noomienooMemberJuly 7, 2011 at 6:17 amPost count: 2
I am a 40 year old gentleman from the UK. I have had sciatica and weakness in my right leg and foot for 2 months. I have had an MRI which confirms l5/s1 disc pressing on spinal column. My right ankle reflex is absent.
I have seen the orthopaedic consultant today who says I need a discectomy. I forgot to ask questions, and am anxious for answers to the following:
1. How long is the operation, and how long is the expected time needed off work to recover?
2. What is the percentge chance of being partially paralysed if I have the operation?
3. If I don’t have the operation, I understand I will experience foot drop, is this reversible?
4. Will I be able to walk okay without the l5/s1 disc?
5. Will the operation be likely to cure the back/leg pain, and associated weakness?
I would be extremely grateful for a reply as soon as possible. I am waiting approximately a month for my next referral to a spinal orthopaedic surgeon. I do a sit down job at a desk. Will I be able to return to work before the operation?
Thanks very much for your help.Donald Corenman, MD, DCModeratorJuly 7, 2011 at 8:40 amPost count: 8506
The microdiscectomy procedure typically lasts about 40-60 minutes but the set up for the procedure can take as long as 40-60 minutes (anesthesia, positioning, X-ray marking and preparation).
Time off work depends upon your job demands and how you recover personally. For a sedentary job (desk job) – you could normally be back to work part time to full time in 7-10 days. For a professional athlete, it might take as long as 8 weeks.
The chance of paralysis after the operation is very- very rare. I have never seen it with myself or any of my colleagues but I have read about it in case reports. I know this is the most feared complication to the general public but is so very unusual that in good hands, you should not worry about this.
You state that without the operation, you will experience foot drop. Do you have foot drop now? (Foot drop is weakness of the tibialis anterior muscle that allows the foot to drop and catch the toes on the ground when walking). If you do not have foot drop now, it is unlikely you will get it in the future unless something significantly changes. If you do have foot drop now caused by a disc herniation, it is my opinion to have surgery as soon as possible to allow the greatest chance for the nerve to heal. If someone comes into my office with significant leg weakness from a herniated disc, I try to get them into surgery within a couple of days.
Will you be able to walk okay without the L5-S1 disc? The disc is not going away after surgery. Some of the jelly that acts as a shock absorber has been lost but the annulus, cartilaginous endplates and some of the nucleus contents are still going to be present.
There are two problems that can occur to a disc that has herniated regardless if surgery was or was not done. One is a recurrent disc herniation. This can occur about 10% of the time in an active population. The other is disc pain from lack of shock absorption or instability which can occur about 10% of the time.
The microdiscectomy is designed to take pressure off the nerve root which reduces or eliminates leg pain. It is not designed to reduce back pain although this surgery can on occasion reduce back pain.
Dr. CorenmannoomienooMemberJuly 8, 2011 at 7:39 amPost count: 2
Dear Dr Corenman.
Thank you for your reply. I forgot to mention I have hydrocephalus which is controlled by a VP shunt (3 bouts of neonatal bacterial meningitis caused this at 5 months old). I have had 4 shunt operations. Would the fact I have a shunt cause a problem with the csf when the spinal operation is performed, or does it have absolutely no bearing on it? I forgot to ask the orthopaedic surgeon this yesterday.
Thanks a lot. I would appreciate an early reply.Donald Corenman, MD, DCModeratorJuly 11, 2011 at 3:45 amPost count: 8506
The shunt should have no bearing on the surgery as long as the shunt is functioning properly and the anesthesiologist is aware of the shunt and takes typical precautions.
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