Surgery or not ?

[oldcelica]

Hi,

I'm a 42-year-old bodybuilder with 18 years of natural bodybuilding under my belt.

Five years ago I slipped a disc lifting a dishwasher in my garden (stupid thing I agree) and since then I have experienced back pain almost continuously with some bad deterioration ultimately.

Last weekend 24h after an osteopath manipulation (coincidence?) I just couldn't move and had to stay 3 days in bed. I went to hospital for X-rays which revealed a congenital spondylolisis on L5 which I knew was there and a former listhesis that seems to have gone worse. I am sure it’s an unstable spondylolisthesis as I can sometimes feel my bones ‘move’ laterally with the odd ‘crooch’

I had a scan yesterday and an electromyography which showed the sciatic nerve to be pinched at some point giving those excruciating pains in the left leg (left glute, hamstrings, especially calf and even the foot).

The scan showed a big (?) hernia and my doctor says I have to see an orthopedist surgeon for some kind of treatment, most probably sugery.

My questions are : should I go through a surgery or not ?
will a surgery permanently fix it or will the hernia
spread again from another weak point after some effort at the gym?
are there any other forms of treatment (laser beam or anything)?

Thanks for your appreciated help.

Oldcelica

[bensearle]

Hi,

I'm a 42-year-old bodybuilder with 18 years of natural bodybuilding under my belt.

Five years ago I slipped a disc lifting a dishwasher in my garden (stupid thing I agree) and since then I have experienced back pain almost continuously with some bad deterioration ultimately.

Last weekend 24h after an osteopath manipulation (coincidence?) I just couldn't move and had to stay 3 days in bed. I went to hospital for X-rays which revealed a congenital spondylolisis on L5 which I knew was there and a former listhesis that seems to have gone worse. I am sure it’s an unstable spondylolisthesis as I can sometimes feel my bones ‘move’ laterally with the odd ‘crooch’

I had a scan yesterday and an electromyography which showed the sciatic nerve to be pinched at some point giving those excruciating pains in the left leg (left glute, hamstrings, especially calf and even the foot).

The scan showed a big (?) hernia and my doctor says I have to see an orthopedist surgeon for some kind of treatment, most probably sugery.

My questions are : should I go through a surgery or not ?
will a surgery permanently fix it or will the hernia
spread again from another weak point after some effort at the gym?
are there any other forms of treatment (laser beam or anything)?

Thanks for your appreciated help.

Oldcelica
Depends - you do not mention whether they plan to operate on the hernia, or operate and do a sabilization on the lumbar spine.

[bensearle]

Depends - you do not mention what the surgery is that they intend to do.
Is it a disc repair or is it a lumbar stabilization, or both?

Apart from manipulation, have you tried any other form of conservative treatment/physio?

If the disc bulge and instability are big enough, and syptoms are not improving then I would suggest considering surgey, although this does not always give 100% results.It is important to discuss things with the surgeon first and ensure that you undergo appropriate post op rehab.

It could be that the manipulation to an already unstable part of the lumbar spine made things worse so i definately would not try that again

[oldcelica]

Thanks. I am seeing the surgeon tomorrow and will know better. What are those conservative treatments /physio ?

I've already tried kinesitherapy with some relief but no treatment of the affection whatsoever. Tha't's all I've had apart from two manipulations from my osthepath, the first one with great results (a year and a half lifting normally , no pain, and some gains) and the second one last week with the results we know.

Oldcelica

[sydunisportsmed]

You could definitely try a guided cortisone injection to around the nerve root, which should help a lot for the referred leg pain.

WRT surgery to remove the piece of disc which is pusing on the nerve, this should be excellent for getting rid of the leg pain, but may not help the back pain itself very much. Unfortunately the options (surgical or otherwise) aren't nearly as good for the back pain itself. The referred nerve pain should be able to be treated more easily (although it will involve invasive methods).

[drboden]

I would suggest entering an intensive course of conservative care, with flexion distraction, ultrasound, IFC, injections of a substance called discum compositum and traumeel in the muscles around the L5 disc area.

A 12 week treatment period, with specific CHIROPRACTIC adjustments (osteopathic manipulaition tends to be a more long lever type with too much torsion on the disc) on the opposite side of the disc bulge after your symptoms of leg pain have subsided, which they should do since you have not sequestrated your disc.

Early gym/physio ball exercises will also help stabilise and off load the disc.

After 12 weeks of 2-3 treatments if you have not signicicantly improved then consider percutaneous resection, not total disc removal. The less surgeons fiddle around with the disc, the better.

[oldcelica]

Thanks for all the input :-)

Tomorrow's Friday and I am seeing an orthopedic surgeon in the morning. He 'll have a look at the scan and x-rays and will suggest some kind of treatment which I will post here in the afternoon.

I also asked the emergency doctor who took care of me in hospital during the weekend to get me an appointment with a neuro surgeon just to have two different points of views but I am already definitely seduced by the options posted here so far...

[drboden]

Keep a few things in mind:

1. You are choosing to get an opinion from two surgeons, an orthopedic and a neurosurgeon, and you will therefore get a surgical opinion. This sounds obvious, but in fairness you are not balancing the opinions at all since they are both surgeons.

2. Get an opinion from another Osteopath, a Chiropractor or a Physio who specialises in disc injuries. This would be the conservative opinion to balance out the surgical ones you will be getting.

3. Your clinical symptoms and signs need to be correlated with the changes on MRI. Remember that many spondy's and discs' can pre-exist such an injury, and that their needs to be strong correlation with the symptoms and signs you present with.

For all intents and purposes, it sounds like a bulging disc, but that nerve can be entrapped elsewhere. I have had patients with terrible disc bulges but with relatively minimal pain and symptoms, vice versa.

Hope this advice helps. Have a look at http://my.webmd.com/hw/back_pain/hw225848.asp for info on percutaneous disc surgery.


Thanks for all the input :-)

Tomorrow's Friday and I am seeing an orthopedic surgeon in the morning. He 'll have a look at the scan and x-rays and will suggest some kind of treatment which I will post here in the afternoon.

I also asked the emergency doctor who took care of me in hospital during the weekend to get me an appointment with a neuro surgeon just to have two different points of views but I am already definitely seduced by the options posted here so far...

[oldcelica]

Will meet one of them for sure, thanks.

In the meantime the orthopedic says the disc is quite heavily herniated according to the scan and requires an MRI which is scheduled for Monday after the visit to the neuro. Surgery is not an immediate option for him as long as I don't get another severe crisis or lose more sensitiveness in the foot. Cortisone injection will bring relief he says but nothing else.

I have to say I train my left leg (especially the calf which lost some muscle mass) every day for 2 or 3 minutes (just flexions with body weight on both legs and flexions on toes and heel with the affected one) and walk around a mile (up flat and down) in order to recover the lost strength in the calf and front foot. Seems to work already but don't want to be too optimistic as pain still occurs once or twice during the night...

[injuryupdate]

If you can notice it getting better then try to avoid surgery. Sounds good. Cortisone injection is probably your option to have up your sleeve if you feel you hit a plateau and want something extra, but you can try to avoid this as well if you notice gradual improvement.