The Eurospine link above talks about dehydration of the disc then this link [url]The Process of Disc Resorption[/url] suggests the macrophage theory:-
[INDENT]Just as your body would recognize and fight bacteria that try to invade a cut in your skin, so too does your body recognize the extruded nucleus pulposus from an annular tear as a material that should not come into contact with other bodily tissues. Your bodys immune system kicks in and uses macrophages white blood cells that destroy pathogens to break down the disc material until it can be completely resorbed by the body. With time, the annular fissure will close and heal.[/INDENT]
It's from a website I think SPINELF uses.
Why are we all told different things - it is so frustrating.........
Trust me I researched this to death last year and asked the surgeon so many questions, I don't think he knew what hit him!!!!
Jayne x
Hi Doog,
How did he know it would never go away though? My surgeon said in all honesty, they weren't actually clear what happens.
Jayne
Jayne, like you I had researched it to death but am still no clearer. I read somewhere that they did a study of patients and after 10 years those who didnt have surgery were at the same level as those who did - so much for surgery eh!
I think half the problem is that people who recover well from surgery and go onto lead a normal and active life tend not to post about it. My surgeon has apparently done 10,000 of these procedures - I have only seen his name mentioned once on these forums and that was a pre-op post - so that would indicate that the procedure may be successful - who knows?
As for differing advice, tell me about it. Same ward, same day, same operation, two different surgeons - both of us patients told different things- what you can do / cant do..its crazy
I have been told by my surgeon that it is unlikely to fix itself and that even with the operation there is no guarantee that it won’t return at a later date (so I wonder what’s the point?!) I will clarify this with him tomorrow and let you know what his response is.
What he did say is that it is unlikely to get worse....
Jayne, yes there are positions i can get in that make it less painful - standing and lying flat mostly. Like you I stand up often, I can still for more the 20 minutes when it is bad so i have no option.
I spent 6 hours of a 12 hour flight standing recently! I also sometimes need to stand when I am out for dinner - in the office I am constantly up and down. Like you I have research this topic to death and the more I read the more freaked out and indecisive I become….I have tried making lifestyle changes and they have gone so far to making it better. The more active I am (walking etc ) the better it seems it is…the problem comes when I try to relax, for example if I go on holiday, or go to the movies (this one is a total no go!). I even had to leave my bed and sleep on the sofa on several occasions as getting comfortable was impossible….how do you make changes with that? Yes still going with the Physio…I’m not giving up!!!
Doog, I can understand why you needed to make the decision in your circumstances, luckily I don’t have that pressure and work are being great. I think one of the main reason I am considering it is due to the fact I travel a lot with work, both long and short haul flights and several times a month – even on a trip over to Berlin I end up hanging out by the toilets as I can sit! Not even business class seats long haul are bearable when its bad….
I guess it doesn’t help that I have DDD with the discs above and below
One other questions, on my admissions sheet is state’s I will be having the following
‘Left L4/L5 Discectomy and L5 Nerver Root Decompression and and LA Injection into the skin’
Obviously I will be asking for more info on this tomorrow, but have you got any ideas what an LA injection into the skin is and what the root decompression is?? Is this standard with a discectomy?
Thanks guys
Hi 'Painintheback',
My question to you would be ; if the surgon said that he had desided not to operate on you how would you feel ???
I think, but maybe wrong, that there are no clear answers, thats why these forums are so helpful to all of us trying to make desisions !!
I have read post after post with the theme that all the info out there is inconclusive.
I am NOT an expert but have concluded that; a back operation can help and have positive outcomes, it can also help very little, there are also risks. Why the outcomes are so different there seems to be little answer wise !
I think that without a cristal ball you can not know what the best desision for your body is!!!!
However, you can deside if you as a person feels you should go ahead !! Sometimes others can take a persons need to talk about it and question it as it being the wrong thing for you to do!!!
As I sugested at the begining of this post,have a think, if the option to have it done was taken away would you feel relived or upset/angry. And, why.
I belive in 'gut feeling'. Good Luck 🙂
GREAT INFORMATIVE POSTS GUYS!!
SPEAK SOON!
BEST OF LUCK FOR YOUR CONSULTATION HEIDI!
THAT LOOKS LIKE A 'VICIOUS' L4/5 DISC HERNIATION OF YOURS HEIDI! WHICH MEANS THAT YOU NEED TO GET YOUR QUESTIONS ANSWERED TOMMOROW!! DON'T LET THE SURGEON BULLY YOU INTO SILENCE OR INTO A QUICK EXIT!!
BEST WISHES
SPINELF
Hi Painintheback!
Just saw your post. Its brought me right back to that same place i was in before agreeing to have the operation. I really feel your stress, frustration and indecision. Its emotionally draining and even when you decide yes or no you'll still doubt yourself.
Firstly your scan shows a a decent rupture and the disc above and below bulging. So thats 3 possible causes of pain / back ache. With the rupture in the middle it'll put further pressure on the disc above and below in time as it shrinks.
Nobody can give you an answer only yourself. I reached ut on this forum and a personal message from another poster confirmed to me that you don't have to be carried into the hospital to get this done - its ok to get it done during a period where the pain subsided. If theres a pattern of it easing and returning etc. . If life has become limited by the condition and you feel its the right choice then go for it - if your not 100% convinced and ready for the 8wk rehab period then don't. The web is full of horror stories so my best advice is limit what you focus on.. First hand experience is best.
I met with 2 people who had a fusion and a disectomy beforehand. The disectomy was 10wks post surgery.
I guess i'll conclude with this. If this is stopping you working or living comfortably. As in a complete stop bed ridden. Then its time to consider surgery.
You have to now accept you have a back condition. Thats forever more and will need counter action - walking exercise etc
You have to very careful what surgeon you choose. Spend the time researching because your life is literally in there hands. Its a serious procedure.
I'm 8wks post op now. I was trimming hedges yesterday, i was at the gym swimming walking etc. Its always at the door but if you keep the walking and exercise going it works. I return to work tues 10th april. We'll see how that goes!!
Best of luck. Take your time and research and make the right decision.
Hi Heidi,
I left this forum alone for a year and now can't seem to leave the place! I just wanted to stop by and see if you had added an update from your surgeon.
Firstly, and I hope Ricky and Spinelf won't mind me saying, but just to reiterate we are not healthcare professionals and therefore certainly not qualified to report on your MRI scan. I found this link from the British Spine Surgeons Association very useful when trying to make sense of my scan [DLMURL="http://www.spinesurgeons.ac.uk/article.asp?article=29"]The Spine and MRI Scanning[/DLMURL]. We can all have bulging discs and the degree of prolapse does not necessarily correlate with the amount of pain and this is where the phrase "we treat the man (or woman!) not the scan" came from.
So please, please, please don't get hung up on the scan image. I really know how difficult it is not to and Doog is right it can almost convince you that you have to get it operated on now as the only option. But remember there are many people who have sciatica and have the same treatment as us, but never have a scan. My understanding is that the NHS won't even request an MRI before 12 weeks of symptoms and then there is often a waiting list - in my area another 5 weeks. There are others where a prolapsed disc is found coincidently on an MRI and the patient has no pain! So all in all the scan isn't the foremost consideration - it is how you feel and how it is impacting on your life that is important. Sorry rambling again......
I guess overall and I think Lizzy touched on it - is if you are happy that you have tried everything and say 3 months post op if you still had pain, you are comfortable that you won't turn round and think "I wish I had tried.........." or "I wish I had just given it a bit longer" and you can no longer live as you are and you trust your surgeon, then I guess it is time.
Some things to consider, some of this is for new patients looking at this thread. Other contributors please add/disagree/comment and remember I am NOT a healthcare professional - this is just how I see it:-
- Look at trusted websites like [url]EuroSpine - Sciatica[/url] to help you make an informed choice.
- prolapses can get better on their own. Nobody seems to know exactly how but dehydration or reabsorption via macrophages seem to play a part. It is not necessary for the disc to "go back in" (and it won't anyway). It just needs to pull back off the nerve.
- Nerves can repair themselves if damaged - don't get too panicked or pressured into quick surgery because of permanent nerve damage - that is rare. The only time emergency surgery is necessary is if you have Cauda Equina syndrome.
- Nobody seems to know how long it will take to get better - in most patients the most severe pain seems to have settled within 6 - 12 weeks. But other pain may continue for many months. My physio says up to 2 years, whether I had surgery or conservative treatment
- The bigger the prolapsed disc does not necessarily mean more pain. There are theories that bigger prolapsed discs may resolve more quickly because the body is more likely to recognise it as a problem and react to it. Comments from surgeons that "It's the biggest prolapse I have ever seen" are irresponsible.
- If your symptoms don't seem to be clearing ask your healthcare professional (Physio, GP or surgeon) if piriformis syndrome or nerve adhesions are a possibility and contributing.
- Physiotherapy (McKenzie exercises work for some) and talk to your Physio, I found mine much more knowledgeable than the GP and had experience of post surgical and conservative management of prolapsed discs and could give me stories of both recoveries. They also don't have any vested interest - they see you whether you have surgery or not! Remember you have to play an active part in physiotherapy and do your exercises regularly for it to work!
- Keeping gently active, keeping the spine moving helps blood flow and nutrients to get to it to help it heal. But listen to your body and rest when it tells you to. Walking is great but gently increase the amount you walk each day.
- Be prepared for a lifestyle change while healing - e.g. don't sit for too long, use a lumbar roll e.t.c. Prolonged sitting puts a lot of pressure on discs - so get up every so often to move around. Try not to bend too much, don't lift anything heavy (I was told max 5kg) and try not to twist.
- Drugs that don't heal but they help you keep active and do the physio exercises which does help with healing - amitriptyline, gabapentin or pregabalin (although they may have side effects). X ray guided epidural injection.
- Other pain relief - heat pads, TENS machines, acupuncture may be useful.
- Choose your surgeon carefully. If private or insurance think to yourself are they too keen to operate on me (very lucrative business) and conversely if NHS are they too reluctant. You would like to think that they would do the best for you, but targets, egos and empire building can play a part - don't be afraid to seek a second opinion.
- Think about the type of surgery - SPINELF has written many threads on this.
- Surgery is for pain in the leg only, it is not for pain in the back and may make back pain worse.
- Pilates can help improve core strength and stability - helping to reduce pain and prevent recurrence.
- Remember people do tend to post negative things rather than positives on websites. The successes tend to just get on with life. So don't be too scared by things you read on the internet!
Trusted websites I found useful:-
- European Spine Surgeons Website [url]EuroSpine - Sciatica[/url]
- British Association of Spine Surgeons Website [DLMURL="http://www.spinesurgeons.ac.uk/patientinfo.asp"]Patient Information[/DLMURL]
- NHS Choices - [url]Sciatica - NHS Choices[/url]
- Prodigy (this is what GP's use) [DLMURL="http://prodigy.clarity.co.uk/sciatica_lumbar_radiculopathy"]Prodigy - Clinical topic - Sciatica (lumbar radiculopathy)[/DLMURL]
Famous people who have suffered prolapsed discs:-
I found reading their stories really encouraging
Undergone surgery:-
- David Tennant (whilst in Hamlet!)
- Kate Silverton (BBC newsreader - possibly Cauda Equina - went on to have a baby).
Not had surgery:-
- Steve Redgrave - went on to win Olympic medals!
- Kelly Sotherton - two prolapsed discs - now doing the high jump as part of the Heptathalon for the Olympics!!
- Tony Blair - whilst PM
- David Walliams - whilst doing his Thames swim
Can anyone think of any more?
I may come back and add to this as I think of more. Sorry but after all I went through last year, I feel very passionate about things!!
I hope this helps someone.
Jayne xx
Heidi,
Hi, I was wondering how you were doing, if you had made any desisions ?
lizzy
Hi guys,
So sorry for not up dating sooner.
so after seeing my consultant I decided that I wasnt mentally ready to go ahead with surgery so cancelled and instead went ahead with a L5 nerve root block,despite being informed there was only a 20-30% chance of success. I have now had two of these within 6 weeks and I am disappointed to report that it hasn't worked.I had the last one on Thursday and was initially positive and convinced it had worked....but today as I sit here writing this I am still in pain.
I fear now my options are more limited than ever and the op it will need to be. I am seeing my consultant again in 2 weeks so guess that will be 'D' day.
Any last thoughts?!
Thanks
Heidi
Heidi
I fear now my options are more limited than ever and the op it will need to be. I am seeing my consultant again in 2 weeks so guess that will be 'D' day.
Any last thoughts?!
Hiya Heidi!
I am glad you made the decision you did, I think it was the right one!
I have had four nerve root bock injections, 2 were in the wrong place and completely
failed to work, the other 2 were injected in to the correct lumber level and worked completely, killing the pain 'fully' for 6 weeks and gave me an 11 week restbite from the worst of the symptoms.
So my thought is, that diagnosis for the location of your pain source is wrong and therefore the location of the pain releif injection was in the wrong place! It just makes sence to me!
Seriously think about getting a second opinion and more X-ray and MRI scans, I think more questions need to be asked of your Consultant when you see him, but don't be railroaded into a decision, make your own mind up, just as you did about the operation.
Best wishes and kind thoughts
SPINELF
Hi guys,
So sorry for not up dating sooner.
so after seeing my consultant I decided that I wasnt mentally ready to go ahead with surgery so cancelled and instead went ahead with a L5 nerve root block,despite being informed there was only a 20-30% chance of success. I have now had two of these within 6 weeks and I am disappointed to report that it hasn't worked.I had the last one on Thursday and was initially positive and convinced it had worked....but today as I sit here writing this I am still in pain.
I fear now my options are more limited than ever and the op it will need to be. I am seeing my consultant again in 2 weeks so guess that will be 'D' day.
Any last thoughts?!
Thanks
Heidi
Heidi
Hiya Heidi
HOW ARE THINGS NOW, ANY NEWS?:confused:
We Look forward to hearing from you.
SPINELF