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When is surgery necessary?

Quick backstory: herniated L5/S1 at 16 years old, but doctors gave me the run around about my pain for almost 7 years. Just had microdiscectomy in 04/2018. Started working out and lost ~65lbs, but unfortunately I overdid it at the gym in 10/2018 and I have recurrent herniation- a pretty large one. I took it easy for a few months and gradually got back into exercise and my back GREATLY improved. 

HOWEVER... I'm now having a lot of new symptoms in my right leg. I've always had sciatica, and that didn't resolve after surgery. But now I am getting numbness and tingling, muscle spasms, and definitely weakness. I'm seeing my doctor on Monday to see what options exist. By the way- I'm a 24 y/o female, about 5'10 and 178lbs, I exercise very regularly (usually 5x/week)

At this point, I don't feel that I would benefit from PT. I've done a lot of PT over the years. I feel that it's more beneficial for people who have an injury AND are sedentary. Im a pharmacy technician and I do sterile compounding, so I'm on my feet all day and I exercise very regularly.

 I'm willing to try steroid injections, but at what point should I be treating the underlying herniation and not just the symptoms of it? I'm still able to tolerate standing and walking, though it can be very painful. My right leg is markedly weaker, which I can tell when I workout at the gym and my trainer also noticed that my muscle definition in that leg is noticeably less than my left leg. Of course I don't WANT another surgery...but what's the alternative to get rid of the weakness so I can continue on my fitness journey and also live as pain free as possible?

Thanks in advance! 



  • I may be mistaken but I think doctors usually go the steroid/epidural route before a microdisc is done. And if the microdisc isn’t working then maybe a replacement or that big F word (which I am currently terrified of) I means there’s only so much of the disc they are going to remove. Have you considered pain medication? But then again that’s just gonna kill the pain and not fix the underlying issue.

  • That's my dilemma. After microdiscectomy #1 I got really into fitness. Damn kettle bell swings caused me to herniate again... at this point I honestly could just suffer through the pain, if t was only pain. I've lived the past 8 years in terrible pain so I'm used to that. What I CANT handle is the leg weakness that is limiting me in my fitness goals and just daily life. I'm also not really too fond of the fact that my leg goes numb while I'm driving...that's an accident waiting to happen. So I just don't know if I should be pursuing surgery so that this whole bum leg is actually resolved, not just have a band aid over it. 

    Also don't wanna start managing my pain with meds at 24 :( 

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  • I guess what I'm asking is, if I want the leg weakness gone is there any option outside of decompression surgery? 

  • I’ve briefly looked at something called pulsed radio frequency that relieves sciatica. That’s the only other thing I’ve herd of, don’t know much about it

    edited 06/18/2019 - 12:58 PM


    Everything I have read indicates weakness is a pretty strong indication to take some immediate action.  I would highly recommend seeing your surgeon or MD soon - they may tell you an injection could work but I hear the sooner you get that resolved the better your odds to get the function back.  


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  • Martine

      First let me tell you I am no expert but I am more concerned by the symptoms your saying your suffering from ..those I have experienced. Mine was due to cervical cord compression. I am again having some of those problems return.

      Whenever theres problems in the upper spine like your having symptoms of whole body fatigue and weakness is a very serious thing. I know many time I would almost feel like I had the flu for days after even doing simple tasks. I too have pulled away many time from activity with friends and family knowing if I had done them I have a week or some of recovering from it.

      The cervical neck is a major hub for all your bodies activity.  Even breathing and heart rate. Any damage to this area from any impingement on the cord can be very bad . I am in no way saying surgery is the answer but my concerns again is more or less the progression if one isn't done. But even saying that again surgery is no guarantee thing. I'm more saying if you choose surgery its may or may not take away the symptoms your having now as some permanent damage may have already been done . But more or less surgery could hault more problems down the line...hope you understand the jest of what I'm saying ?

      I would sit down and have a serious talk with your surgeon.  The pros verses cons of having and not having the surgery..and what if you opt not to have it should you watch out for as red was said you are the only one in the end that can choose at this point..but it may come to a point it becomes more of a emergency thing..I'm not trying to frighten you I'm just being honest. So those are the kinds of thing you need a open Frank discussion about.

      Please keep us posted on how things turn out. I hope all goes well.

  • Thanks for the advice everyone. 

    I know that there are steps to take before surgery, I'm mainly just more concerned about maintaining proper functioning in my right leg. When I had the second herniation they said it was central; however, there has obviously been some change in the past month or two. I'm going to ask for a repeat MRI to see if there has been progression or shift, given the increased pain and new symptoms I'm experiencing. 

    As boo mentioned, the main thing I'm concerned about is what may happen down the road if I choose to only manage symptoms.

    I see my pain management doctor tomorrow, hopefully he's willing to get the ball rolling on injections and not force me through PT that I don't need. 

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