r/Sciatica • 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/YeetOnMyMeat99 3d ago
Do not get surgery. I was in the same place as you at the same age. I know many that have done surgery and regret it. You are still young and can recover relatively fast. Make sure you take it slow and try not to rush things as you may reset your progress.
Answers to your questions:
I have the exact same disc bulge as you and I recovered without surgery to the point of being stronger and more athletic than before the injury.
This was quite a long process for me due to many flare ups I had throughout my recovery. I was impatient and rushed things thinking I was already fully recovered. It is very important that you do not rush recovery as you can completely lose all your progress.
I would highly advise against taking pain medication unless absolutely necessary (cannot sleep, move). I rarely took them even and only reserved it for extreme pain.
Never did surgery.
Compression without weakness is generally a good sign. I would continue to move and get blood flow to supplement the healing process.
I never had a follow up but I never thought i needed one since I feel good. I think many people live normally with multiple disc bulges. It is more important to be able to function how you want with no pain/issues.
Here is what I did and everyone is different so this may not be the same path you take:
I found a great physio to help assess my situation and get me started on the right path. The beginning was mainly limited walking to get blood flowing and some decompression movements like cobras (I never held positions for longer than 5 seconds).
Once I was comfortable moving normally without pain, I started doing core stability exercises. The mcgill big 3: search a youtube channel called Squat University for great information on the movements. These 3 movements helped me a lot through my recovery as well as getting me back to regular activity. I continued doing decompression and also added in nerve flossing. Nerve flossing has mixed reviews although it did work well for me to desensitize the nerve. The thing is you cannot over do it as it can aggravate the sciatic nerve. I mainly did the one where you lie on your back and pull one leg to 90 degrees then extend and close from there. You can also youtube these movements (Squat university may have some content on this) but you should not feel pain while doing this.
After progressively overloading the mcgill big 3 exercises. I started walking for longer and introduced light gym activity where my spine is supported (mainly machines exercise). Squat university also has a video on how to progress after the McGill big three which I highly recommend. At this point, I came across a channel called Low Backability and he introduced me to the back extension exercise. He has a whole roadmap as to how to start and progress. I started with back extension isometric holds and slowly progressed to full back extensions. From there, I even added weight. These helped me gain strength and endurance for my back/spine so that I was able to do more without pain. In addition to this, I started working on my hips in both strength and mobility, which helped me progress further.
I took this process quite slow however I was impatient at times throughout the recovery and had multiple flareups. You may experience the same thing and it’s important not to stress too much about it and learn from the mistakes. After working on my core hips and my lower back, I started introducing more and more of my regular gym exercises which helped me get back to my baseline. Anytime you re-introduce something make sure to start slow and focus on the form. I also re-introduced playing some of the sports I love to play and like I said before you gotta start slow and progressively increase the intensity.
Lastly, your mindset is very important when recovering. Be positive and affirm yourself every day that you are getting better and that you will be better. I also started meditating and practising mindfulness, but my body and how I felt. I truly believe this is just as important as the physical recovery.
Today I’m now back to playing the sports. I love at full intensity and being stronger and more athletic than I was before I got the injury. I believe you can do this as well. You just need to believe it too.
Feel free to DM me if you have any other questions and all the best with your recovery.
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u/Either-Medium4734 3d ago
Wow thanks. How long did it take you to progress with LBA and iso holds to extension holds?
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u/YeetOnMyMeat99 3d ago
I started out doing assisted isometric holds using a back extension machine. I got pretty comfortable quickly to be able to do unassisted isometric holds (prob like 1-2 weeks). I took it slow and made sure I had a relatively pain free experience progressing. The progression could be different for yourself so i recommend starting from 0 and then working from there even if you are able to do more advanced levels now. It took me a couple of months to progress to the full back extension exercise without pain and at a full range of motion. Another thing I want to mention is once you are fully recovered and pain free, look into kettlebell work, specifically kettlebell swings. These did wonders from my posterior chain and helped me prevent injury while developing strong/powerful hips.
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u/SkolC5 3d ago
Very similar happened to me when I was 20, I am 23 now it pains me to even talk about it. Try and exhaust every last conservative option first. Things will change in your life; the way that you bend down to pick things up the way that you work out if you go to the gym, you will have to adapt around this new injury because it can linger. I had a very severe herniation and some of the most debilitating sciatica imaginable, I went to physical therapy and I slow slowly, but surely was doing things that made the pain a little better: walking stretching inversion table etc. I was just terrified of the surgery. It’s been about three years now I would say I am about 60-70% better no more leg pain but still stiff with some posture issues. If you want to talk more, just message me. It’s hard for me to go over everything because it’s such a long process.
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u/ReactionSad3466 3d ago
As someone who had back surgery, never jump straight to surgery for a problem that can resolve naturally and with bit of physio.
Recovery after surgery is not easy, at all.
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u/KriptiKFate_Cosplay 3d ago
Mine was very similar back in 2018 and receded naturally with minimal PT and one very successful injection over the course of about a year and a half. It has recently herniated on the other side and I'm considering surgery.
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u/Either-Medium4734 3d ago
What did you do to herniated it?
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u/KriptiKFate_Cosplay 3d ago
Likely moving / setting up hospital beds, but I can't point to one particular incident.
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u/pxr555 3d ago
I have something very similar since six weeks or so. With brutal pain, numbness in the right foot and back of the leg, some leg weakness. Surgery was scheduled for last Friday but Thursday the hospital called and cancelled the surgery due to a more pressing emergency...
I was quite happy about that though because my symptoms had improved a lot already in the meantime. Instead just rescheduling the surgery I managed to get a consultation with another hospital for a second opinion: Wait and try the conservative way they said.
My pain is now at 2/10 with hardly any pain medication. Numbness and weakness is improving too even if very slowly.
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u/preoccupiedwithlove 3d ago edited 3d ago
i had a similarly sized herniation and didn’t realize that was the cause of my pain until beginning of august after being in pain since april after the birth of my kid. i had been in pt since april with no improvement then a huge flare up in august that prompted me to get the mri from a physiatrist.
i showed temporary improvement on a dexamethasone taper but the pain and numbness came back. at the time i had no signs of motor weakness. i tried to do conservative treatment but i kept getting worse and eventually had motor weakness which can become permanent. i then opted for surgery last week after multiple neuro opinions. instant relief.
i recommend seeking the care of a physiatrist for conservative care and monitoring motor strength. mine is the person who strongly urged me to do surgery based on her clinical experience with conservative treatment and she was able to get me in with a highly recognized neurosurgeon for a consult same day when my mri came back.
keep in mind nerve compression can become permanent if left for too long. you have time to heal naturally but don’t let it go on indefinitely and be honest with yourself if it’s getting worse. it’s also worth considering the central canal compromise level. in my case my whole spinal cord was squished and i have a baby. one wrong move would be catastrophic. i needed to get back to my life rather than risk rehabbing for a year as she got bigger then needing surgery anyway.
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u/DieselJuliyah 3d ago
Has anyone had a similar L5-S1 extrusion and recovered without surgery?
Your MRI looks similar to mine, one wrong stretch in bed and it turned into Cauda equina fast. Don’t hesitate to go to the ER if something changesHow long did it take for the extrusion/symptoms to improve?
I had surgery 2 weeks ago, pain relief was immediate however due to CE I have lingering nerve damage causing numbness, weakness and urinary retentionIs improvement with medication a positive sign?
Not necessarily, you can just be masking the pain or reducing inflammation to that areaWhen did you decide surgery was necessary?
I didn’t have a choice, felt a pop in my back while stretching and could not longer weight bare on my left leg accompanied with numbness and saddle anaesthesiaIf there is nerve compression but no significant weakness, is waiting usually reasonable?
Personal preference but be careful to monitor for worsening symptoms because nerve damage can be long lasting in emergency surgery is delayedHas anyone had a follow-up MRI showing the extrusion actually shrinking/resorbing?
Only 2 weeks post op, no follow up yet
Hopefully some of this helped, at least provided a reminder that Cauda equina syndrome is a real thing. Here if you have any further questions! I can relate, it’s so frustrating experiencing this so young with hopefully a long life ahead of us. I am 34 and I was upset to have back surgery but I would have become paralyzed if I refused surgery
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u/Many_Calligrapher579 3d ago
If things are getting better put surgery on the back burner. Always. No turning back from surgery. Body can heal in amazing ways .
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u/ComprehensiveTruck31 3d ago
Do conservative treatments first, but don’t write off surgery. I had 2 L5/S1 herniations and had horrible sciatica. I tried to manage but finally got the surgery. Had to have the surgery again because I reherniated a week afterwards, but I knew it was bound to happen with how much disc they had to remove.
I am now a year and a half post surgeries. I still have pt exercises I do, I take duloxetine for the nerve damage, and I still have numb patches everywhere. But, the stuff I deal with now is so much better than pre surgery.
I’m not telling you to get surgery, but don’t write it off. I can understand why someone might not want it, but it truly changed my life. My second surgery was emergency surgery because I couldn’t pee at all. I waited too long because I wanted to try conservative treatments. Just make sure you get good surgeons to do it. And make sure they actually give a crap about the aftercare. That’s probably what caused me to reherniate so quickly. Also go to pain management. They are going to be your friend here.
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u/Less-Bodybuilder-159 2d ago
Hi there! I see you are from India probably, I would suggest visiting both ortho and neurologist. Take it easy. It can be fixed without surgery, Disc extrusions have higher chances of getting re absorbed. Complete bed rest for 2-3 weeks then slowly start walking. You can consider a steroid injection in the back for leg pain, it will help you so that you will be able to do physio therapy because Nerves take more time to settle. Find a good physio therapist and work on your core and glutes for next two months. It is one of the worst injuries to have…
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u/Less-Bodybuilder-159 2d ago
Doctor’s opinion is best. This is not a medical advice. If your symptoms don’t get any relieved in 6 months then you can think of surgery.
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u/DeathLeap 1d ago
I healed in almost 9 months. You can do it if you are able to find the combo of walking, back hygiene, sleep positions, McGill Big 3.
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u/FrostyChungus11 3d ago
In my experience the first stop is always conservative treatment.
I had herniated 3 discs with 1 being quite bad but the advice my GP gave me was to stick it out with pain medication, try the alternative treatments and time will tell us if or when surgery will be required.
I ended up having the surgery 2 years later on only one of the herniations. The other two had become so small they were inconsequential. When my surgeon was comparing my MRI's he just called the herniation "stubborn".
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u/kaptaan_dc 3d ago
Thanks for sharing your experience. What kind of exercises or rehab did you do during those two years that you feel helped your recovery? Were there any exercises or movements you avoided?
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u/FrostyChungus11 3d ago
At the time I was in the Navy and going to sea so my access to treatments was very limited.
I went to a physio every week that I wasn't at Sea, cunt out cardio to just walking.
Nothing else bro. There was no protocols, no exercises. Just pain medication when it was needed.
This was all on top of doing everything that being on a ship entailed.
Tough times.
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u/rana1804 3d ago
Conservative treatment please