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Considering surgery for L4/L5

I am 48 male, moderately active and slightly overweight. I have had very minor lower back issues for twenty years from an motor vehicle accident but have always been able to manage it with taking it easy when it flared up or seeing my chiro. In March of this year I was pouring some concrete and started to have some severe pain. It got so bad I could barely walk but this time the chiro couldn't help. I scheduled an appt. with a ortho surgeon and have been on a path toward surgery since then. Prescribed drugs didn't touch the pain, back to the dr. x-ray didn't show anything, back to the dr., MRI, back to the dr. The MRI showed a herniated disc at L4/L5. It is a moderate herniation but the pain it causes is anything but moderate. I tried an inversion table and it seemed to make it worse. I basically live on about 1600 mg of Ibuprofen a day. The pain is 24/7 and when the Ibuprofen kicks off it is enough to make a grown man cry. I have never experienced pain like this. 

I have had one steroid injection and it helped for less than a week. Since it didn't really do anything my ortho said surgery was a good option. The way he explained it to me was he would make an incision at the troubled spot, get through the muscle, move a nerve to the side and clean out the "jelly" that has petruded from the herniation. That all sounded fine and I was scheduled for surgery this Monday. Went to the hospital and got all my blood work, EKG, and all that preliminary stuff out of the way. Then the dr. called me back to the office yesterday and said he wanted to change course and try another injection and not do surgery. I don't completely understand this but from what I understand the herniation or "jelly" is on the inside side of the disc, meaning he would have to cut part of the bone of L4 to get to the damage. He basically said it is more complicated than first thought, and cutting part of the bone does seem much more invasive.

I walked away with no confidence in the dr., wondering why he didn't see that the first time he read the MRI three weeks ago. It kinda depressed me that the surgery changed three days before it was to take place, and wonder what would have happened if he hadn't caught it. So I now have an appt. with a pain institute on Monday and a NEURO same day. I feel like I am back to square one and last night the pain was off the charts. I am a minister but haven't been to work for three weeks. I am hoping someone on here has had a similar experience and I can learn from your journey.



  • hi timf

    welcome to spine-health

    your pain will be something a lot of members will sympathise with.  and a lot of members will be sorry to hear of your late change of treatment.  it is a horrible thing to experience so close to you thinking surgery would remove your pain.  i had my surgery cancelled just before being wheeled into the operating theatre, so i also have some idea about last minute changes.

    on the pain levels, i have to ask, has your doctors prescribed that amount of ibuprofen a day?  that is a lot for your stomach to deal with.  i am showing concern as i was on a lower dose and ended up having to take ometprozale for severe stomach pains caused by long term use through two previous surgeries.  have you been offered any other pain relief apart from the injections?

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    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015
    L4-S1 TLIF with decompression June 2017
  • @TimF I can totally relate. I have a severe herniated L4-L5 disc. I started off on just ibuprofen and tried physical therapy. It got to the point where I couldn't even drive to my sessions anymore. My orthopedic pretty much told me steroid injections probably wouldn't help with how bad the hernia is so I didn't even bother. I searched for the best possible neurosergeon around my area and outside of my area. I ended up finding one about an hour away. On my first visit he immediately said surgery was the best option. He explained how he can do a minimally invasive discectomy and the procedure would be very quick about an hour or so. Same day surgery, I would be going home an hour or 2 after the operation. 90% success rate. I am so confident in him, he performs this surgery all the time. I would suggest you shop around, do some research and see if you can find a surgeon you'll be more confident in. I would also discuss some better pain medication. If you're experiencing nerve pain, gabapentin is a life saver! I'm currently taking a mixture of tramadol for pain, ibuprofen for inflammation and gabapentin for nerve pain. I'm pretty much bed ridden and have bad flare ups if I get up and move around too much but I find this combination of medication makes me the most comfortable. And yes, when you miss a dose it becomes agony :( 

    Best of luck to you! Keep us posted.

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  • I would agree with shopping around.  Sometimes imaging isn't perfect. In my case imaging showed a sizable herniation at L45 but the fact I couldn't pick up my right foot suggested urgent surgery. The surgeon said actual herniation was 2x size predicted on imaging and nerve was bruised when it looked "normal" on MRI.  Only 3 days from image to surgery so I doubt there was a lot of change.  If conservative treatments aren't working there has got to be something to help. I'd just be looking for better.


  • May be a blessing in disguise that the surgery was cancelled - given that the doctor was not confident in his ability to help your issue. Agree with the others, shop around for other surgeons (it sounds like surgery is the path you are on). My situation: I did a year of conservative treatment when I herniated L5/S1 and finally surgery, was a huge relief and was able to live medication-free. I had a bulge at L4/L5 that herniated earlier this year, I live in a different city now and had to find a new spine surgeon. I went with an orthopedic surgeon at a teaching hospital and lucked out, I'm 14 weeks post op and doing great. 

    Don't give up. 

    Jan 2009 L5-S1 ALIF
    May 2017 ALIF L4-L5 with PLF rods added L4-L5-S1
  • my PCP knows my neurosurgon and referred me down to them which is an our   away from home but i am happy he did my surgery and the pain management team he set me up with is truely a blessing for me the pain management docs nurse sent me for na EMG to find out the problem and it seems to me in my l5/s1 area im having problems with byt i am  not going to give up i am going to hang i there 

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