Should I have surgery?

[Entmad]

Hi,

I am new to this forum and I really need some advice. I first injured my lower back 28 years ago when I was 20. I have bad Sciatica in my left leg for about a year and could not walk or stand for longer than 5 minutes. After several months of PT I had an intensive course of hydrotherapy and this really helped. I was relatively trouble free up to about 10 years ago with only a few occasional problems up to then. I should mention I am a keen dinghy sailor and am out most weekends. However the last few years and in particular the last year have proved difficult and I now have sciatic pain most days. I have to say the intensity of this is normally only low to moderate and I do not take pain killers. Some days I hardly have any pain at all. I normally sleep ok and walk about 3 miles a day.

I have been having PT for the last couple of months, which has helped with soem of the general stiffness I had in my lower back but not with the Sciatic pain. I had an MRI last week and my spine surgeon has said I need a microsurgery decompression of the left L5 nerve root, as the disk has slightly bulged and there is evidence of a small tear. He is confident this will have a 90-95% success rate. Initially I was keen to have this procedure, as the thought of being pain free and be able to do more dinghy sailing without the fear of subsequent pain sounded great. I now can only sail in light to moderate wind conditions and then for limited periods. However having read many of the experiences of people on this and other forums I am beginning to think I should not even be contemplating surgery as my back pain is obviosly not nearly as bad as compared to others.

Any advice appreciated.

Regards

Peter

[Keano16]

Hello, welcome to the boards.

Unfortunately, for such a "simple" diagnosis as a disc herniation, there are too many unsuccessful cases and complications associated with traditional open back surgery. When I say simple, I just compare your case with some more complex cases that may require open surgery (spondy, severe disc degeneration, infection, etc.).

I strongly advise you to explore possibilities and advantages of minimally-invasive procedures like laser spine surgery or endoscopic spine surgery.

While having same short-term success rates, it has additional advantages like:
- multiple lower FBSS rate (failed back surgery syndrome)
- no bleeding
- less chance of infection
- less chance of rehernation
- no hospital stay
- fast recovery

Let me know if you are interested in this topic or need more information.

[Maria]

Welcome to the forum and sorry you needed to find this kind of information!
That being said~ when to have surgery is a very individualized situation. Some of us have had multiple surgeries and ended up badly because of this or it could have been we would have ended up badly anyway with no intervention.. rather difficult to say in hindsight.

My first surgery which was an open surgery (not microsurgery) with a discectomy of L5S1 and partial laminectomy actually turned out very good. It was just that there was also some problems already going on in the two discs above and the L4 disc later bulged and several years later I had a percutaneous discectomy (nicknamed bandaid surgery back then because it was not open surgery) failed miserably. I ended up worse off because of it.

What I do not know is how much of the failure was attributed to surgical skill and technique and how much of it was my own body's response to the surgery. What I do know is I had much more pain/probs after this for a long long time.

I was in my late 20's when I first injured my back, in my late 30's with first surgery and near 40 at the time of 2nd surgery. After many years (I'm almost 57) I'm feeling better tho doubt I could be out doing what you are by any means.

That doesn't mean you do or don't need surgery (comparing cases). What it does mean to me is that you should get more than one surgical opinion and if there's no impending reason (urgent/emergent) to have surgery think it over.

One thing I learned is not to make hasty decisions re spine surgery tho the other thing I learned is waiting too long (several years) can lead to natural degenerative changes that may not allow for some surgeries to still be an option (in my case ADR vs. fusion should I need more surgery in the future).

There are people that will respond to your post such as Keano and Mark that have a great deal more knowledge and information for you regarding surgeries, techniques, spine surgeons and so forth. Their input is definately desirable. Good luck and hope your pain isn't too bad tho to be considering surgery it must be!

** I wanted to edit to add that if you are able to do most everything you want without problems or limitations but there is one activity you love to do and you have some limitations with it having spine surgery doesn't guarantee that you will have success to the point that you can do that one activity you really love as much as you want to or like you were once able to. Be careful and truthful with yourself with regard to your limitations and reasons for surgery. And again, good luck with whatever you decide.

[dshobbies]

Hi Peter and welcome,

I understand you are at a crossroads, to surgery or not to surgery. Only you can make that decision. To do so, you should have more knowledge than you do right now. There are downsides to surgery and there's no going back once you have it. Also, only you know how much daily pain you're experiencing and if it's bad enough to warrent the risks.

Has your pain interfered with your life? Are you a slave to your pain? Does it dictate what you can and cannot do?

When you have surgery on one disc, that disc is changed forever. Often, the load from the now compromised disc transfers to adjacent discs and the cycle of degerative disc disease begins. Though the success rate for first discectomies is high, the percentages decline drastically for second and subsequent surgeries. This is so common, it has a name, failed back surgery syndrome.

So if you can avoid surgery, maybe you should. If however, your pain is too intense or interferes with too much living, surgery should be considered. Then you need to find out which procedure would be best for you.

I realize this is far more complicated than the question, should I have surgery. Only you can make that decision for only you will reap the benefits and/or suffer the consequences. Research, learn and when you ultimately make that decision, know you're making the right one for you.

Listen to the advise others offer on this and other forums. Certainly get other opinions - you have only one spine. Research minimally-invasive procedures. Ask tons of questions until you're satisfied with your own knowledge and than decide what is best for you. And good luck,

Dale

[pauljackson]

before going for surgery i would suggest you should meet a chiropractor may be it can help you Regular exercise relieves back pain by strengthening and stretching the muscles that support the spine and helps to prevent future injury It is best to do these exercises under supervision Posture Exercise designed for your body to retrain poor patterns of body motion.if you encounter any problems with these poses, you should consult an expert.


Chiropractor Lawrenceville GA

[Maria]

There are persons w/small bulges and huge symptoms and people w/large bulges and no symptoms. Tears.. ? as to what degree of pain it causes tho anular tears can cause a great deal of pain or so I was told when my L3 tear was supposedly culprit in part of my pain scenario.

I would be very careful re any type of hands on care that involves manipulations/crunches that could possibly excelerate a disc prob or even too vigorous PT. Sometimes you don't know until after you've had even some very standard treatment that you're feeling worse than better.

Just move forward w/care re your spine. Core excercises are a pretty safe bet re physical reconditioning. Get a few more opinions before you act surgically.

[Rob Wilson]

I believe in your case you could consider a very minimal endoscopic decompression. You should exhaust all conservative measures first. Injections, PT, etc. In other words do the minimal since you are not that bad. It is a difficult decision but if you have exhausted all conservative measures and can find a good surgeon it might be worth it.

[mmglobal]

peter, the 'should I have surgery?' question is very personal and can only be answered by you. However, that decision should only be made when you are certain that you have evaluated all your options and truly understand the implications.

It's easier to pull the trigger if you have a low risk, high success surgery. When facing a multi-level fusion, we are told to wait until we can't stand it anymore, because it is percieved to be a high risk, low success surgery.

All I can say is... "Do your homework... Make informed decisions!"

Good luck... let us know what you decide and how it goes.

all the best,

Mark