Discectomy or no Discectomy

[superstar dj]

Hi guys,

(newbie, attracted by the wealth of experience you all show regarding back pain, ops and procedures) Hello all!

There is such a wealth of knowledge in this place, I thought it'd be a good idea to run something past you all and see what you have to say.

My name is Andrew, 29 y/o and I have been suffering with back problems for about 5 years. Intermittently for the first 3 years, but more severe for about the last 2 years.

I am a gardener (Ha!), I guess back problems go hand in hand with the job, however my back suddenly became much worse when when I felt it go, and I would like to hear your experiences with regards to this sudden pain...

2007 my back "went" about 4 times, by this I mean that when making a bending or leaning motion I would feel this pain in my lower back. It would be sore for the rest of the day, but the next day I wouldnt be able to move arround much, and on some occassions not be able to get out of bed at all. This would last about 2 weeks. My last bout of my back going was about October and continued right up untill about second week in january and I was still going to work. This sudden pain I attribute to a "slipping" of the disc. What do you think?

I now limit the amount of lifting I do and try to manage my posture and I am possibly restricting my movements too much wich is probably putting more stress on my back? Anyway, these sudden bouts have stopped since January, but now all I get is a milder (still quite sore) pain in the back and pain down the right leg, pins and needles in my right foot and sometimes in my left foot.

Anyway enough about me... now about the so called professionals!!!

I have been visiting various ammounts of GP's over the last 5 years about my back problem(s) and as I am sure most of you know that they are not allways as helpful as you'd like them to be. Right? Anyway, after lots of pills and brush off's in December 2007 I insisted that my GP refers me to the hospital to get it looked at properly.

2 MRI scans later and in June I Attended my first appointment with a registrar... This is almost laughable...

I was called into a room where when I sat down he told me to tell him everything as they had lost all my notes, so I did. He then looked at the MRI scans on the computer and said "Nothing's jumping out at me", to wich I replied "Have I waited 6 months for you to tell me that!!?", I explained that I wasnt happy, so he went to see the consultant. When he returned to said that it was clear to him what the problem was and that he'd send me for a caudal epidural and if that didnt work they would be happy to operate.

Had the caudal epidural and I got benifit for about a week, but everything is back how it was, if not slightly worse.

Right it gets worse...

Went back to see a different registrar yesterday, who breifly asked how I reacted to the caudal epidural. So I explained and while I was explaining his bleeper kept going off, he was making calls looking at peoples notes on the computer, huffing puffing and all while I'm sat there. Not nice. Anyway, after the calls he looked at the computer at my MRI scans for about 2 mins and said he couldnt see anything (deja vous). So I protested again. He went to speak to someone else, came back and said "I cant see any other way of helping you other than taking out your disc completely or as much as we can, are you happy with that?". Well ofcourse I didnt know what to say. So he gave me a bit of paper to take to recepion and then I was directed to go for a pre assesment. Waiting to hear for a date for my op.

I am having a Discetomy of the L5 | S1 right sided.

Is it not negligable to send someone for a Discectomy when the doctor cant see any cause for one? I really dont know what to think. Should I have it or not?

What do you think...

 

[Cassandra G]

Hi
I had a L5/S1 discetomy in May as without a doubt I herniated a disc and lost sensation and mobility in my leg. Ironically I am a sports massage practitioner. If the MRI was inconclusive to you having herniated/slipped a disc then I question why the doctor said he would operate. Does he think this is what you want to hear?
I don't want to generalise but as I haven't seen you as a client and done the assessments I would do, I can only say this. In around 90% of hernaited disc cases, the soft pulpy nucleus of the disc is gradually reabsorbed into the disc, easing pain on associated neural structures (the sciatic nerve being the main one) and a conservative approach to treatment can be made by the therapist eg, unilateral or bilateral tractioning, releasing tension from the associated muscles etc. But there is work to be done by the client too - ie, back strengthening exercises, pliates, exercise in general etc. For the other 10% of cases, the pulpous does not reabsorb often leading to loss of sensation and/or mobility, in their lower limb/s and feet. In this instance surgery is the only option.

Having had the op myself, if I had had the choice of conservative treatment vs op, I would have gone conservative. The reason being, you will be on a waiting list, have to go through the stress of the op, it's not the greatest feeling having to recovery from any op and the process puts strain on you and those around you who have to look after you. So when you've gone through all that, the rehab starts and guess what you need to do in rehab - back strengthening exercises, pliates, exercise in general etc, but this time you are starting at zero, post op when you could have been starting from a better place.

Perhaps you could get the name of a good physio, sports massage therapist or fitness instructor and look at the conservative treatment. It could be the quicker and less stressful way to recovery.

Bon courage!

 

[judy.gideon]

Hi 90awk

I had terrible back pain a few years ago. I woke up one morning and could not get out of bed. A friend recommended a chiropractor - I went to him and it was totally successful. I attended for a number of weeks til my back was 'back to normal'. I now attend every 4/6 months just for check up and realignment.

My cousin, who works on cruise ships, suffered severe back pain, and couldn't work, (couldn't even stand up for his wedding pictures). He was sent to the ship doctor and other doctors in America. They recommended an operation. He didn't want to go down that road, so came back to Scotland and attended the same chiropractor. He now has no back pain at all.

Do you have a good chiropractor near you? If so it might be worth a try.

 

[Kate M]

It might be worth sitting it out a bit longer if you can bear it. I prolapsed my disc last summer and started getting the nerve pain in my leg and bottom in Sep 07. By Christmas I had a real limp and my mri in March showed a prolapsed L4/L5. I was all set for a discectomy but was told I would have to wait until Nov 08 due to holidays and flying. In the meantime, I got myself on the list for a nerve root block which I had two days ago.

For the past month my symptoms have improved - my leg pain has gone along with my limp, and I can now walk and stand for as long as I like. Six weeks ago I would never have imagined such improvement - I have read about the body breaking down and absorbing the prolapsed material but was a bit dubious as I thought that as it had been bad for so long, I had lost all hope of recovery. I'm now glad things worked out how they did and I didn't rush for the discectomy as advised.

I don't know what a caudal epidural is, but if it's different from a root block, maybe you should try that too to sort the leg pain?

Good luck,
wol

 

[PAYET M]

Thanks for your replies guys, much valued input.

I am still concerned at the thought that the registrar may have misconstuded my diagnosis. I have always thought that what I experience is a slipped disc with sciatica, however if its something else that the registrar is missing, might a Discectomy be completely useless.

I have read heartfelt posts from allot of people in this particular forum, who after a Discectomy think there they will never recover, but I know after reading further that they do, but have to put in allot of effort into recovery and some are still at the stage that I am now. Would I be taking two steps back to go one step forward?

I guess I am concerned that I have not actually had a concise diagnosis of what is wrong with my back, and if I voice my opinion will this set back any treatment?

After 2 years of 'back to back' back problems is it possible that my back might recover, and more inportantly should I give up my job as a gardener wich I love?

None of the professional I have seen are very helpfull and offer minimal information, so I guess I am looking to you guys to help me form a informed dicission on wheather I should have this Discectomy or not. I think that my back problems lie within a disc prolapse, bu t why wouldnt this show up? Any ideas?

4 to 6 months to find out as much info as possible, and to be honest after googleing "Discectomy" this is the best info I have found, can anyone point me to better info?

Regards

Andrew

 

[elcastano001]

Have you seen a chiropractor?
What you describe sounds absolutely like a disc, but if the MRI is clear, then you hve to assume it isn't.
So what else can cause the same symptoms? well pain in the back can come from many, many different structures, discs and facet joints being the most common and obvious. Botha re generally treatable by chiropractors. Both can also cause leg pain, though joints will rarely hurt below the leg, and shouldn't be associated with pins and needles (P&N). Bear in mind that whilst it shouldn't, it doesn't mean that it cannot.
The other obvious answer is a nerve entrapment elsewhere along the route of the nervel most commonly the IVF (inter-vertebral foramen; the hole at the side of the spine, between the bones, where the nerve root comes out), which can be caused by, amongst other things, arthritis; this may be better seen on X-ray than MRI; and the symptomatology would be identicle to that of a disc, though it's history and onset would be expected to be much more gradual and poorly defined. The history you've given us above doesn't rule this out. Chiropractic is as effective as anything for this condition (acupuncture being the other big one to try) and 1st choice treatment would be exactly the same as for a disc injury - Flexion-Distraction.
The next most common nerve entrapment for the leg (outside of the spine) would be piriformis syndrome, which is a common mimic of disc injuries, though again, with a different typical presentation. A chiropractor should be able to diagnose this condition, explain it, and offer treatment, though massage is just about as effective; though they'd be unlikely to touch it without permission from a primary care practitioner (GP, chiro, osteo, physio).
Beyond that, there's always the consideration that the patient has a right to more than one cute thing (a favourite saying of my old radiology tutor); basically, there is nothing to say that you can't have 2 problems alongside each other; a 'simple' lower back pain, AND a peripheral nerve entrapment, one causing lower back problems, and the other causing leg symptoms.
Of course, there's also always the option that the MRI you had simply isn't good enough for whatever reason, or possibly even mixed up with someone elses (especially if they lost your case notes).

 

[teehee(:]

Thanks for all your input guys, much appreciated.

I actually got a chance to sit and talk with my wife last night. She was there when I spoke to the registrar on wednesday. She explained to me that because of me being so anxious about the whole thing and because he was so busy and rude, the he didnt put himself across very well and didnt explaine things to me very well. However I now understand that registrar did go and speak to someone else and identified the prolapsed disc, he just didnt explain that to me very well.

This puts my mind somewhat at rest, I cant explaine the releif I got when I finaly understood what was happening.

Thanks for the good info BIA. I am thinking of going back to a chiro. Just wandering how a chiro is likely to react when I tell them I have a disc prolapse. Would they be a little hessitant to touch my back?

Also can I get a copy of my MRI from the NHS, has anybody been able to? Just thinking to show other professional for conservative treatment. Would a chiro want to see it?

 

[Chris M.]

wouldn't phase us in the slightest, but we would want to see the MRI if possible.

You certainly can get copies from the NHS (on CDROM these days usually)