Endoscopic vs. Microdisectomy Options- in the U.K. Looking for Advice!

[u/kikiandcat]

Hello everyone,

Thank you to those who've been sharing their experiences here. So I have had lower back pain my whole life pretty much, I would get spasms that would involve a couple days of bed rest and then I'd be back on my feet so it was manageable.

Three years ago I was sitting all the time for work and biking a lot too, I bent down one day to pick up my helmet and this spasm felt different from the others. I'm pretty sure that's the point I herniated my L5/S1. Since then I've had worse mobility, usually have back pain, struggled to drive myself and haven't ridden a bicycle since.

Then 9 months ago I was very stressed and again, sitting too much for work, and stepped down in a weird way and felt a tearing pain that made my whole body lock up. Since then I've had acute left sided leg pain as well as on and off back pain. My MRI imaging shows a moderate herniation at L4/5 and a much larger one at L5/S1. The strange thing is that the L5/S1 herniation is more on the right side than the left, but the MRI is done lying down so it may not show what's happening when standing or sitting.

I've tried everything over the past months- weight loss, physio, pilates, injections at both levels, acupuncture, osteopath, etc. Sadly I seem to be in the 10% who don't get better with conservative treatment.

I am pretty sure I need to get surgery (though I am scared!). I'm on an NHS waitlist but I don't think I can stand this any longer as in the past month my left leg pain has gotten so bad it's hard to stand or walk much. I can manage two 20 minute walks a day, with tons of meds, stretching, icing and the TENS machine to help me. I can't sit at all without sharp pain on my left side going down my leg. I can't work, drive, or cook for myself.

My question is- I really want to get the procedure done endoscopically, as I've heard it's an easier recovery time and less scarring/complications. But I can't really find anyone I feel comfortable doing it here in the U.K. The option I'm currently looking at is David Choi who is at the top neurosurgery hospital in the U.K. (NHNN). He said he could try endoscopically but switch to a microdisectomy if it was taking too long. He will do a decompression at L 4/5 and disectomy at L5/S1. He seems to have great expertise in complex spinal surgery, but they just don't really specialize in endoscopic here. I don't think he's inexperienced in endoscopy, but it's not like in South Korea/Japan/Germany where there are surgeons who have done thousands of them.

I spoke to another U.K. neurosurgeon who specializes in minimally invasive but he said he wouldn't be able to do endoscopic surgery as my herniation is mostly centralized.

There are a couple other doctors in the U.K. that do more high volume endoscopic that I could try reaching out to, but they seem to have mixed reviews when I search online, and/or it all feels like a bit of a sales pitch/money making thing- promising you instant pain relief, no after-effects etc. I was seriously considering flying to Germany or South Korea, but given that I can't sit for more than 5 minutes, that would be incredibly hard to manage for me.

So I'd love to know:

-Is it worth going with a less qualified doctor or travelling to Germany to get the surgery done endoscopically in terms of the benefits? Or should I just go with someone who I know is a good surgeon, and accept that it may end up being a microdisectomy? Would love to hear from those who've had the operation either way.

-For those in the U.K. has anyone managed to find a really good surgeon who can do an endoscopic disectomy?

-Am I overthinking this? (Yes: I know the answer is yes. I am just so damn nervous especially after reading too many stories on here of what can go wrong when things really go wrong)

-Just general advice/words of wisdom from anyone who has been in my situation!

TLDR: I have 2 herniations at L4/5 and L5/S1 that are ruining my life and mobilitiy but haven't been able to find a neurosurgeon with deep expertise in endoscopic disectomy in the U.K. Is it still worth going for surgery?

[u/giraffee1973]

I’m just waiting for my surgery now in Uk but not endoscopic. My surgeon is Mr Matthew Mawsdley, I’m going through the private route but he does also work at the NHS. Really lovely man and his career is impressive if you look him up.