Best Tx for herniated disk?

[markov]

Have any of you been through treatment (surgical or non-surgical) for a herniated disk? I have a decent-sized one at L4-L5, and am most interested in an option that will allow me to have a winter ski season, even if it starts in January.

 

I could wait it out and continue with the acupuncture, meds & physical therapy, but I'm interested in whether anyone has climbing or skiing-specific insight into recovery from this injury, or recovery from surgery such as microdiskectomy.

 

Thanks for your insights.

[Doug]

Lots of ice, ibuprofren, and walking. Chiropractic care when it becomes tolerable. In one instance, the herniated disk slammed into the sciatic nerve, and the nerve was so inflamed I ended up taking a cortisone shot in the nerver root. It helped that problem pretty well.

[Mark_Husbands]

I have had 2 microdiskectomy surgeries on my L 4/5. The first one was in Winter 2000, the last one was Summer 2001. However, my first experience with back injury went back to 1992 (carrying furniture during a move). At that time I was laid up for several months, but because of the cost of MRIs in 92 I never got one. I went through several months of physical therapy and things improved to "normal" for many years...

 

Unfortunately I didn't really learn my lesson, and went back to doing episodic hard labor jobs. So when my back went south in 2000 following a summer of USFS trail construction and backcountry rangering, I had a track record of back trouble. That, combined with the very bad condition I endured for 3 months or so--I was actually crooked, could barely walk, and my MRI showed a massive herniation--meant that I opted in for surgery pretty quick. I couldn't justify waiting around for another 3 months to see if a non-invasive treatment would work out.

 

After that surgery I recovered to comfortable wlaking condition after about 2 months, and then strted going to gym to see if I could get back into athletics. I was in my fourth year on a ski patrol (which I spent at radio dispatch), and by Spring was taking very casual turns on groomers. The skiing body position wasn't really uncomfortable, but I was quite worried about falling. For me, the feeling of instability in the lower back persisted long after the sciatic pains were erased. By summer I was out in the mountains doing alpine moderates (which is all I can get up anyway). I moved to New England in Fall 2000 and had a great season ice climbing.

 

Unfortunately, that spring I started to get bad persistent sciatica again, not following any identifiable injury event. I went in for an MRI and had a huge herniation of a disk fragment. My pain wasn't nearly as powerful as the first time, and my subsequent recovery after surgery was quicker, probably four weeks.

 

Now its been several years and things seem to be going pretty well. I've accepted that certain activites aren't worth the risk of recurrence. I avoid heavy lifting when I can, avoid using using heavy hand tools, and don't carry big packs. I have skiied very little, but that's really because I have gotten more intersted in ice climbing. Likewise, my lifestyle doesn't really allow for long trips so real big packs aren't really an issue.

 

The main thing that causes me back pain now--soreness that is limited to the injury site and does NOT include sciatica--is driving and sitting too long at a desk. Excercise usually makes me feel better, looser and more flexible. Sometimes after a long hike I get a bit sore, but its not unacceptable.

 

Your goal of skiing after a 3 month recovery from microdiskectomy may not be totally unreasonable, but I would urge you not to let this season weigh into your decision-making at all, even though it's hard not to focus on the activities you want to be doing while you are laid up suffering. Go for surgery when you think you have exhausted non-invasive alternatives--that would be my advice. On the other hand, surgery has produced acceptable results for me.

 

Mark

(NOTE THAT 6TH PARAGRAPH IS EDITED...WORD "NOT" TENDS TO ALTER THE MEANING OF SENTENCES)

Edited September 27, 2004 by Mark_Husbands

[glassgowkiss]

as far a pain relief in people i work or worked with in surgery is not the answer. usually there is a light or moderate improvement up to about 2 years and then the pain returns. the surgery might help with loss of strenght, motor function or numbness/tingling in the area. looks like you are trying right things. try also someone work on your gluteus muscles and your it bands. with L4/L5 my experience is working with iliopsoas, gluts (gluteus minimus), quadrutus lumbarum and hamstrings brings a lot of pain relief. be patient- you were screwing up your body for a long time to get to this point, so it will take some time to reverse this condition- there is no magic pill formula.

remember- this is going to stay with you for life. so proper stretching, strenghtning and icing will be your regular routine. good luck

[markov]

Thanks for all your excellent and insightful advice. I'm going to get an epidural steroid injection next week and see if that helps. Although I was super-resistant to it initially, I ended up taking some oral corticosteroids last week and they really worked. That leads me to believe that local application of the same drug will have a good effect.

 

In any case, thanks for the replies. I think 'letting go' of this ski season will probably be mentally helpful. Then, if I make it back before March it will be a bonus.

 

I'd be happy with the early March pow and the late March corn.

[Clivus]

What are your symptoms? Many people have back pain and a finding on MRI that are incorrectly associated. If you look at studies where people with no symptoms have MRI of the lumbar spine many of them have disc herniations and other findings. Furthermore, many people have surgery for lesions on MRI that result in litte or no improvement in the symptoms. Surgery may be successful if the majority of your symptoms are leg pain, but in general it is not helpful for back pain. This is all compicated by the fact that the only person who can evaluate you for surgery likely makes his or her living doing it. If your predominate symptom is back pain the first things i'd ask are how is your flexibility? and is you hamstring/quad strength balanced?

[gslater]

FYI - There was a decent thread about this recently in the fitness forum.

[markov]

FYI - There was a decent thread about this recently in the fitness forum.

 

Thanks - I don't know how I missed that. Even though there's a ton of 'objective' medical evidence circulating on the internet (and in med school libriaries), anecdotes from people who ask similar things of their bodies afterwards are very valuable.

 

What are your symptoms?

 

Leg pain (profound. intense.), leg numbness, occasionally feeling like my leg is in a breath mint commercial, inability to stand for more than a minute or two.

 

Many people have back pain

 

as I have for about 15 years. This is radically and fundamentally different. I've even had sciatica as a component of my back pain, but this ain't that (with regard to the quality and intensity of the symptoms).

 

and a finding on MRI that are incorrectly associated.

 

Well, if they're associated, they're associated. The question is whether they're causally related, and in that regard it's true that MRIs are neither perfectly sensitive nor perfectly specific. My MRI is attached, and the lesion on the film is an anatomic match to the pattern of the pain, in this case.

 

If you look at studies where people with no symptoms have MRI of the lumbar spine many of them have disc herniations and other findings.

 

Exactly. That's why, mathematically the performance (in this case the specificity of this test, or avoiding false positives) of the test improvies when the population being tested has a greater prevalance of the disease in question. In other words, it's the right test to do when you have symptoms that indicate an underlying condition that can be evaluated. In the absence of symptoms, you're guaranteed to get true negatives or false positives.

 

Furthermore, many people have surgery for lesions on MRI that result in litte or no improvement in the symptoms.

That would suck! Though I agree. Modern procedures (such as microdiskectomy) have a greater long-term success rate (>90%) than any of the older procedures (laminectomy, diskectomy, fusion, etc).

 

Surgery may be successful if the majority of your symptoms are leg pain

...Thats's me!

 

but in general it is not helpful for back pain.

True. I've sought non-interventional care for mine for the past 15 or so years, but now this is different.

 

Thanks for taking the time to reply with your thoughts (and thanks to the posters on the previos threads, which I somehow missed in my search.