Time for surgery ? L5/S1 prolapse

[TaylorB]

Three years ago I suffered an L5/S1 prolapse with severe sciatica. I was off work for 6 weeks and it was over a year until I returned to what I would say was 80% recovery. However since the original injury I have suffered several relapses and niggling sciatica.

A month ago I suffered a major relapse and have been off work since with repeat symptoms. Due to the complete disinterest from my GP who insists on only plying me with medication I paid £200 for an MRI scan. This has shown a 10mm protrusion at L5/S1 compressing and displacing the S1 nerve. This was the site of the original injury.

I showed this to my GP and he showed 'no interest whatsover', I asked if the NHS wanted a copy of the scan and he said, no its a waste of time. On every occasion he talks about 'weeks' Do they work to an agenda ? ie epidural after 8 weeks, consultant after 12 weeks, MRI scan after so many weeks?

For me its been 3 years so one can only presume its not going to fix itself. How can I see a consultant?

Is it worth considering surgery? but how can I without being referred? I have been on diclofenac for 3 years on and off , had numerous physio sessions for core strengthening yet seem stuck in limbo?

 

[Power of m squared]

Hi Doog, Welcome

First I would say get a new GP!!

Is there another doctor in the practice you can see perhaps? From my experience the NHS intesely dislikes people that take matters into their own hands and have private mri's etc. You have to get tough and demand a referral to a consultant. An epidural won't change the main problem.

Not sure if you are aware of the benefits of MISS minmally Invasive Spinal Surgery, search Dr Martin Knight and the Spinal foundation, he does some wonderful operations that really fix the problem rather than the rather drastic versions the nhs use.

Good Luck.

 

[TonyJFerdinand]

Hi doog, I had the exact same thing for many years, more than 20. I was in Canada at the time, and doctors there were the same as what you've described, so I had to suffer for many years.

When I was living in Phuket, Thailand, I had a really bad flareup, so bad that I could barely walk or stand. I went to the hospital there and the doctor sent me for an MRI. They asked me if it was OK if I had to wait a couple of hours to get the MRI.

Anyway, the MRI showed that L5 S1 was severely prolapsed and that L4 L5 was starting on its way. The doctor sent me for physio, I think it was 8 sessions. But at the same time, he gave me suggestions on what I could do to help it, things like streching, gentle massage and a couple of other things that I can't remember off hand.

He had also said that my condition was so bad that I was bordering on requiring surgery. He would see me after the physio to follow up and see how things were. So, I went for my physio which included heat, electrodes, ultrasound and traction.

Towards the end, they also gave me exercises to ease things and to strengthen the muscles. You know what? After the physio, I was cured! what I really liked was the fact that they didn't push me to take any drugs.

I do find that about twice per year I'll get a flareup and either it clears up whithin a couple of days, or if it doesn't, I just go for physio again. I'm in Dubai now, and we have many private hospitals, so there's a choice, not like in Canada.

I'm not really sure how it works in the UK. Are you able to go to another doctor or hospital and have them refer you for physio?

 

[Ana P]

Many thanks for your replies. I really do need to see another GP . My previous GP retired recently however when he assessed me three years ago I was referred straight away, saw a consultant, had two failed epidurals and had plenty of physio but at least he seemed to make the effort.

I fully understand that most prolapsed discs do sort themselves out so can understand the waiting period, however surely if the same disc has gone again to such an extent then you would think perhaps a more detailed examination would be required.

My problem is that i am extremely active,into cycling , used to love running and playing golf and I guess I am looking for some long term solution rather than just being given a shed load of amitriptyline and told to get on with it.

I note the comments on physio, It never really worked for me although I religiously followed my core exercise programme. I actually saw a surgeon once, he looked at the scan and then asked to name my pain level between 1 and 10. I said 2 (I was dosed up), he said told me surgery wasnt an option then !

Dont get me wrong i would love to beat this thing without surgery but after 3 years I am being backed into a corner.

Thanks for suggesting the MISS option, I will look at that.

 

[kcxqmege]

Natalie you are so lucky! Doog keep researching

I do understand that physio can work for some prolapses, it all really depends on where the disc is protruding into. Obviously if it is the spinal cord or cauda equina then there really is little option but surgery.

For just over two years I have been battling with an S1 L5 L4 L3 left side herniation, and touch wood, jeez should I even write this, tempting fate? but so far so good, yes drugs lots of, especially anti inflammatories and a little gentle exercise that I got from the Back Bible and the nerve effects have lessened massively. The physios won't touch me incase they do more damage, but that is just me. However it's not all good news, the right side is pretty bad, different problem, lol, pretty much bone on bone there due to an old injury, 10 would be a result lol.

But my point is that discs can get better!

Could I run if it was only my left side? maybe.

Everyone is an individual so listen and take it all in then apply to your own situation

 

[Footballher10]

If conservative therapy has failed, your pains/spine problem is affecting your everyday life and activities, then its time for surgery. Of course minimally-invasive (MISS).

 

[guRl]

I agree about the need for surgery but not necessarily MISS! Other surgeries DO work!

 

[Greta]

Its necessary to avoid up to 40% failure rate of traditional spine surgery.

 

[Peaches]

Sorry but I disagree. I have had traditional surgery and know a large number of people who had the same with 100% success. There is room for both and you cannot disregard either. All surgeries are surgeon dependant regardless of the method used.

 

[Pompal 09.]

Worldwide studies based on thousands patients stand behind my statements. I am glad that you and your friends are fine, but statistics and scientific studies are very clear on this matter.

 

[gwettucbijaifgewd]

Im not going to disagree with studies or reports, scientific or not, but I am speaking from first hand experience and traditional surgery can be completely succesful in a lot of patients. If the surgery was so bad it would not be performed anywhere in the world! Patient, Surgeon and the correct attitude to recovery is paramount in any surgery including MISS!

 

[Destiny Maker]

In the amazon rain forest they still amputate with a saw and no anaesthetic......doesn't make it good.

The point is there IS a better way

 

[AceOfJambos]

Now if only we could get this available for all on the NHS. I actually found a surgeon that does disc replacement via keyhole, so the search is narrowing.

 

[MJsLiberianGirl]

Cascara, please be aware that ADR surgery can be done in minimally-invasive manner (keyhole approach), but its still aggressive surgery with risky outcome. With ADR surgery, surgeons experience is the key, and not the incision. Surgical approach is from stomach, that is why incision size is not important. None of the muscles are damages nor the nerves are manipulated....

 

[JamesHenderson]

Often these type of disc prolapses get better by themselves, given a few weeks, which is why most GP's opt for conservative treatment in the early stages. Painkillers, moderate rest and a 16 week wait for physiotherapy, during which many peoples' problems would resolve themselves. As the lesion resolves, an irritation of the spinal nerve may set up an inflammation circle, with the nerve itself becoming irritated. In addition, the nerves in the dorsal horn of the spinal cord can become hypersensitive, and amplify incoming signals which are then experienced as pain. This goes some way to explaining recurring symptoms, the "niggly back".

Of course, for a prolapse to happen in the first place there needs to be some underlying weakness, which if unresolved leads to later recurrence in the same location, hence the "glass back" syndrome.

It's possible that something like tai chi or pilates could help with any structural and muscular disorder, couple with acupuncture for the pain. Personally, I'd try anything before spinal surgery; I've met too many people with "failed back syndrome" after cumulative surgical procedures have failed to work.

Nature is the biggest healer of all; you just need to to find out what is holding her back and then remove it.

 

[OooZsu]

Thanks for your replies.

My current condition is this, six weeks after the latest relapse (10mm L5/S1 paracentral extrusion) and 3 years after the original accident : acute sciatic pain in right leg and deep pain in back, however it is being controlled by Naproxen. There has been an improvement in the last 2 weeks.

Physio is aggravating the sciatica, which clearly it shouldnt. I am walking further every day and am not suffering acute pain unless I cut down on Naproxen.

I have an appointment with my occupational health GP next week, they have stated they will pay for a consultation with a surgeon if necessary.

David- Maldon - you mention the glass back syndrome. The same disc has gone twice in 3 years. Do you think this disc will always be weak? If surgery will prevent it going again I will have surgery - however as I am seeing signs of improvement will a surgeon operate? Seems unlikely, I have also read the discectomy after the operation thread and dont know if I could go through that rehabilitation.

It looks like a repeat of 2008 and many months of recovery, core strengthening and medication. This is what gets me down and nothing to say it wont happen again- even if I have surgery.

 

[junebug493]

I don't want to perpetuate the agruement and I do accept that there are caring Surgeons carrying out 'standard spine surgery' in a caring way, but I do believe they are (sadly) few and far between. However, you can quite easily answer your own question and find out whether your hypothosis is correct.

Send the following 'Freedom of Information request' to your local NHS spine unit!

((Please supply me with full details of your safety & efficacy rates for all spinal decompression procedures. These include, but are not limited to, open back surgery, Microdiscectomy, Laminectomy, Minimally Invasive Spine Surgery, all Fusions procedures, Disk Replacement procedures and so on.))

((Also, Please supply me with the all and any information regarding the appropriateness of the above procedures, togeather with the results of all randomised and other clinical trials related to the above procedures.))

I have tried to get this information for over 4 years from 5 NHS Trusts (UK wide), and each time the responce was the same:
''we do not rutinely make, record or keep this information''
In other words Fitbird, they cannot prove that these procedures are safe, effective or appropriate! As a potential recpient of these procedures, I am 'totally unable' to make an 'informed choice' regaring whether to undergo these procedures, because the Spinal Surgeons do not make or publish information that is available to the public! WHY?
Believe me, if thier procedures were any where near a 100% success rate, we would never here the end of their self pomotion.

I am not being facicious Fitbird, please try this, let us know what you find.

Best wishes

SPINELF