seb_nied

Thank you Doctor, makes sense. If it comes to surgery I will try to discuss with my surgeon the details of the operation.
The surgery is now scheduled for the 21st of April. My doctor proposed to fix the date and perform or not the surgery based on how I feel. If during these next 3 weeks I see any improvement and feel that perhaps I want to try without surgery I can always cancel.
Just for your information, my physio is planning to work a little on the alignment of my lumbar spine which he says is lacking the natural curvature and being straight the loads are very high on the last L5-S1 segment. So we are working on gaining some more mobility on the upper lumbar segments and a better alignment of the sacrum bone to gain some curvature and relieve the last segment.
I have started also acupuncture this week. Will report the progress.
Thanks again and have a nice day!
Sebastian

Hello Dr. Corenman,
just got a second opinion from another neurosurgeon.
He states there is clearly a recurrent herniation or a small fragment from the first surgery which is still compressing the S1 nerve root. Additionally this is aggravated by the nerve swelling which he could clearly see on the MRI. He is also of the opinion that a revision surgery is necessary as after 3 months I still do not have any noticeable improvement of my symptoms. Answering my question if time will help he said “you can wait but I really doubt that without a revision you will get better”.
Apparently the first surgery was done well, no material was removed from the facet joints and the residual scar tissue is not causing any problems from what he can see.
He suggested that a revision surgery should be minimally invasive and should aim only to remove the residual disc material and remove any material from facets and lamina. Apparently the hole in the disc from the original herniation was really big and it most likely caused the reherniation. He also mentioned for the revision surgery it would be good to use some sort of scaring agent on the disc to improve the healing of the hole.
I am feeling in a limbo now. I am hearing a lot of opinions that for the long term (>6 months) a surgery and conservative treatment will have the same effect, also in this forum. On the other hand I have opinions from 2 neurosurgeouns that a revision is necessary.

Hello George, Hello Dr. Corenman,
Just recapping my whole situation.
Herniated disc with light symptoms (back pain with positice straight leg test, no leg pain) started in September 2020.
Symptoms got worse in November to extreme leg pain and to a point where I could not walk or sleep for a duration af a week.
Symptoms partially resolved and I was relatively pain free but motor weakness was present in my leg and after a recommendation from two surgeons I decided for surgery as the massive herniation was completely smashing my S1 root.
December 30th 2020 – Decompression from large L5-S1 herniated disc.
Pretty much normal symptoms after surgery, little nerve pain, back pain near the incision.
Three weeks after surgery I had a small accident sliding on ice after which I felt my symptoms slightly aggravated but not dramatically.
January 28th 2020 – MRI which shows potentially some remaining disc fragment or scar tissue on the level of S1 root but not a clear RDH. Looks there is some sort of “blurred” area where the previous herniation was which might be affecting the nerve root but the sagittal view does not show any disc protrusion. My doctor suggested to try EPIs and start physio 6 weeks after surgery and check again the situation with another MRI. If this does not help he proposed a revision surgery to “clean up” what’s left.
I had two EPIs, started physio and cannot say that I have seen any big improvements in my symptoms. I still feel pretty weak, have pain in my hamstring, calf and foot (last 3 toes) and occasional back pain in the lumbar area. Prolonged standing makes the symptoms worse, laying alleviates the symptoms. I usually have 4-5 days of relatively low pain and 1-2 days of aggravated pain which force me to lay down for most of the day to recover. This cycle is relatively constant from end of Jan.
March 15th 2020 – New MRI which shows no substantial change from the previous one. Still no indication of a severe S1 compression, and there is still this “blurred” spot where the old herniation removed by the surgery was. Looks slightly less pronounced though.
My first surgeon is proposing again a revision surgery based on these results.
I will now consult this new MRI with another surgeon to get a second opinion as the image is not really clear to me. My osteopath/physio is recommending to wait it and if in 3 to 6 months my symptoms are not getting better then consider a revision surgery.
In general I have to say that I feel worse that before surgery. I feel weaker and I feel that the nerve pain is present more often. I think motor weakness is relatively the same or perhaps slightly better, definitely not worse (I lost a big part of my leg muscles), but pain is definitely worse. Back pain is also worse. I felt I could do more before surgery while now, almost 3 months after surgery I feel really weak.
I frankly don’t know what to do now, as surgery does not feel like the solution of the problem being the nerve compression not that severe.
Just as a reference, I’m 32yo and before the surgery I was a rock climber at an advanced level but normally had a desk job which involved sitting for most of the day.
Any additional feedback would be appreciated!
Sebastian