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Herniated Disk in daughters back - deciding on surgery vs injection - any suggestions? (1 Viewer)

b-snatchers

Footballguy
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making
 

gianmarco

Footballguy
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making
These surgeries now are pretty straightforward and usually make a huge difference.

That said, it's always an option to start conservatively and try the injections first and see what kind of a difference it makes. You can then proceed to surgery if it's not really helping. That said, she's almost certainly going to require surgery at some point in the future.
 

Galileo

Footballguy
I don't have much in the way of suggestions, but we are going through the same thing. My 18 yr old has 3 herniated discs. She has been doing PT for a while now, but it hasn't helped much. She is in her freshman year of college and it has been fairly hellish...difficulty sleeping, difficulty getting around campus, etc.. I really think she will need surgery, but we are running through the alternatives now. She is scheduled to get a shot next Wednesday when she comes home for Thanksgiving. I hope it brings her some relief and at least buys us some time to get through the school year and explore the possibility of surgery in the summer.
 

ProstheticRGK

Footballguy
I am not in any way qualified to give medical advice. However, if this were my 25-year-old daughter, this is the advice I would give:

1. Put off back surgery as long as humanly possible. Unlike knees and hips, backs are very complicated. The ultimate success rate for surgery is comparatively low, and complications are comparatively high. The one exception is to have someone clean out bulging disk that has direct nerve impingement. But make sure it is ONLY to clean out the bit of disk that is impinging on the nerve. No structural changes, no taking out the entire disk, no fusions, Just a straightforward microdiscectomy.

2. Go get a second opinion, from a neurosurgeon. Orthopedic surgeons are great. But, no offense to anyone here, I would never let an orthopod work on my back. Even for something as straightforward as a microdiscectomy. I am sure there are good orthopods doing backs. Guys that do nothing but spine, all day long. I still would go to a neurosurgeon.

So, if you've exhausted all of the other possibilities, and are still suffering, then get the surgery. And then, work like a demon to do every physical thing: PT, core strengthening, flexibility and stretching, etc. to make sure the problem doesn't come back.
 

Max Power

Footballguy
I was faced with a similar situation in early 2021 with a herniated disk causing extreme pain and radiating down my arm to point I was struggling to function. I had an MRI and the orthopedic doctor gave me the option of surgery. He was honest about it and said I'm right there on cusp of recommending surgery or giving it some time and seeing how I feel. The procedure was going to go through the front of the neck and I'm prone to keloid scaring, so I decided to wait. I was also working out in the gym like I was training for the NFL draft at the time and knew that was compounding the issue.

I spoke with a co-worker who had the same procedure and he said it was the best thing he ever did. After the recovery period he felt good as new. I was dragging my feet on a decision and the pain slowly went way. I stopped working out all together for about 6 months. When I started up again with the same previous regiment, I was right back to the pain within a month and took about a full year away from weight lifting. I've recently gotten back into the gym with some lighter work and machine more, but recently realized its barbell squatting that triggers my disk issue. I've cut it totally out and I'm "ok" now, but I think I'm just kicking the can down the road until I finally cave and get the surgery. It's a degenerative disk issue, so it's never going to get better on its own.

All of that to say that if your daughter is having triggering events just going about her everyday life, it might be best to opt for the surgery. If she is doing things she can avoid to reduce the likelihood of the pain, then I think its worth waiting. I'm sure the surgery is safe, but I've always been a surgery is a last option kind of guy.

Good luck to her.
 

kevzilla

Footballguy
I'm not a spine surgeon, but I get them paid. Perfectly acceptable to try injections (plural-she may not make it through the spring semester on a Thanksgiving injection) first. As RGK stated more eloquently while I was typing, one of the most common outcomes of back surgery is more back surgery.

Our orthopods are fellowship-trained, same as the neurosurgeons, but they don't do a ton of discectomies. They mostly build scaffolding, sometimes from T2 to the pelvis, to hold fusions in place.
 

b-snatchers

Footballguy
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making
These surgeries now are pretty straightforward and usually make a huge difference.

That said, it's always an option to start conservatively and try the injections first and see what kind of a difference it makes. You can then proceed to surgery if it's not really helping. That said, she's almost certainly going to require surgery at some point in the future.
Yes that is what I was thinking that eventually she would need surgery. She said she is worried about injections as they are not good for you but I think she is thinking if she had multiple ones. She also said that her numbness would probably not go away with the injection?
Thanks for your response!
 

b-snatchers

Footballguy
I don't have much in the way of suggestions, but we are going through the same thing. My 18 yr old has 3 herniated discs. She has been doing PT for a while now, but it hasn't helped much. She is in her freshman year of college and it has been fairly hellish...difficulty sleeping, difficulty getting around campus, etc.. I really think she will need surgery, but we are running through the alternatives now. She is scheduled to get a shot next Wednesday when she comes home for Thanksgiving. I hope it brings her some relief and at least buys us some time to get through the school year and explore the possibility of surgery in the summer.
Thanks for your response and best to your daughter!
 

b-snatchers

Footballguy
I am not in any way qualified to give medical advice. However, if this were my 25-year-old daughter, this is the advice I would give:

1. Put off back surgery as long as humanly possible. Unlike knees and hips, backs are very complicated. The ultimate success rate for surgery is comparatively low, and complications are comparatively high. The one exception is to have someone clean out bulging disk that has direct nerve impingement. But make sure it is ONLY to clean out the bit of disk that is impinging on the nerve. No structural changes, no taking out the entire disk, no fusions, Just a straightforward microdiscectomy.

2. Go get a second opinion, from a neurosurgeon. Orthopedic surgeons are great. But, no offense to anyone here, I would never let an orthopod work on my back. Even for something as straightforward as a microdiscectomy. I am sure there are good orthopods doing backs. Guys that do nothing but spine, all day long. I still would go to a neurosurgeon.

So, if you've exhausted all of the other possibilities, and are still suffering, then get the surgery. And then, work like a demon to do every physical thing: PT, core strengthening, flexibility and stretching, etc. to make sure the problem doesn't come back.
Great advice and we are thinking of a 2nd opinion. Didn't even consider a neurosurgeon. Will look into this
 

NutterButter

Footballguy
Prostetic's advice is spot on.

Definitely try injections. Surgery is surgery and should be a last resort. Injections are straightforward and in and out within an hour at least for the 2 I had a couple of years back. Although, my mom and girlfriend both had to get put under for theirs so I don't know what that's about.
 

The General

Footballguy
Nothing to offer that hasn‘t been said other than backs are delicate flowers and the worst injuries. Once an injury happens there you wonder how they ever work properly. They come out of no where with no warnings and I wish your daughter the best.

Multiple docs opinions is what I would go with and accept that it’s something to work on for rest of life. Not a bad thing just something to be aware of and work on.
 

Kanil

Footballguy
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making
I've found I really trust my PT folks. They are the ones that really see the aftermath of these types of things and they know what it takes to get back. I'd go with the surgery.
 

fatness

against the grain
I had spinal surgery in mid-August, after 3 years of having no innate sense of balance and 6 months of losing feeling in my legs. Finally gave up on the various PT being of any help, saw my neurologist, got an MRI, and my neurologist said I had to see a neurosurgeon which I did. I had 2 disks squeezing my spinal cord and parts of 3 vertebrae squeezing it as well. Looking at the MRI I'm not quite sure how I was able to walk at all, the spinal cord was so squashed. I was far, far worse than your daughter is and I'm far older. No injection or laproscopic surgery was going to help me, so I got cut open August 18 and am in my 12th week of recovery. Spacers were put in between my vertebrae, parts of 3 vertebrae were trimmed of, and the L4/L5/S1 were fused together with rods and stuff.

My understanding of the shot your daughter would be getting is that it may not fix anything, just make things more bearable for her at least for awhile, whereas the surgery would actually fix it. I strongly suggest talking to a neurosurgeon about it, so you and she can make the most educated decision you possibly can. I felt lost until I talked to my neurosurgeon, and after that I had a pretty clear picture of what to do.

edited to add: I now have full feeling in both legs, can walk with normal steps again instead of dragging a leg, and most of my sense of balance is back.
 
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SWC

Bromigo
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making
if your talkin surgeries odds are i have had it as a matter of fact last december i had a laminectomy and discectomy at l5s1 due to left leg pain numbness and tingling and it was immediate pain relief before that i had two injections and they did ok but wore off just sort of temporary if i had it to do again i would save myself the delay and cost of the injections my thing is that my whole back except l34 is messed up like a full paragraph at every level on the mri except l34 and now i need another surgery at l45 which i guess is not too uncommon that once one level is cleaned up another gets bad adjacent to it so read up on that but anyhow this has been my experience and i am sorry your daughter has this so young to deal with take that to the bank bromigo
 

BigJohn

Footballguy
I had the same surgery, on the same disc, at the same age as your daughter...:oldunsure:

Went through 2 years of PT. Aggravated it washing my face off after shaving. Lost all feeling in my right thigh. I'd get shooting pain down the outside of my right calf.

Best decision of my life. I'm 44 now and have had very few problems since.

At the end of the day, injections are still temporary.
 

b-snatchers

Footballguy
Thanks all for the great advice! It is greatly appreciated!
I think she is leaning towards the surgery. She has been pretty much been told that surgery is probably inevitable and the pain she is going through right now, she doesn't want to be delayed by the injection especially if it doesn't work or is only temporary
The one thing that I see here is that some recommend a neurosurgeon but she has an orthopedic dr that specializes in spine surgery. Just wondering if we should see an neurosurgeon too?
 

fatness

against the grain
I'd see a spinal neurosurgeon as well, just for another professional opinion on what the problem is and what the best solution is, and to bounce questions off of. As for which doctor performs the surgery, that's obviously your daughter's choice. I'm not sure the type of spinal surgeon matters as much as the quality of the doctor. You can get a pretty good idea of the quality of the doctor from physical therapists, primary care physicians, etc.
 

Mrs. Rannous

Footballguy
I'd see a spinal neurosurgeon as well, just for another professional opinion on what the problem is and what the best solution is, and to bounce questions off of. As for which doctor performs the surgery, that's obviously your daughter's choice. I'm not sure the type of spinal surgeon matters as much as the quality of the doctor. You can get a pretty good idea of the quality of the doctor from physical therapists, primary care physicians, etc.
I agree. A second opinion at this point helps. Not so much after the surgery.
 

Terminalxylem

Footballguy
It’s a tough call. In general, I fall in line with others who recommend delaying spine surgery as long as possible. From what I understand, surgery alleviates symptoms more quickly than conservative treatment, but with added risk incurred by the procedure. At 1-2 years out, outcomes are virtually the same between surgical and non-surgical management. While she won’t regrow a new disk, the body can heal/remodel herniated disks to some extent, and strengthened core/paraspinal musculature can protect her from reinjury.

I think PT are biased to recommend surgery by the better early results, while clinicians who care for patients with bad surgical outcomes prefer to minimize the risks. And surgeons are trained to operate, so they prefer to cut when given a chance. Just realize the medical literature in nowhere near conclusive on the correct plan of action, and there probably isn’t a one-size-fits-all approach.

Pain alone isn’t generally an indication to operate, but severe numbness might be. Weakness is a much more concerning finding, which tips the scales in favor of surgery. If she chooses to go through with the procedure, just make sure it’s performed by a mid-career surgeon with plenty of experience with microdiscectomies. Although I might err on choosing a neurosurgeon, a cursory literature review shows outcomes between neurosurg and ortho-spine are comparable.

Lastly, make sure your daughter does her part to optimize the chance for success. She needs to follow the PT advice/exercise/stretch religiously, optimize her posture, maintain a healthy weight and not smoke. Good luck.
 

fatness

against the grain
Lastly, make sure your daughter does her part to optimize the chance for success. She needs to follow the PT advice/exercise/stretch religiously, optimize her posture, maintain a healthy weight and not smoke. Good luck.
And, since there's likely a wait before surgery would happen, PT may help prior to surgery to strengthen the areas that will be affected during and after the surgery. Go in stronger, come out stronger.
 

GordonGekko

Footballguy
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making


I don't know all the logistics, but I'd say get the surgery now. Don't wait.

She has insurance now, will that be true in X amount of time from now? Will it be the same insurance? Worse? Better?

The dynamics of our current health care system is going to undergo some massive changes soon. Not tomorrow, but within the practical timeline of your daughter's situation. Don't allow her to get squeezed between the sides when the bureaucratic mess of it all spills over. If the world and our country were in a different timeline, I'd say something different.

But everyone here, for you and your kids, if you've been delaying something in terms of your health care that you can take care of today, and you have the insurance for it, then do it as soon as possible. If she waits, her options could narrow. Some subjects I won't and can't get into because this is the FFA.

Everyone here should operate in a manner to put the odds in their favor. Exercise regularly. Stay active. Work on your flexibility/mobility. Take care of your teeth. Eat better. All that stuff adds up. Don't assume the "system" you've relied on will always be there tomorrow or a year from now or a couple of years from now.

Good luck
 

Terminalxylem

Footballguy
While I agree our current system is a mess, and potentially the quality of care may decrease in the near future, those factors really shouldn’t influence timing of an elective procedure for a young adult. Not only does that strategy ignore the possibility that access to care improves over the long term, it negates any technological advancements on the horizon.
 

fatness

against the grain
She has insurance now, will that be true in X amount of time from now? Will it be the same insurance? Worse? Better?

The dynamics of our current health care system is going to undergo some massive changes soon. Not tomorrow, but within the practical timeline of your daughter's situation. Don't allow her to get squeezed between the sides when the bureaucratic mess of it all spills over. If the world and our country were in a different timeline, I'd say something different.

But everyone here, for you and your kids, if you've been delaying something in terms of your health care that you can take care of today, and you have the insurance for it, then do it as soon as possible. If she waits, her options could narrow. Some subjects I won't and can't get into because this is the FFA.

Everyone here should operate in a manner to put the odds in their favor. Exercise regularly. Stay active. Work on your flexibility/mobility. Take care of your teeth. Eat better. All that stuff adds up. Don't assume the "system" you've relied on will always be there tomorrow or a year from now or a couple of years from now.
You're really good at doom. Kudos.

He asked pretty specific questions which you ignored. Stop inflating yourself.
 

Kal El

Footballguy
I had a herniated disc in the same exact spot, and it hurt for 2 years before I was able to walk without any pain. I avoided surgery, but I did get the injections, and they helped temporarily.
 

GordonGekko

Footballguy
She has insurance now, will that be true in X amount of time from now? Will it be the same insurance? Worse? Better?
You're really good at doom. Kudos.

He asked pretty specific questions which you ignored. Stop inflating yourself.











Patients in pain as omicron wave leads to surgery delays: ‘It’s a bona fide mess right now’: Coronavirus cases and staff shortages force hospitals to close beds

The omicron surge has exacerbated a national health-care staffing crisis, forcing medical workers with coronavirus infections to isolate (even those without symptoms) and hospitals to close beds. The staff shortages and bed closures in turn are forcing hospitals to cancel surgeries that require overnight stays. For procedures to alleviate pain or correct non-life-threatening conditions, postponements have become routine....

...But infections from and exposures to the omicron variant require vaccinated staff members to stay home for days, even if they exhibit no symptoms....Those absences on the front line — already under strain from the high number of unvaccinated patients who have fallen ill — are compounding the effect of longer-term staff shortages caused by pandemic-related burnout and attrition....

.....Doctors said in interviews that calling patients to advise them their surgeries are being postponed has been among their hardest tasks during the pandemic. Hospitals, doctors and administrators have been learning over the past two years how to triage surgical cases to manage increasing infections and resource shortages.They said the term “elective surgery” can be misunderstood by the public to mean something like cosmetic surgery when it applies to a broad range of critical procedures....If a patient is not an urgent case and delaying a procedures does not put them at risk of dying or getting sicker, then their surgeries may safely be postponed. Still, doctors said, they anguish about prolonging suffering....


By Christopher Rowland January 21, 2022

https://www.washingtonpost.com/business/2022/01/20/surgery-postponed-delayed-covid-hospitals/



*********


"My 25 year old daughter has a herniated disc.....Insurance finally allowed her to have an MRI"



The OP's daughter is 25. He certainly doesn't need to doxx himself, but is she still on his insurance? If she's out in the workforce, how stable if her current job/career right now? How easy is the pathway for her to potentially be laid off? What is the pathway for her to get another job with good insurance if that happens?

The entire American health care system took and is still taking a massive hit from the pandemic. You could plan for and decide for surgery today and have to wait. And wait. And wait. That's happening right now to lots of people.

Will another pandemic hit? What will be the state of hospitals in 6 months? Will America go to war? ( I'll lean into that area just for second, to point out that there are a lot of reservists in emergency services and health care, which will sap the already thinned ranks of police officers, law enforcement personnel, paramedics and yes even doctors and nurses) Under the Health Care Personnel Delivery System, which is federal law, you could have a two to three week process system where already trained and established civilian doctors and nurses are essentially "drafted" into compulsory war time service. That's exactly as far I will go on that part of the subject.

This decision tragically goes beyond just one person's personal decision, this extends now into the entire state and perceived stability of our entire health care system. The options for surgery you get today might not the same ones you get in 6 months, a year, or two years from now.

I did not just advise this for the OP, I advised it for everyone. If there's some issue that people have been delaying with their health care, then just go get it done. Do it for yourself, do it so you can be in the best position to provide for and protect your family and dependents.

The entire American health care system is under heavy load and strain and has been for a very long time. The pandemic hyper accelerated many issues in that regard. There are clear fracture points emerging that can no longer be denied. These issues trickle down to every day people like the OP's daughter.

I answered the OP now, twice, and here's my question for all of you -

If his daughter or any of your daughters need major surgery and their options start to dramatically dwindle to the point of impossibility, based on the larger scale issues in the current health care system, what are you going to do if you were the one to advise your child to wait?
 
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Da Guru

Fair & Balanced
I had L5 surgery when I was 24. I was working out all the time with very heavy weights and when I was 22 by back started bothering me. The last 6-7 motnhs I would not take it anymore. Could not get in and out of a car, the pain going down my leg was intolerable as well. If I coughed or sneezed it was unbearable. Finally had the surgery. The pain was gone almost right away, just had to recover from surgery. I had surgery on Good Friday and played baseball and was working out again that summer.

The choice to be made is the pain so bad it is ruining and taking the enjoyment of her life? With me it was as I was miserable.
 

Terminalxylem

Footballguy

I answered the OP now, twice, and here's my question for all of you -

If his daughter or any of your daughters need major surgery and their options start to dramatically dwindle to the point of impossibility, based on the larger scale issues in the current health care system, what are you going to do if you were the one to advise your child to wait?
The OP’s daughter doesn’t definitely need surgery, and the alternative involves the passage of time, for healing to occur. Plus, there’s additional risk incurred from the operation itself, which exceeds that of epidural steroid injections and physical therapy.

I agree our healthcare system is a mess, but the availability of spine surgery isn’t going to evaporate overnight. Moreover, there’s a good chance technology improves over the course of her lifetime, as it’s not even clear current procedures outperform conservative treatment in the long term.

While I believe both are very low probability, I think the likelihood of a bad surgical outcome far exceeds healthcare becoming inaccessible in the near future. What would you tell his daughter if she rushed to surgery, only to have the same or worse pain postoperatively? What if she develops a surgical site infection, deep venous thrombosis, nerve damage, etc.?

Reread the original post. The orthopedist seems like he’s on the fence to perform a bread-and-butter procedure on a low risk patient. Why do you think the surgeon isn’t rushing her to the OR?
 

GordonGekko

Footballguy

I answered the OP now, twice, and here's my question for all of you -

If his daughter or any of your daughters need major surgery and their options start to dramatically dwindle to the point of impossibility, based on the larger scale issues in the current health care system, what are you going to do if you were the one to advise your child to wait?
The OP’s daughter doesn’t definitely need surgery, and the alternative involves the passage of time, for healing to occur. Plus, there’s additional risk incurred from the operation itself, which exceeds that of epidural steroid injections and physical therapy.

I agree our healthcare system is a mess, but the availability of spine surgery isn’t going to evaporate overnight. Moreover, there’s a good chance technology improves over the course of her lifetime, as it’s not even clear current procedures outperform conservative treatment in the long term.

While I believe both are very low probability, I think the likelihood of a bad surgical outcome far exceeds healthcare becoming inaccessible in the near future. What would you tell his daughter if she rushed to surgery, only to have the same or worse pain postoperatively? What if she develops a surgical site infection, deep venous thrombosis, nerve damage, etc.?

Reread the original post. The orthopedist seems like he’s on the fence to perform a bread-and-butter procedure on a low risk patient. Why do you think the surgeon isn’t rushing her to the OR?


https://forums.footballguys.com/thr...ts-on-vaccination-a-poll.797962/post-23583824

Sep 13, 2021

"Well, my 550 bed hospital has been operating at or over-capacity for weeks. Both ICU and regular bed occupancy was >100% on Friday, the last day theses tallies were available. But that’s not the point of the article. Do you think it’s reasonable to check 40+ hospitals in a three state area to find an ICU bed?"



https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23771692

Dec 19, 2021

"Hospitals are full many places already. .....So we really can’t afford an uptick in hospitalizations at all."



https://forums.footballguys.com/threads/government-response-to-the-coronavirus.783982/post-23576359

Sep 10, 2021

"....None of those problems is readily remedied. Nurses are being brought in from around the country, doctors not trained in critical care are being asked to manage ICU patients, elective procedures have been cancelled and we are restricting oxygen use in the meantime. Our hospital has never operated this way - none of this is routine.

The cause: Too many covid patients in a profit-minded healthcare system.

The best fix:.... Long term, we need major healthcare overhaul."




https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-24117904

Jul 21, 2022

"This all applies to US hospitals as well. Our broken healthcare system was badly exposed by the pandemic."



https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23939278

Mar 18, 2022

"....there is a point where hospitals are so overwhelmed that healthcare infrastructure fails. When that happens, bad outcomes, including death occur more frequently than would be expected based on disease severity alone."



https://forums.footballguys.com/threads/official-covid-19-coronavirus-thread.783421/post-23819256

Jan 13, 2022

"A lot of people feel this way, but it's hard to come to that conclusion when our hospitals are floundering..... Moreover, there will be scores of survivors with permanent debility, plus long-term consequences to healthcare workers, if we continue to push them to the brink."



https://forums.footballguys.com/threads/i’m-back-new-and-improved.799809/post-23565792

Sep 5, 2021

"The staffing shortages result directly from healthcare workers being burnt out from taking care of covid patients. And the sustained volume of hospitalized patients, particularly those requiring ICU level of care, is unprecedented."



https://forums.footballguys.com/threads/official-covid-19-coronavirus-thread.783421/post-23772491

Dec 19, 2021

"I’d like to know which hospitals aren’t already full. Locally, it’s been a sh!t show for the last month or so, almost all non-Covid.

Any bump in hospitalizations is gonna hurt."




https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23939297

Mar 18, 2022

"Even locally, I’ve seen really unprecedented straying from standards of care during peak hospital caseloads."



https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23939363

Mar 18, 2022

"Overwhelmed hospitals are a b!tch."



https://forums.footballguys.com/threads/government-response-to-the-coronavirus.783982/post-23632293

Oct 7, 2021

"I know there’s a small subset of people who believe hospitals operate on surge status for months on end, divert patients hundreds of miles away, refuse transfers, cancel elective procedures, etc., but surely most of us recognize what hospitals are going through is unprecedented?!?"


*********


I would tell the OP's daughter that you were a seasoned heavily experienced front line health care worker who saw the brunt of the pandemic on a daily basis.

And to measure ALL your words on the state of the overall American health care system over time.

Your words. Not mine. Again, these are your words on the state of our health care system. And how fragile it has become and the negative fallout that has followed. I've added links so people can back-trace the context if they wish, but nothing you've said here is overtly political, it's generally a birds eye view of the front lines of the "new normal" in the health care industry.

You have your viewpoint. I have mine. My viewpoint remains the same, the fracture points are growing in the American health care system. Some of the best surgical options for the OP's daughter might leave the health care profession if she waits a year. Even if she waits 6 months. Your viewpoint is entirely reliant on the stability of the known current health care system. And in your own words, how "stable" does any of that sound?

Tragically, post operative risks, complications and negative fallout are NOT the only threat points to the OP's daughter's overall health profile. I'd tell him to error on the side of caution against the ENTIRE backdrop, not just his daughter's individual situation. If this was 10 years ago, maybe my response would be different. I wish the OP and his daughter only the best.
 

Terminalxylem

Footballguy

I answered the OP now, twice, and here's my question for all of you -

If his daughter or any of your daughters need major surgery and their options start to dramatically dwindle to the point of impossibility, based on the larger scale issues in the current health care system, what are you going to do if you were the one to advise your child to wait?
The OP’s daughter doesn’t definitely need surgery, and the alternative involves the passage of time, for healing to occur. Plus, there’s additional risk incurred from the operation itself, which exceeds that of epidural steroid injections and physical therapy.

I agree our healthcare system is a mess, but the availability of spine surgery isn’t going to evaporate overnight. Moreover, there’s a good chance technology improves over the course of her lifetime, as it’s not even clear current procedures outperform conservative treatment in the long term.

While I believe both are very low probability, I think the likelihood of a bad surgical outcome far exceeds healthcare becoming inaccessible in the near future. What would you tell his daughter if she rushed to surgery, only to have the same or worse pain postoperatively? What if she develops a surgical site infection, deep venous thrombosis, nerve damage, etc.?

Reread the original post. The orthopedist seems like he’s on the fence to perform a bread-and-butter procedure on a low risk patient. Why do you think the surgeon isn’t rushing her to the OR?


https://forums.footballguys.com/thr...ts-on-vaccination-a-poll.797962/post-23583824

Sep 13, 2021

"Well, my 550 bed hospital has been operating at or over-capacity for weeks. Both ICU and regular bed occupancy was >100% on Friday, the last day theses tallies were available. But that’s not the point of the article. Do you think it’s reasonable to check 40+ hospitals in a three state area to find an ICU bed?"



https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23771692

Dec 19, 2021

"Hospitals are full many places already. .....So we really can’t afford an uptick in hospitalizations at all."



https://forums.footballguys.com/threads/government-response-to-the-coronavirus.783982/post-23576359

Sep 10, 2021

"....None of those problems is readily remedied. Nurses are being brought in from around the country, doctors not trained in critical care are being asked to manage ICU patients, elective procedures have been cancelled and we are restricting oxygen use in the meantime. Our hospital has never operated this way - none of this is routine.

The cause: Too many covid patients in a profit-minded healthcare system.

The best fix:.... Long term, we need major healthcare overhaul."




https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-24117904

Jul 21, 2022

"This all applies to US hospitals as well. Our broken healthcare system was badly exposed by the pandemic."



https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23939278

Mar 18, 2022

"....there is a point where hospitals are so overwhelmed that healthcare infrastructure fails. When that happens, bad outcomes, including death occur more frequently than would be expected based on disease severity alone."



https://forums.footballguys.com/threads/official-covid-19-coronavirus-thread.783421/post-23819256

Jan 13, 2022

"A lot of people feel this way, but it's hard to come to that conclusion when our hospitals are floundering..... Moreover, there will be scores of survivors with permanent debility, plus long-term consequences to healthcare workers, if we continue to push them to the brink."



https://forums.footballguys.com/threads/i’m-back-new-and-improved.799809/post-23565792

Sep 5, 2021

"The staffing shortages result directly from healthcare workers being burnt out from taking care of covid patients. And the sustained volume of hospitalized patients, particularly those requiring ICU level of care, is unprecedented."



https://forums.footballguys.com/threads/official-covid-19-coronavirus-thread.783421/post-23772491

Dec 19, 2021

"I’d like to know which hospitals aren’t already full. Locally, it’s been a sh!t show for the last month or so, almost all non-Covid.

Any bump in hospitalizations is gonna hurt."




https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23939297

Mar 18, 2022

"Even locally, I’ve seen really unprecedented straying from standards of care during peak hospital caseloads."



https://forums.footballguys.com/thr...s-discussion-on-severity.802008/post-23939363

Mar 18, 2022

"Overwhelmed hospitals are a b!tch."



https://forums.footballguys.com/threads/government-response-to-the-coronavirus.783982/post-23632293

Oct 7, 2021

"I know there’s a small subset of people who believe hospitals operate on surge status for months on end, divert patients hundreds of miles away, refuse transfers, cancel elective procedures, etc., but surely most of us recognize what hospitals are going through is unprecedented?!?"


*********


I would tell the OP's daughter that you were a seasoned heavily experienced front line health care worker who saw the brunt of the pandemic on a daily basis.

And to measure ALL your words on the state of the overall American health care system over time.

Your words. Not mine. Again, these are your words on the state of our health care system. And how fragile it has become and the negative fallout that has followed. I've added links so people can back-trace the context if they wish, but nothing you've said here is overtly political, it's generally a birds eye view of the front lines of the "new normal" in the health care industry.

You have your viewpoint. I have mine. My viewpoint remains the same, the fracture points are growing in the American health care system. Some of the best surgical options for the OP's daughter might leave the health care profession if she waits a year. Even if she waits 6 months. Your viewpoint is entirely reliant on the stability of the known current health care system. And in your own words, how "stable" does any of that sound?

Tragically, post operative risks, complications and negative fallout are NOT the only threat points to the OP's daughter's overall health profile. I'd tell him to error on the side of caution against the ENTIRE backdrop, not just his daughter's individual situation. If this was 10 years ago, maybe my response would be different. I wish the OP and his daughter only the best.
As I've said repeatedly, our healthcare system is broken. But posts made in the midst of covid surges do not translate to elective procedures being unobtainable in the foreseeable future. Fortunately, the numbers are down, with covid-related hospitalizations near their nadir since the pandemic began.

And lucrative subspecialties like spine surgery are hardly the medical disciplines most impacted by the pandemic, or our for-profit system, for that matter.

But you're completely missing my point. It isn't clear the OPs daughter needs surgery, period. Future pandemics and crumbling health infrastructure don't change the reality of lumbar disc disease: surgery is generally reserved for the most severe cases, after medical therapy fails. Even then, there's no guarantee it will outperform non-surgical management. From the OPs original description, his daughter hasn't exhausted her medical options, so avoiding surgery is the path of caution.
 

Terminalxylem

Footballguy
surgery is generally reserved for the most severe cases, after medical therapy fails. Even then, there's no guarantee it will outperform non-surgical management. From the OPs original description, his daughter hasn't exhausted her medical options, so avoiding surgery is the path of caution.
I have a lot of respect for you posts on COVID and other medical matters. I don't think a statistics-based approach matters much in an individual case. OP isn't asking about what would help the most people out of a group of 10,000. He's asking about his daughter, who is getting worse despite physical therapy --- "PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness."

Statistics also don't help in an individual case to determine if an injection will help resolve the problem, or will make the problem tolerable while it stays in its present state, or whether it will mask the fact that the problem is getting worse. It's one person. The risk of non-surgery is that things will just continue to get worse for her.
I realize group statistics may not apply to every individual, but evidence-based medicine is the best way I know to objectively predict outcomes. I've also acknowledged the uncertainty regarding our understanding of lumbar disc disease, and will add we don't have all the information necessary to answer the OPs question. Specifically, we don't know what his daughter has used to manage her pain, how long she's done PT, how compliant she is, and other medical history including anesthesia tolerance, etc. But the doctor privy to all this information isn't exactly insisting she proceed to the OR, despite being his area of expertise, with financial incentive to do so.

Statistics can tell us the likelihood her symptoms will improve with time, which generally speaking, is higher for a young, otherwise healthy person. And analgesics won't mask the problem getting worse in a clinically meaningful way (nerve damage). To be fair, epidural steroid injections aren't risk-free, nor are pain meds, but their downside is far less than a botched operation.

Sometimes in the rush to "do something" we underestimate our body's ability to heal, as well as the potential for harm we're introducing through our actions. That's why I said it's a tough decision in my first post. In contrast to people who've had good luck with surgical outcomes, I've seen the other side of the coin, and it ain't pretty. Moreover, I have personal experience with a herniated lumbar disk (the same disc, actually), which has only flared up a couple times in 20+ years since the initial injury. So it's not a foregone conclusion things will get worse if she doesn't pursue surgery.

All that said, I wasn't trying to convince the OP to avoid surgery altogether. I think his daughter will be fine either path they choose. But if it were my loved one, I'd make sure all medical options were exhausted before going under the knife, largely because the data don't conclusively show surgery is better in the long-term. And I certainly wouldn't rush the procedure, for fear of our healthcare system collapsing.
 

Judge Smails

Footballguy
And back surgery should be an absolute last resort. When I had horrific sciatica and couldn't walk 10 steps for months I thought I absolutely needed surgery. Doc at UCLA, whom I greatly appreciate, said no way. Said give it time, let the inflammation come down, get another epidural, do PT, etc. Said I wasn't a candidate for surgery. Scary stuff can happen when you get cut...
 

b-snatchers

Footballguy
So my daughter heard back from the Dr and she is scheduled for a microdiscectomy on the 12 of December. I was happy that it wasn't scheduled too far out so hopefully gets relief soon! Thanks for all of the advice.

One question I had. We are planning on traveling for a week of 1/15/23. Not sure if she would be well enough to make the trip. The plane ride is about 4 hrs. Any thoughts?
 

ProstheticRGK

Footballguy
So my daughter heard back from the Dr and she is scheduled for a microdiscectomy on the 12 of December. I was happy that it wasn't scheduled too far out so hopefully gets relief soon! Thanks for all of the advice.

One question I had. We are planning on traveling for a week of 1/15/23. Not sure if she would be well enough to make the trip. The plane ride is about 4 hrs. Any thoughts?
I would imagine, barring unforeseen complications, she will be better able to tolerate a 4 hour plane ride. A month is plenty of rehab time for a minimally invasive procedure. Unless the procedure is completely unsuccessful (low chance) she will already be feeling a lot of relief from the nerve impingement.

Encourage her to take the PT process seriously. I remember being 20 years old, and having no concept of my own mortality, or how my body would age. She needs to develop a daily routine for flexibility and core strength to protect her back and keep this from being a serious issue in her 40's-50's. She is not going to see the utility in that in her 20's. Convince her.
 

Galileo

Footballguy
I don't have much in the way of suggestions, but we are going through the same thing. My 18 yr old has 3 herniated discs. She has been doing PT for a while now, but it hasn't helped much. She is in her freshman year of college and it has been fairly hellish...difficulty sleeping, difficulty getting around campus, etc.. I really think she will need surgery, but we are running through the alternatives now. She is scheduled to get a shot next Wednesday when she comes home for Thanksgiving. I hope it brings her some relief and at least buys us some time to get through the school year and explore the possibility of surgery in the summer.
We are a week removed from my daughter getting the spinal injections...was 2 injections that she described as absolutely miserable to get. They appear to be helping a little, but not sure if enough. She is still getting numbness in her leg and discomfort when walking/standing, but she can walk further and stand longer than she could before the shots. So there seems to be some positive gain. I hoping that the PT can be more effective now since she can tolerate a little more activity.
 

fatness

against the grain
One question I had. We are planning on traveling for a week of 1/15/23. Not sure if she would be well enough to make the trip. The plane ride is about 4 hrs. Any thoughts?
I don't have an answer, but there are 2 things to consider.
1. Will sitting 4 hours in the same position in the same seat cause any physical harm to the area operated on?
2. Pain management.
 

b-snatchers

Footballguy
So my daughter heard back from the Dr and she is scheduled for a microdiscectomy on the 12 of December. I was happy that it wasn't scheduled too far out so hopefully gets relief soon! Thanks for all of the advice.

One question I had. We are planning on traveling for a week of 1/15/23. Not sure if she would be well enough to make the trip. The plane ride is about 4 hrs. Any thoughts?
I would imagine, barring unforeseen complications, she will be better able to tolerate a 4 hour plane ride. A month is plenty of rehab time for a minimally invasive procedure. Unless the procedure is completely unsuccessful (low chance) she will already be feeling a lot of relief from the nerve impingement.

Encourage her to take the PT process seriously. I remember being 20 years old, and having no concept of my own mortality, or how my body would age. She needs to develop a daily routine for flexibility and core strength to protect her back and keep this from being a serious issue in her 40's-50's. She is not going to see the utility in that in her 20's. Convince her.
All makes sense. Thanks for the advice!
 

b-snatchers

Footballguy
I don't have much in the way of suggestions, but we are going through the same thing. My 18 yr old has 3 herniated discs. She has been doing PT for a while now, but it hasn't helped much. She is in her freshman year of college and it has been fairly hellish...difficulty sleeping, difficulty getting around campus, etc.. I really think she will need surgery, but we are running through the alternatives now. She is scheduled to get a shot next Wednesday when she comes home for Thanksgiving. I hope it brings her some relief and at least buys us some time to get through the school year and explore the possibility of surgery in the summer.
We are a week removed from my daughter getting the spinal injections...was 2 injections that she described as absolutely miserable to get. They appear to be helping a little, but not sure if enough. She is still getting numbness in her leg and discomfort when walking/standing, but she can walk further and stand longer than she could before the shots. So there seems to be some positive gain. I hoping that the PT can be more effective now since she can tolerate a little more activity.
Sorry to hear about your daughter - hope she finds relief soon! I hope that PT helps her as well.
 

Terminalxylem

Footballguy
So my daughter heard back from the Dr and she is scheduled for a microdiscectomy on the 12 of December. I was happy that it wasn't scheduled too far out so hopefully gets relief soon! Thanks for all of the advice.

One question I had. We are planning on traveling for a week of 1/15/23. Not sure if she would be well enough to make the trip. The plane ride is about 4 hrs. Any thoughts?
I would imagine, barring unforeseen complications, she will be better able to tolerate a 4 hour plane ride. A month is plenty of rehab time for a minimally invasive procedure. Unless the procedure is completely unsuccessful (low chance) she will already be feeling a lot of relief from the nerve impingement.

Encourage her to take the PT process seriously. I remember being 20 years old, and having no concept of my own mortality, or how my body would age. She needs to develop a daily routine for flexibility and core strength to protect her back and keep this from being a serious issue in her 40's-50's. She is not going to see the utility in that in her 20's. Convince her.
Agree on all counts. Too many people expect surgery + meds to solve their problems quickly, and shirk personal responsibility in the rehabilitation process. Maintaining her spine health will need to be a lifetime commitment.
 
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making
i have a cervical issue, so i can’t speak for lumbar nor sacral? but several years ago i began to suffer from what i thought i was a torn rotator cuff in the left shoulder…..moved on to 5 months of sleepless nights and the worst discomfort i ever had. mri finally showed that c-5-7 had bone spurs pushing on the nerves. met with a surgeon and he suggested epidural. once you operate on the back, it just is never 100% again and while shots aren’t a cure, they can alleviate symptoms and get you back to living. took me 2 shots about 2-3 months apart and some smart living to feel better. but seems i have avoided the knife.

my point is, it can’t hurt to try the shots, cause it’s a lot less intrusive than the knife. if it doesn’t help or helps and fails later, you can always get the surgery.
 

flapgreen

Footballguy
I'm sorry I missed this thread earlier, but I've worked with countless backs and dug through research on this topic for years and could show you study after study that shows the majority of herniated disc problems resolve on their own eventually and usually have worse outcomes with surgery over the long-term. Looks like she is already scheduled for the procedure. Best of luck.
 

Orange&Blue

Footballguy
Hi,
My 25 year old daughter has a herniated disc. Not sure how it developed but she has been having some back issues for some time. PT didn't really help her and she tweaked her back again lifting something pretty light and then developed leg pain and numbness.

Insurance finally allowed her to have an MRI and here are the results: Large central/paracentral disc extrusion at L5-S1 with effacement of the left lateral recess and mass effect on the left S1 nerve. Disc also contacts the right S1 nerve without mass effect.

She finally saw a orthopedic doctor who looked at her MRI and left it up to her whether she wanted to do an injection or surgery (microdiscectomy). I was hoping he would offer her some better advice, but left the decision up to her. Both her PTs recommended surgery.

Just looking for suggestions from people on this board. Maybe you had the operation? And advice would be appreciated. Not really sure what option she will be making

I wouldn't see an orthopedic for a back issue. Give me a neurosurgeon please.

Also, I would avoid surgery at all possible costs.

I had three herniated disks (11m, 9mm, and 7mm) displacement. It sucked for two years and i got addicted to codine, another story, but my neurologist pushed me to avoid surgery. Being 30 at the time, he said no matter how successful the surgery was I would have issues later on in life and this wouldn't be the first surgery. So, I did PT for three years, got regular steroid shots, pain blockers, and got addicted to codine, but eventually it healed itself and my back rarely bothers me.

I know everyone is different, but I had a coworker have the same issue and he had surgery. It didn't work and led to more surgery and eventually he had to fuse his back. He is in constant pain and hating life.
 
Last edited:

Orange&Blue

Footballguy
So my daughter heard back from the Dr and she is scheduled for a microdiscectomy on the 12 of December. I was happy that it wasn't scheduled too far out so hopefully gets relief soon! Thanks for all of the advice.

One question I had. We are planning on traveling for a week of 1/15/23. Not sure if she would be well enough to make the trip. The plane ride is about 4 hrs. Any thoughts?

Make sure she gets and isle seat so she can move her legs and walk around.
 

b-snatchers

Footballguy
So my daughter had her microdiscectomy surgery yesterday and everything went well!

She seemed fine last night as I am sure the anesthesia and medication was still in her system.

Hoping she wakes up in little or no pain

She does say she has numbness still in her leg but I think that may take a while. Is that true?

Any tips that you can share?

Thanks!
 

fatness

against the grain
She does say she has numbness still in her leg but I think that may take a while. Is that true?
I was told before and after my surgery that relief could be instantaneous or could gradually occur within up to 6 months, depending on how badly the spinal cord was damaged and how long it took to repair itself. Glad her surgery went well.
 

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