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L4 herniated disc options

hey guys, 44years old  i have never had back pain until 3 weeks ago then it happened in what seemed like a subtle way. I went to the gym at 530(i did do light weight deadlifts trying to learn the proper technique) then went went to work all day played with kids after work went to martial arts class that night got home with no problems at all.  Went to sleep feeling good.  Woke up the next am to go to work and fell on my face with back pain.  

Pain lasted for about a week but it was terrible for 4 days.  I could walk about ten feet before i had to stop because of pain.  Pain was non radiating just in my back and right butt/hip.  Xray was normal.  Saw a chiropracter and felt a little better. Then as back pain started going away i started noticing leg numbness in the front of my lower leg and then started having leg weakness.   No foot drop or anything that effected normal ambulation. But stairs were obvious that i was having a problem.  

Mri shows l4 latterel transforaminal herniation impinging on l4 and l5 nerves.  Saw a neurosurgeon and fot an esi.   Pain is 95% improved. Only limited butt pain now when i wake up.  Leg is still moderately numb across l5 distribution per neurosurgeon.  The biggest thing is weakness.  I have quad, hamstring, glute, hip flexor, and some anterior tibialis weakness.  I can walk without difficulty but stairs are hard.  The gym makes iy so obvious to me.  Doing different leg workouts ive determined ive lost about 50% strength in my right thigh.

Neurosurgeon reccomended an esi(which i did) then revisit after 2-3 months.  He said i would be a good candidate for a minimally invassive procedure that wouldnt take any muscle or bone.  Recovery per him is very fast.

im getting mixed messages from various sources so i thought id post here and see what people say.

some say never do back surgery, some are saying wait and see if it returns to normal.

i just dont know what activities to do or avoid and dont have a good direction other than wait and see


  • MetalneckMetalneck The Island of Misfit toysPosts: 1,772
    Unavydoc - Welcome to Spine-Health!

    So to clarify .... You did light weight deadlifts a a novice then went went to work all day - played with kids - after work went to martial arts class.  You believe this to be a subtle cause for onset? OK? Hmmm?

    I've managed my severe back issues wi ESI's and oral medications for a number years but I have yet to hear of ESI's or minimally invasive procedures providing a life long solution to spinal pathology.

    Perhaps a consult with an orthopedic surgeon or a pysiatrist would be in order?



  • Well yes because i didnt hurt at all when i did the exercises or all day. It wasnt until i woke up the next am 24h later that i was in pain.

    ive talked to an ortho told me same as neurosurgeon wait and see. Good candidate for minimally invassive procedure if i need to go that direction.

    im wondering about the weakness and if i should wait or try to rehab it or get surgery. As a 44 yo i do not want to be weak in my leg.  The esi took the pain away but the weakness is only somewhat improved.
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  • pgeorgepgeorge Bristow, VAPosts: 3
    Weakness and numbness are sometimes a result of nerve damage or irritation. Even if the disc has gone back to where it belongs, it may take a long time for the nerves to recover.  If the disc continues to bulge out and hit your nerves you gotta get it taken care of.  I'm a big fan of letting the neurosurgeon handle this.  X-Rays are useless when you need to see the disc.  I would push for another MRI at your 2-3 month revisit.

    Also, I am not a fan of epidurals.  I had three before turning to surgery.  I think they are temporary fixes that reduce swelling for a short time.  The swelling is a symptom, not the cause.

    What's the minimally evasive surgery?

  • MetalneckMetalneck The Island of Misfit toysPosts: 1,772
    edited 12/01/2016 - 9:44 PM

    Motivation - adrenaline - training - and our drive push through our goals and passions can lead us to rebound pain - and paresthesia(s) - also referred to as just plain old overdoing it..

    Due to the disc on nerve situation - you can expect varied amounts of symptomatology - after the disc has decompressed the nerve - and the nerve can try to function properly again. Symptoms can vary during that time also. (Hopefully less pain)


    Minimally invasive procedures are done via a small incision and scope (s) ..... Much like arthroscopy of the knee.
    Many can be done via a scope these days.  It very much depends on the severity of your pathology.


  • jimandjrjimandjr Dallas TXPosts: 735
    Small incisions have been typical for decades for spine surgeries. Again, we are wondering what they will do when they get in. There are many options when they get in.  
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  • hvillshhvills Suzhou, ChinaPosts: 991
    edited 12/02/2016 - 4:33 AM


    Regarding your comment on what activities you should or should not do... you should not take on any activities that will overly stress your back. I'm sure your doctor must have cautioned you on this.  Your L4-L5 herniation will NEVER heal like a cut on your finger... once you have it you have it... however it can subside somewhat and potentially no longer give you nerve pain or weakness.  So the suggestion by your doctor to wait and see is probably a good one.  However if you go out and do all the back stressing activities you did before your face plant 3 weeks ago... you will likely only make things worse. 

    If you do have the surgery the term minimally invasive is a very generalized term and often misleading.  I would guess your doctor is suggesting a micro discectomy which can be very helpful and successful in treating such back issues, but again if your doctor does perform this procedure your L4-L5 disc will ALWAYS be compromised and it will never heal back to the healthy pre-herniation condition.  Don't get me wrong you can certainly live an active pain free and healthy life style post surgery... but you must always be aware of not overly stressing your spine to ensure you don't end up back on the operating table again.  In short some life style changes may be necessary...

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
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