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Will surgery help in HERNIATED DISC with back and leg pain?

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Hi, I am 31 years old, I have 54 kg, 158 cm, female. I used to seat 8 hours a day on a chair in front of the computer, bending forward towards the monitor. This is the reason I started to have back pain in 2010, but only in the right side, above the buttock. It was like 2,3 fingers distance from the spine. It wasn't a severe pain.

After 5 or 6 months, seeing that the pain is constant, I saw my family doctor, who said that I'm all right without examine me. She didn't gave me any investigation, she just said that I'm young and the pain should disappear.

In time, the pain began to increase, and I felt that pain more often, specially in the morning and the afternoon while working at my desk. At that time I used to sleep only on my back with knees extended (flat) on a firm mattress.

Then I searched the internet and found that sleeping with a pillow under the knees may help, so I slept with a pillow under my knees approximately one year, until I had pain in my knees. I felt intense pain when climb down a street or even when I stand in the buses or open the doors to enter certain buildings. So, I decided to see a orthopedic surgeon who gave me some medication to decrease the inflammation and said to me to stay with the knee stretch (not bent). The diagnose was tendonitis.

He didn't know how I was sleeping, and at that point I understood that my knee pain is due to the sleeping position. And I stopped sleeping like that. I continue sleeping lay down on my back but without the pillow (the knees at 180 degree).

In several months, the knees were better, but the pain in my right side of the back was increasing. I continued working several months until I felt the same pain in my left side of the back, above the buttock, at 2,3 fingers distance from the spine. This scared me, so I decided in November 2012 to go to a private hospital. I didn't know what specialist to see, but the secretary made me an appointment at rheumatic section. I made a radiography and I had the lumbar discopathy diagnosis.

I followed the advices of the doctor, meaning making some procedure (currents - TENS, ultrasound, massage) and physical exercises. This treatment was for 3 weeks, each working day. Before this treatment I felt pain in the left part and right part above the buttock, but no pain was going down to my leg.

During and immediately after the treatment I felt that the pain is going down to my right leg, on the lateral of the leg, but not under the knee. One of the exercises that I learn there was bending forward with a stick, which each time induced pain in my back. I told the girl (physical therapist) about pain while bending forward and the answer was that is normal and that these are my exercises given by the doctor and I should continue doing them even at home each day of my life.

In July 2013 I went into the mountains and I picked up a rucksack (lift it). I continued the holiday without major problems, I had more intense back pain but only when resting in bed, not while walking. Then the first day I went to work, after 2 hours I felt numbness and thrust into the legs. In a few days I had my first MRI. I barely could walk.
I saw a neurosurgeon with my assurance who did not recommend operation, instead send me to a neurologist. There I received some medication, arcoxia, midocalm, bagagamma, neuromultivit and one month medical holiday. After one month, I saw another neurosurgeon to a private hospital and again did not recommended surgery. I could not seat on a chair, but I could walk very slowly and feeling twinge and thrust into my legs and feet. Some of the toes (the smallest ones) and the big one were in pain. I took unpaid holiday for 5 months, until I made a second MRI to see of the herniated material shrinked in dimension. With this result I made an appointment to the doctor from the private hospital and again said I still can wait. I tried to make physical therapy which put me in a worse condition. Basically they put me to bring the knees to chest one by one. After 2 day of exercises I felt more often and more intense current down the leg, so I stopped.

Seeing that the herniated material did indeed shrink in dimension and being better than I was initially I took another 5 months unpaid holiday, until 28.06.2014 when I made a third MRI. In this time, almost one year, from the first MRI until now, the only treatment was walking. At the beginning 10 minutes in the evening, then 10-15 minutes 3 times a day. Before the second MRI I could walk 50 minutes, 3 times a day. Before and after walking I lay down in my bed, for resting. This is the only effort that I made. The first 4 months I also eat standing, not seating.
Initially (July 2013):
L3-L4: AP-8mm, LL-12mm, CC-11mm;
L4-L5 AP-9mm, LL-11mm, CC-9mm,
L5-S1 AP-8mm, LL-15mm, CC-5mm.

The dimensions after 6 months was (January 2014):
L3-L4: 11mm;
L4-L5 4mm,
L5-S1 6 mm.

The dimensions after 6 months was (June 2014):
L3-L4:10 mm
L4-L5 4mm,
L5-S1 5.5 mm.

Because they did not shrink as I expected, I have 2 questions:
1. Will this material remain inside my body for ever? What chances are to continue shrinking? I read that it is not good to calcify. The writing result from MRI states that the herniated material touches my root nerves L5. I hoped that they will shrink enough such that do not touches my nerves.

2. Do I need surgery? My fear is not to damage my nerves permanently. I can walk and even seat 40-50 minutes, but I still do not work, because seating on a chair puts me in a worse condition. I would like to begin work next week with 4 hours a day instead of 8 hours per day, but I'm afraid not to damage my nerves. After I seat on a chair, I feel back pain all over the lumbar region and some sensation down to the legs even in the arch of the foot, but if I lay down in bed a half an hour and then walk 20-30 minutes, I will became better. I also can walk through toes and heels.

3. Is it true that I have to do exercises for back and abdominal muscles? Is it safe to swim on back? I would prefer to have another activity besides walking, but I'm afraid that those material can split into smallest fragments during movements.

I also bought an adjustable arm from the monitor such that I do not bend forward and an adjustable desk so I can work standing, but I also need to seat from time to time. And seating scare me.

I still have patience to wait one year and work with 4 hours a day, if I would know that I can have again a normal life, meaning walking an road hump even to climb down a heal, lift at least 2 kg. Now I cannot carry my foods from the supermarket. Of course I would enjoy be able to walk into the forest, playing basketball, swimming, riding my bicycle, but these seems impossible. I do not know if the surgery can give me this chance to have my life back.

I will upload here the last MRI but I can send on e-mail the 3 MRI in a zip folder.

Thank you.


Category: Neurosurgeon

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Category: Spine Surgeon
Dr. Goutham Cugati is online now

Expert:  Dr. Goutham Cugati replied 4 Days.

Reply by Spine Surgeon Dr. Goutham Cugati:
Hello Dear,
Thank you for such a detailed and elaborate history. And I sincerely apologise for the delay in my response.
I understand that chronic back pain can be debilitating and very difficult to cope with.
Let me answer each of your questions specifically.
1. The extruded fragments touching the nerve root, most of the time, will regress. However, they can persist or increase. If they increase, we will have to operate. About calcifications, nobody can prevent calcification of the extruded disc which can occur in few patients.
Even if these fragments persist in your body, you do not have to worry. They will not further divide into small pieces.
2. As per the MRI scan findings, you do not need a surgery.
Your MRI shows that the L5 nerve root is being touched by the disc fragments, but this still does not warrant surgery. Surgery is required only if there is nerve root compression.
3. You will have to do exercises to keep your abdomen and back strong. This is recommended and will not result in nerve damage or splitting of fragments. You need not worry about that. You should only avoid doing activities that can put strain to your back like jumping, travelling on a bad and bumpy road, skipping, squatting etc. There is no harm in walking or swimming. Make sure that while sitting for long periods, you take a break after every hour.
Although your condition might take a long time to improve, it will definitely improve. To make your recovery easier, you need good pain control and physical therapy to strengthen your back. Good pain control through more effective medication and therapy will provide good relief and improve your quality of life to a good extent. For this, you can consult a pain specialist and a physiatrist.
Feel free to ask queries.
Thank you.
---------------------------------------------------------------------------------------------------------------------------------------------------------
Hello,
Thank you for your consult at DoctorSpring.com. I am one of the In-house physicians here. Could you please upload the MRI with reports you mentioned. After you share them the consult will be assigned to a specialist.
Look forward to hear from you,
Regards


Patient replied :

Hello,
Thank you very much for this answer. It helps me a lot! I would like to ask you one more question. Did you see patients with lumbar spine disorders treated with stem cell therapy? Does it really work?
I hope that this technique will improve and that it will spread to Europe in the near future. Until now I just found this procedure available in the US.
Thank you


Expert:  Dr. Goutham Cugati replied 3 Days.

Hello. Thank you for writing to us again.
There have been quite a many studies on stem cell therapy. But they are still in experimental stage. Nothing proven with evidence. But your problem has nothing to do with stem cell therapy. You are not a candidate for this.
Feel free to discuss further,
Regards


Dr. Goutham Cugati
Category: Spine Surgeon
Experience: 
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
Dr. Goutham Cugati and 4 other Medical Specialists are ready to help you

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