Re-occurring herniated disc - advice needed

[Piaffe11]

So I’ve herniated my L4/L5 disc - again. I had a microdiscectomy/laminectomy surgery in January on the same disc after I lost feeling in my legs and finally got an MRI after waiting 5 months (Ontario/Canadian healthcare system). About 4 weeks after my surgery the disc herniated again (confirmed with an MRI). This would be the 6th time the disc has gone in the last 4.5 years.

My neurosurgeon wants to do another microdiscetomy surgery next month. However, he said if I herniate the disc after this, we should be looking at fusing the vertebrae. So I’m a bit freaked out and doubting everything right now. I have been working with my PT and a great osteo/MT to get stronger and I have started swimming along with my strengthening exercises.

I have worked with my family doc to come off of my pain meds over the last month to see where I am at. My pain isn’t terrible. Probably a 3-4 and when I’m sitting it might go up to a 1. I have had much, much worse. But it’s definitely not just muscle tightness as there is a burning sensation on the left side (disc bulged left). I am considering working with my doc to stay on some meds (where I have next to no pain) and see where I am at in 6 months and push off the surgery.

I just want to be able to live my life. There’s risks that if I go into another surgery with such minor symptoms, I’ll come out with the same or worse on the other side (let alone the possibility of re-herniation). I want to ride my horse, which I have started to do a bit for 10-15 min at a time after not riding her for 7 months and having to keep her in a full training program (and would need to do so again if another surgery happened).

Any advise or insight?

[imbassetma]

Dec 2019 I had L4-L5-S1 fused with laminectomy. My disc were essentially gone, vertebrae not lined up, and was bed ridden for multiple 3 month periods. Epidural steroid injections weren’t doing a thing. Today, I’m 100% pain free with zero riding limitations, I can sit the trot again for the first time in 20 years! I’ve even been ejected a few times, landed flat on my back, fusions are completely fine. But I definitely took healing and recovery slow. I’m just sorry I waited so long to get surgery done. Another friend, same surgery, a year out is also pain free and resumed all life activities including riding with zero limitations. It was life changing in the best way for us both!

[TWH_Girl]

I would move to a lumbar fusion vs another microdiscectomy. So sorry to hear- back issues suck!
My ESIs have long worn off and my hubby needs either a laminectomy or fusion once his afib is under control. Back pain really does interfere with life.

[Piaffe11]

Thank you both for your input!

My struggle is that my surgeon told me if I fuse my back this early (I’m just on the wrong side of mid-thirties) it’s a guarantee that there will be complications later in life from it. He said the screws will eventually start to work loose. So I’m hesitant.

I spoke with my family doctor and we decided that I would put off surgery in general for some time and see how my back is doing in a few months. So I am back on my meds (low levels of NSAID and gabapentin) and working to get strong again. It at least allows me to ride my horse, so at least I am not going crazy!

[Turntable]

I would look into either Foundation Training or the Postural Correction Institute. They are two (different) approaches to correcting your posture and core. I’d give each one 4-6 weeks to see an improvement then move on. I suggest this as regular PT has now worked and you want to avoid surgery.

[Piaffe11]

Thanks for those recommendations!

Have you done either of them? I looked at the Foundation Training as I can stream online vs the Postural Correction Institute, which doesn’t look like it has any locations in Canada.

[Turntable]

I’ve done both. The Foundation Training didn’t really work for me as it’s more of a strengthening program but the PCI was very helpful. It’s more neuromuscular retraining than strength building and that’s why I personally needed. If you keep reinjuring the same thing but aren’t “weak” I think that neuromuscular retraining is worth a shot: PCI is kind of one philosophy/ brand but I think they are all good and helpful.

I now do a daily dose of Classical Stretch/ Essentrics which is a ballet/ tai chi/ focused strengthening and rebalancing workout that works really, really well for me. I am always strong so building more strength tended to just injure me more before I learned to reprogram my movement patterns. Which had been affected by prior injuries and things like desk work etc.

[FitToBeTied]

I have three herniated disks in my lower back. The worst is the l4/l5. I have had my back injected 19 times in 16 years. The most recent three days ago.

After a particularly bad event back in the fall that required two injections and 8 weeks of PT I went to two back surgeons for opinions. They both said that since I was not in constant pain and since the back injections can alleviate the pain then I should not do surgery. The problem with back surgery is it is about 50/50 whether it works or not. And that is for the first attempt. After the first attempt your odds drop sharply.

When I had the pain management doc do the injection this week he concurred. He knew both surgeons and said they were excellent but that I should put off surgery as long as possible.

My approach is to really improve my strength to weight ratio. I am really focused on core strength. I do stretching and P/T exercises every day. I recently added a pull up bar. When I do that I do it with my knees pulled up to waist high. Since starting that I have cut over an inch from my waist.

I’ve added back the dumbell weights I had cut out and also my rower. I figure the stronger I am the better I can hold a better position riding.

It takes about two hours a day to get through all of this but I am retired and have the time. I wish that when I was in my 20/30’s that I had been better about doing stretching as I believe I wouldn’t have the problems I have now if I had been better about flexibility.

[SBrentnall]

Have you looked into spinal decompression?

I had herniations at L4/L5 and L5/S1 in 2015, with compression of my sciatic nerve root and paralysis down the back of my right leg from the glute to the little toe. I consulted a spinal surgeon at Keck/USC and he advised me to spend a couple of months trying to recover with PT and spinal decompression before looking at surgery.

I did 40 sessions of spinal decompression (3x weekly) and regained all the function of my right leg. I no longer have sciatic issues, and I’m fitter than I’ve been in years. I never did have surgery.

Plus I’m an inch taller than I was before the accident! No joke - after every treatment I had to adjust my rearview mirror when I got back into the car because I was taller. Years later, the height increase has remained.

[Piaffe11]

My physio does decompression every time I am in (currently 1x a week). Most of the time there is a release when he does it. I have an inversion table that my friend lent me. Not sure that does anything at all. To be honest, I have been able to move my disc twice now stretching on my picnic table. Shouldn’t be a thing, but somehow it works. I don’t do it to actively try to decompress anything - just for stretching. Helps my tight hip flexors too.

I cancelled my surgery and I’m going to see how I do the next few months. I actually think the disc has finally gone back to its normal position (thanks picnic table!), but I’m still on NSAIDs and gabapentin so unsure. I’m going to keep going to physio and getting stronger and then try coming off my meds again.

[SBrentnall]

That’s great! You might also look into decompression using a machine. That’s what my doctor did. It inverts your slightly, you’re strapped in at the shoulders and hips, and the doctor sets the psi. Then the machine slowly separates the bed, pulling your shoulders and hips apart. It holds the separation briefly, then releases slowly. This pull and release goes on for about 20 mins.

[Calvincrowe]

I was told I’d need a lumbar fusion two weeks ago, but following my MRI last week, I was just diagnosed with sacral ala fracture— or SIF. Usually found in elderly women or those with osteoporosis. I’m 54, had a discotemy/laminectomy nearly 20 years ago at L5S1, three injections since then, piriformis syndrome and some really bad nerve issues. Has anyone been treated for SIF (sacral insufficiency fracture)? It sounds straightforward, injection bone cement into the fracture to stabilize it. I am struggling to ride as it hurts— yes, I’ve stopped for now.

[sdlbredfan]

I am sorry I cannot remember where I read this, but it might not hurt to proceed as if this might be a contributing factor? (Costs nothing to try anyway?) Be sure you are optimally hydrated. Since many of us are (allegedly or possibly) subclinically dehydrated, that reduces the cushioning available via synovial fluid. Dang, I wish I could remember where I saw that. If you try additional hydration, and if it helps, please report back so we all can learn.

[mst]

I have L3-L4 and L4-L5 fused. I was in my 30’s when I got it done. My advice is to find the best surgeon you can and get it done. Get it behind you and move on. I’m a professional and now ride pain free