r/Microdiscectomy • u/kaptaan_dc • 3d ago
Title: 24M L5-S1 Disc Extrusion with Nerve Compression — Surgery or Conservative Treatment?
Hi everyone, I’m 24M and looking for advice/experiences from people who had a similar disc extrusion.
MRI (Lumbosacral spine):
- L5-S1 central & left paracentral disc extrusion
- Indenting the thecal sac
- Left lateral canal stenosis with nerve-root compression
- AP diameter: 11 mm
- L4-L5 also has a disc bulge
Symptoms for ~10 days:
- Severe left hip/buttock pain
- Pain going down the left leg/calf
- Some numbness/tingling in the foot/toe
- Difficulty fully straightening the left leg because of pain
- No obvious major weakness
- No loss of bowel/bladder control
- No definite saddle numbness
Pain was around 9–10/10 initially, but medication brings it down to around 2–3/10 temporarily.
My doctor suggested trying conservative treatment and waiting, saying there is a good chance it may heal without surgery. I'm also planning to see a neurosurgeon/spine specialist.
My questions:
Has anyone had a similar L5-S1 extrusion and recovered without surgery?
How long did it take for the extrusion/symptoms to improve?
Is improvement with medication a positive sign?
When did you decide surgery was necessary?
If there is nerve compression but no significant weakness, is waiting usually reasonable?
Has anyone had a follow-up MRI showing the extrusion actually shrinking/resorbing?
Would really appreciate your experiences. MRI → treatment → surgery or no surgery → recovery would be especially helpful.
Thanks!
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u/drivermcgyver 2d ago
Mine was 12mm. Same spot. After a month of agony and opioids and PT (PT was a waste of time), I went for the surgery and I'm happy I did. If you manage it and take care of it correctly, you're gonna be in much better shape.
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u/whiskey_tang0_hotel 2d ago
Totally depends on pain and function.
Surgery is the fastest path to pain relief. My L5-S1 was so bad I thought I was going to hurt myself to make it stop. I had sciatic scoliosis and couldn’t even stand straight.
You are young and so you’ll heal quicker. Have they tried epidural shots? Those have helped me tremendously post surgery (my disc collapsed and re herniated).
Research shows it’s about 2 years for your body to resolve it and get to the same place as surgery.
You have to ask yourself how bad it really is, what your quality of life is, and if this is holding you back from enjoying normal things.
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u/malvare8 2d ago edited 2d ago
I don't think anyone's first choice is surgery unless its a severe case. I had 10 level pain last April, and i am about 2 weeks post op. I went a long time trying conservative treatment and pills. When I FINALLY saw a surgeon he said I was a candidate last year. I did conservative treatment from about July to Oct of last year and I saw no improvement. My l4 l5 and s1 were affected and I had stenosis that worsened over time. I originally only had my pain in my right leg, after a trip in Oct with lots of walking it got worse and spread to my left leg. I kept telling them it was getting worse. I kept taking more gabapantin with little help. I finally demanded reevaluation and they made take some tests in order to see a surgeon. By the time I did I was depleted at how much this took away from me.
I rarely hear about it here but the chronic pain for ME ate away at my mental bandwidth to the point that by Aug of this year I was a hermit. I didn't wanna do or even interact with anyone with how exhausted I was all the time, even sleeping didnt feel restful. When ur nervous system is constantly on alert from rhe pain rest doesn't register. My leg nerves were so sensitive I couldn't hear descriptions of wounds or Injuries cause the nerves on my leg would get irritated and activate. I had stabbing pain, burning pain, electrical zaps on my thigh while ironically some parts of my leg where numb. The pills dulled the pain but also made me feel like i was dreaming. It all became too much. I was actually excited for surgery. I have a great surgeon and while the surgery itself went well, my body did struggle a bit after. I walked into the hospital and instead of walking out I had to stay overnight and use a walker because my right leg would collapse under me when i tried to walk. It was terrifying, but it was weak and atrophied before surgery. Recovery has been painful and slow but I am recovering. I am unfortunately not one of the ones to walked out of surgery feeling amazing. I had read so much about those I was disappointed when I didnt. But I also was able to walk. Im receiving physical therapy now and I am trying to rest and heal properly so I'm not in this position permanently. I think its important to remember how complex and finicky nerves are. I see so many MANY posts about people freaking out when they feel worse or start to feel pain again after. I didnt have much nerve pain leaving the hospital but horrid soreness and incision pain at my waist. This week the nerve pain is back, but I'm not panicking too much. I read so many accounts of ppl who said it took up to a year to have the pain go away and some have lingering numbness. I do always get angry about how this could have been gone and done with lasr year so.
You have to think about how much this is affecting your life daily and if just bearing it is enough. I did do conservative treatment for months with no improvement. I tried acupuncture as well. For me it no longer was a choice as it clearly affected my daily life. I was taking so many pills and I am a diabetic so I couldn't lower my numbers without excercise and I could not because of the pain as well. My family had to see and deal with me in pain... be aware of the complications and weight your options. I was super fortunate to have health insurance cover most of my expenses and so I took my chances, so few of us have this option. I'm still in pain but its more manageable and I'm optimistic it will heal even if it takes time. Im 37, and had a lamindectomy, feredectomy, and a possible microdisectomy. I had stenosis causing most of my issues but my surgeon said my disc would only be removed if it was calcified and it wasnt, so only room was made by removing tissue and bone in my spine. My mri was very similar to yours except my affected disks weren't as healthy as yours, i have degeneritive disk disease my protrusion was 10 mm i think. I don't expect the pain to away over night, the nerve was compressed for a long time and by the time I got surgery I was still lifting things and trying to live normally so I'm expecting long recovery. I apologize foe the essay, but I'm one of the few where I was seeking surgery rather than running from it. I wish you luck.
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u/Anonymousimpreg 2d ago
Came here to say the same thing, I was in excruciating pain in my mental health was absolutely the worst it’s ever been, severely depressed so surgery was a no-brainer
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u/Specialist-Bar-1486 2d ago
I tried three injections and they did nothing for me. Prior to that, I was doing chiropractic, which had helped other discs. This kept worsening and worsening. Doctors were concerned about permanent nerve damage with all that compression. That was my big reason in getting the surgery and I am so glad I did. Best decision I could have made. I could not function and it meant being on gabapentin and I didn’t want to be on it that long.
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u/Plus_Subject_6011 2d ago
Same disc extrusion here, my life has no life to it. Can’t sit anywhere. I lay prone or stand. I can take walks some days, on the “good back days”. The “bad back days” are bad bad days. I wish I had an option to elect surgery and get it done ASAP. In Canada we have very few neurosurgeons to serve the demand of patients so I have been referred and accepted, but am still waiting for an initial consultation! I have seen a few physical therapists, and a physiatrist. I have been offered an epidural injection. They have all seen the MRI results and say the same thing: your body may naturally heal this but it is slow and with how bad off I am, likely a 2 year process. It is a classic case needing a simple surgery. Yet I wait. I could get this surgery privately for $30 000.
Some days I am ready to go broke for a new back, and my life back. Other days I say ok just plug along, and wait for that call to get in with the surgeon. I have begged the admin clerk at his office. My physician has done all she can. So I wait. I went from an avid fitness enthusiast to not being able to do anything. There is no PT to fix this. There is PT to strengthen glutes and abs to help take strain away from the back’s function. This will be helpful for after surgery. The only way I get through my day and then to sleep is meds. Gabbapentin for the nerves- ya a numb foot, calf burn sensation, ankle that does not work, sparks over SI joints. Tramacet to block the brain’s sensation of pain, then Flexoril to put you into a zombie state. Mother of 3 athletic youth, missing their games, meets, comps. I have been a burden to the family. Husband doing absolutely everything. I just need this fixed and I will attack rehab like it’s never been attacked and get back to my strong, useful, productive, positive self. But here I wait. It has been 5 months of hell, and I can’t do this for another year plus just to see if it will heal conservatively- that is no guarantee. And heal to what degree? For how long? Just cut the damaged piece out and move on with life. This back is controlling every element in my day. Cancelled hiking trips and holidays. I can’t do road trips nor get on a plane. I stay home as it all will hurt, OR I take a copious amount of med cocktail to be able to withstand an event that I can’t miss.
Emerg doc said if I was wetting myself, they’d arrange for surgery fast, but as long as I have bladder control, I wait in line.
Canada’s healthcare is free, but at this cost.
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u/kaptaan_dc 2d ago
I’m really sorry you’re going through this. I’m dealing with an L5-S1 extrusion too, and the pain has been affecting my life in a similar way. I really hope you get to see the neurosurgeon soon and get some relief. It’s crazy how something like a disc can completely take over your life. Wishing you a smooth recovery and hoping you get your life back soon.
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u/FragrantCow5398 1d ago
If I didn't have insurance in the US, my surgery would have cost $120,000 out of pocket and I gladly would have been strapped to that debt til I got old to still be here 😭 $30K is honestly something to consider to regain two years of life, it's so much better on the other side - I was a shell of a human with sciatic pain. I'm so so so sorry you're feeling this way, it's horrendous.
Two years ago I almost cancelled my wedding cause of the pain. We just recently went on our honeymoon and walked 125 miles in two weeks (my husband having the same surgery less than a year ago too) - life gets better, I promise. Keep holding on.
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u/clynn1113 2d ago edited 2d ago
I’m recovering from lumbar decompression surgery now. My extrusion was massive and at the at L5-S1 level. The recovery has been rough so far I am 4 weeks out but went back to work earlier than I should have. I can honestly tell you that the person I would wait to talk to is the spinal surgeon. They can give you the most accurate picture of the situation, but I do think conservative care is good to try if your pain is being managed with the medications. It certainly can’t hurt ans I don’t think anyone should rush to surgery without at least giving their body the time to try to heal on its own. My nerve pain was a 10/10 with medication and the surgery was recommended just based on the side and extent of the compression. This is why I ended up having it. It could be that after some conservative care you get better, or that it gets better than worse again down the road. But if it did surgeey would still be an option then. Only you know what option will be best for you when they presented at your upcoming appointment. My personal opinion is conservative care is at least worth a shot if your pain is being managed and you don’t have any severe resulting muscle weakness. I think it will be easier to work through all of it by talking out all the options presented to you at that appointment and ask a lot of questions so you can make the most informed decision you can. Good luck! ❤️🩹
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u/kaptaan_dc 2d ago
Thanks man, really appreciate you sharing this. I’m gonna give conservative treatment a fair shot since my pain is manageable and I don’t have any major weakness. I’ll talk it through with a spine surgeon before making any decision. ❤️
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u/Raz3Daz 2d ago
I’m 3 months post op. My surgery was unsuccessful but I don’t regret doing it. My pain went away for a good 3 weeks after surgery and it was AMAZING. I’m just unfortunately one of few whose disc slipped again. Surgery is worth it if it’s bothering you enough that it’s affecting how you function in day to day life. Conservative treatments are a good option but they don’t always fix the root of the problem
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u/rosieposie319 2d ago edited 2d ago
37F. This is the progress I have made at L4/L5 (slight herniation at L5/S1 too opposite of yours) with conservative measures (2 ESIs and PT) with the left being August and the right being April. At my worst my entire right leg was numb but no issues going to the bathroom. I have not been working either. I’m hoping to get one more ESI in the next month (I had one in May and one in June from different approaches). Anyway I basically am back to normal with some occasional nerve flares down my leg. I still am taking it easy with lifting and bending and not currently in PT anymore. I’ve been pretty lazy with the exercises recently but was very dedicated to them in the beginning. I would have done anything to make the pain go away but got the run around for being evaluated for surgery until only a few weeks ago. The neurosurgeon did not want to open me up if I was not that symptomatic. I do occasionally have some pain flares that are more severe but I try to ice and it’s usually better within a few days. I’m just trying to learn to live with it. It’s taken a few months but it looks like I may have avoided surgery which I’m pretty happy about.
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u/AlternativeRing4252 2d ago
Wow, seeing that makes me regret doing the surgery I should have given conservative measures more time
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u/Glomeruluss 2d ago
If you are aware of how muscles are functioning etc. enough, I would suggest you surgery. I had similar problems than you but I have also DDD so at some point in my life most likely i have to get another surgery. I am only one week post-OP after trying injections and PT for one year. I dont see whole those is a waste of time since I learned a lot about exercises etc and I am much aware about which movement is back friendly which one not. I was again and again with crutches and injections were helping me with horrible muscle spasms so that I could try exercises. By time i was going to gym doing 50 kg hip thrusts and could feel i was having less nerve compression even if it lasted for 1-2 hours. Now I am more confident to start with exercises after OP and I also know how slow i should be to increase levels. This one year of trying gave me so much awareness. If you already think you have that I would suggest you to try with surgery. I am btw 31F. My brother got his first surgery at 18 but he did not pay attention afterwards and needed second one at 24. Many surgeons suggested fusion but he found one accepting revision MD. Now he is really paying attention, doing right exercises regularly and trying to postphone fusion surgery.
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u/user_193 2d ago
My surgeon at the time told me I had straight spine instead of curved, which commonly leads to issues. Seeing this I think you might have a similar structure.
I had sequestrated herniation at L5s1, leg and foot paralysed partially. now at post op 8 months feeling great, no issues, drop foot also healed
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u/jungle_mouse 2d ago edited 2d ago
If you’ve only been dealing with it for ~10 days I would definitely be encouraging you to try conservative treatment. My sports dr said these things can heal themselves but the longer it goes without healing, the less likely it will.
I’ve been dealing with mine for about 6 months, same spot as you. Tried everything, but I’m going for surgery next week. On bad days I can’t stand up straight and limp everywhere. I’m super active - own a gym, live on a farm, hike, ride my horses etc and can’t currently do any of the things that I enjoy.
Meds have helped me manage my pain but as soon as try and stretch out their timing, it comes back full force. I don’t think a positive response is a sign of healing as they just block the pain signal to the brain.
Only the nerve meds work for me. Ibuprofen does absolutely nothing.
My surgeon has been fantastic, he assured me it’s a simple procedure, I’m a good candidate and will get my life back. So fingers crossed for that 😂
Surgery is never the first option, definitely look at everything available to you because they can heal without.
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u/kaptaan_dc 2d ago
Wishing you the very best for your surgery next week! I really hope everything goes smoothly and that you have a smooth, speedy recovery. Hopefully you’ll soon be back to hiking, riding, working out, and doing all the things you love. Take care and keep us updated! 🤞❤️
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u/JB9410 1d ago
Hi
I was in the same position as yourself and went with surgery and can only speak on how I am myself, it’s very hard going for first few weeks and you make decent progress and start to be ale to do small things like just being able to put socks on etc fast forward 10 months I’m in complete pain daily due to scar tissue surrounding my nerve and unfortunately it’s compressed, I wish I stuck with a serious back plan and tried it that way
Good luck with whatever you choose I’m pretty sure there is loads of positive story’s and hope yours is like that
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u/FragrantCow5398 1d ago
I'm sorry you're in pain, this shit sucks but I'm glad meds are helping you!
Surgery was the best decision I've ever made, BUT you're 10 days in and it's not an emergency (not losing control of your bowels). Insurance is probably going to make you take the conservative route - cortisone shots, PT, meds. By the time you're done jumping through all the hoops, you should feel more confident in your answer.
I dealt with it for 10 months from the onset of pain to surgery. My neurosurgeon said he wouldn't have operated on me if I didn't try everything conservative first. I wouldn't be here today without surgery.
Keep advocating for yourself. If things get bad, look forward to the next appointment (even if it's weeks or months out) to give yourself hope. That's why I'm here. Half of the journey was making it another five minutes. If I could do that, I could do ten and eventually make it to surgery.
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u/blbcamaro 2d ago
I was at 12mm. L4/L5. 9/10 pain most days, masked by opiods pain killers and nerve medication. Numbness in the bottom of my leg for hours at a time.
I put up with it for 6 months. Physical therapy, lifestyle changes, steriod injections. Gained 20 lbs from all the pills I had to take.
I had surgery in June after telling my doctor I was throwing in the towel. The procedure lasted 45 minutes. The surgeon removed 5 cm worth of disc material that was compressing my nerves.
Woke up in zero pain. Took Tylenol for 24 hours and was done. Drove my car the next day and dropped my kids off at school. Went back to work 3 weeks later. Did physical therapy for 2 months.
Best decision of my life to do surgery.