Microdiscectomy for S1 compression

///Microdiscectomy for S1 compression
Microdiscectomy for S1 compression
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  • Avatarbackpain8
    Participant
    Post count: 3

    Hi,

    I have a herniated disc at L5-S1. I’m in my 30’s and this disc has herniated numerous times in my life. A year ago was one of the worst when I had a 13mm herniation which resulted in radiculopathy and a numb right foot. I went on anti-inflammatories and the pain and numbness resolved in about two months.

    Now I have another herniation that is causing severe right leg radiculopathy for about 8 weeks. The MRI showed a large herniation and S1 nerve root compression. I will be having a microdiscectomy in the next 1-2 weeks. I asked my doctor if I should cancel the surgery if my radiculopathy resolves on its own before the surgery since it seems to have resolved in prior episodes. However, I can’t tolerate the intense pain this time which is the reason for the surgery. He said that it was my call and we could cancel the surgery if I start feeling better.

    My question is if my pain resolves on its own, is there still any benefit to having the microdiscectomy? I assume the disc is still herniated but is not compressing the nerve as much. Would having a microdiscectomy perhaps help prevent a future herniation and radiculopathy from occurring again? Should I skip the surgery and just keep the herniation as long as it isn’t compressing the nerve root? This all assumes that the pain diminishes before the surgery but I just wanted to research as many options as possible.

    Thank you so much for any input you can provide!

    • This topic was modified 1 week ago by Avatar backpain8.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    Pain is generated by inflammation which is the result of compression. If you don’t have motor weakness of your calf muscle, then you could wait and see if this nerve root becomes better. However, if this root continues to get battered by reherniation after reherniation, you could develop some chronic problems. See this to understand how to test the S1 nerve: https://neckandback.com/conditions/home-testing-for-leg-weakness/

    Generally, if there have been three herniations and two prior microdiscectomies at the same disc level, it is common to consider a fusion to ablate the disc and prevent further herniations. Further herniations could batter the root and leave the patient with chronic pain. Three prior herniations without surgery is a very unusual condition and a frank discussion of the future of the nerve root needs to be considered.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarbackpain8
    Participant
    Post count: 3

    Thank you so much for your reply Dr. Corenman! I definitely have current weakness in the affected leg which has been noted by my doctor and physical therapist. The herniation that I had last year resulted in a drop foot, but thankfully all of this cleared on its own with just taking anti-inflammatories. My doctor is allowing me to have only this one microdiscectomy. Given my history, he said that if I have a reherniation of this same disc we will move straight to another fix (fusion or artificial disc after ruling out the facet joints).

    Does this sound like a reasonable approach? My biggest concern is having another herniation and I’m wondering if it would make more sense to go straight to a fusion to completely prevent this from happening.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    The general rule is to allow two microdiscectomies before fusion. The recurrence rate of reherniation is about 10-20% so your odds of not needing a third surgery are quite good. Nonetheless, I can understand this surgeon’s reluctance to allow another decompression. I am not a fan of artificial discs in the lumbar spine for multiple reasons and patients do very well with a one level fusion.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarbackpain8
    Participant
    Post count: 3

    Thank you Dr. Corenman. Your responses are honestly very comforting to read. I’ve been in agony for the last several weeks and greatly appreciate the time you take to respond to everyone on your website. It really does make a big difference in people’s lives. I’m counting down the days until surgery and hoping for some relief 🤞🏻

    Thank you again!

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    Please keep us informed of your progress.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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