PauloMemberJuly 22, 2012 at 6:07 amPost count: 2
Hello Dr Corenman. Thanks for this website it is a great resource. About a year ago I herniated l5/s1 at the rear right side, was considered mild. I did a session of PT, but I waited until march of this year to get an MRI which confirmed the herniation, then went back to my life. It never really resolved, I believe i went about it with too little caution. The herniation is pressing on the nerve enough to cause numbness but sciatica hasn’t been too much of a problem, only after I do something strenuous. Up until recently I’ve always just had this pressure and seemingly constant backache, as well as a minor crick in the back when I bend a certain way. My symptoms have been improving, up until yesterday when i went at splitting logs with a 20 pound sledge. I also do a lot of lifting and moving patients in the ER, and for the first time yesterday i dealt with intermittent numbness in my left foot, as well as the occasional numbness in back of left calf and semi usual sciatica. I am 21, 6’4″, 185 lbs in good shape.
Most of the pain can be controlled with NSAIDS and its not constant or overbearing, but I am supposed to get my first epidural shot on Monday. I dont know if this is the right move. Ive seen three orthopedic surgeons now, the two good ones told me to wait on surgery and thus far I have, but I don’t know if the epidural shot is worth it because I’m worried with my job I will just keep pushing the inner disc material out of the wound. My body mechanics have greatly improved but Im terrified i will lose too much disc height, not be able to contine sports, and end up needing to get a fusion. The MRI did not show any noticeable loss of disc height but that was 4 months ago, may have made it worse yesterday, and I can not have this problem further deteriorate.
At this point I don’t know how much more the disc is going to heal, and I don’t want it to get any worse given my lifestyle. I am willing to try one epidural, and I think I may have to in order to give the disc some inflammation free healing time. However I feel that I can overcome the change in spinal integrity that comes from shaving down the facet joint, even though I’m not pleased about that part. Please I need some advice here. Is it worth it to get the epidural and give this 3-4 more months of careful living and physical therapy? Or should I bite the bullet, find the right surgeon and just get this damn thing over with? Like I said, if it’s going to just get worse I can not afford to have that happen, especially at 21. Thank you.Donald Corenman, MD, DCModeratorJuly 22, 2012 at 7:11 amPost count: 8468
By the sounds of it, you have had chronic but mild compression of the root at L5-S1 right (the S1 nerve). The symptoms were stationary. That is, they never became better or worse over time.
When you really loaded your back with splitting firewood, the symptoms progressed but not severely. The numbness increased but the pain did not become significantly worse. More likely than not, you suffered a small recurrent herniation. This slightly increased symptoms but not to the point the increase affected your lifestyle.
The epidural I think is a good move. It won’t hurt you (performed correctly) and could “toughen up” the nerve enough to reduce symptoms for the long term. Do not worry about loss of disc height as this is inevitable regardless of what you do. It is my opinion that some patients are “wired” for back pain and some are not. In my practice, I have many patients with severe DDD and only mild aching in their back.
I don’t understand “shaving down the facet joint”. An epidural steroid injection will not effect the facet joint.
You are at the point that an epidural injection might give you relief for three to twelve months. Repeat steroid injections are typical when the last one “wears off”. A surgery might be helpful as long as you remember that there is a 90-95% success rate and not 100%.
Dr. CorenmanPauloMemberJuly 22, 2012 at 2:21 pmPost count: 2
Ok thanks for the advice, for now I will go ahead with the epidural, and maybe try a second one if it helps enough the first time around.
When referring to shaving down the facet joint I meant for microdriscectomy, I am prepared to deal with the changes in spinal integrity if my condition does not improve. I honestly feel that all I’ve learned about core strengthening, posture, and lifting mechanics would prevent another herniation from occurring but since I can’t know for sure, I am going to put off surgery at all costs like I have been doing, I just don’t want my situation to keep getting worse and end up with a fully sequestered disc because I didn’t get surgery and just let the thing heal. I may post bak again in the future, thanks againDonald Corenman, MD, DCModeratorJuly 22, 2012 at 10:37 pmPost count: 8468
Just because you have a disc herniation now does not mean it will re-herniate with a larger fragment. The chances are higher to re-herniate (10%) than if you never had a hernation (1%) but that is a long way from “an inevitable reherniation”.
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