreased circulation in both legs. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 16 different daily medications. Intrathecal pain pump implanted June 05.


bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 9/1/2009 1:08 PM (GMT -7)   
Susie, what's an ESI?
---Jag---
 
DDD, osteoarthritis, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus left knee 2000 & 2002, buldging disc L-2/3


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 11656
   Posted 9/1/2009 3:16 PM (GMT -7)   
Epidural Steroid Injection-sorry, using my old work language.
Straydog/Susie
Moderator Chronic Pain
 
crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & decreased circulation in both legs. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 16 different daily medications. Intrathecal pain pump implanted June 05.

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