In Bkk With 2 Herniated Disks

[smo]

Just to share here my on-going experience at BKK in getting treatment for two herniated disks.

My MRI shows two herniated disks at L4-L5, and L5-S1. The latter one is protruded (meaning it is slipping out instead of extruded, meaning oozing/leaking out). I saw two orthopedic docs at Bumrungrad, they both recommended physical therapy before really going in for surgery. The kind of surgery they recommended is the mircro-surgery kind, called micro-diskectomy, on just the L5-S1 disk. They kind of discouraged me from opting for surgery anyhow, saying that it doesn’t really do much besides cleaning up the mess, cutting off the part of the disk that is pinching my S1 nerve. My right leg is affected by this pinched nerve, it’s getting numbed and feels like it’s dying….as a result I don’t walk too well. But considering that when I arrived here two weeks ago I could hardly walk (had to use wheelchair assistance during my flight journey from LAX) the Bumrungrad surgeons think that I am responding rather well to the physical therapy that I’ve had for more than a week now. But still the right leg is really trying hard. The discouraging news is that the docs say the operation doesn’t guarantee that the numbness would go away, some of the nerve fibers might have been damaged already. They say the operation is called for when the patient is in a lot of pain, which I don’t have now (I have numbness now, come to think of it, pain is actually better, it means whatever, muscle, nerve, is still alive!)

I also saw another ortho doc at Bangkok hospital, this one was really gung ho, he wants to do a laminectomy which is a larger operation than a diskectomy, involving removing big parts of the bone on the vertebraes involved, and he wants to remove both discs at once. This would require 5 days of hospitalization, and I will be back to my old healthy self afterward. This is what the last doc says, I felt his attitude was rather casual and nonchalant.

Just to share with you all my current experience with having an illness and going abroad for treatment. I suffered for 4 months in the US and not having insurance went to all sorts of quacks. Having arrived in BKK I feel really discouraged that even an operation would not guarantee a happy outcome. Any goodwill advice from any of you is greatly appreciated.

smo

[NedKelly]

I'm not a medico but my mate had a terrible back at one stage and the docs wanted to perform some sort of surgery to fuse his discs together. This is a drastic thing !! I would say you would never be the same after that. My mate was a good golfer so it ruined his chances of going further. (it was a work accident that did him in, not golf)

Anyway, he saw an osteopath (like a chiropractor) and they did loads of massage treatments and manipulations and so on. After quite some time he got a lot better, so improvement is possible.

My own experience was not being able to move through incredible pain from my neck down. I thought I was going to be unable to move for life. A result of a football injury which only showed after about 3 weeks after the initial incident. I had therapy twice a week for 6 weeks and then once a month for 12 months and was never better. Over the years I have gone back for 'maintenance' and have been happy with the results.

So, my message is.......treatment first for sure......do it until you have exhausted all possibility of improvement. Also, not knowing how old you are or your state of health, I woul dhave to say that IF you are overweight/unfit, then you HAVE to address this issue as well. It all goes hand in hand. Eg strong stomach muscles can help your posture and relieve the stresst from your back !!

I once was sitting next to a guy in a mini van in indonesia, he kept jabbing me in the shoulder so after a few jabs I asked him what the problem was...he apologised and said it was his stump (arm) that kept jumping or whatever. I looked and saw that he had lost his arm just below his left shoulder. he was travelling the world looking for a cure for the pain he sufffered.....(phantom pain in the arm). After hearing his plight and all the remedies he had tried, i just said to him that maybe the answer was inside him, meaning, had he adjusted mentally ? Anyway i know this is not relevant but is an interesting story.

[mrmnp]

Your post led me to believe that your L5-S1 disc was protruding, not extruded. Protruding means that the nucleus pulposis, the semi-gelatenous material in the center of the disk is pressing against the annulus fibrosis, causing it to bulge out and impinge on the nerve exiting from the spinal canal through the intervertebral foramina.

If this is the case, then anything short of surgery is indicated. Physical therapy until the cows come home. Traction to take pressure off the disk so the bulge will retract enough to relieve pressure on the nerve.

Once the annulus has bulged or herniated, it is no longer in the same configuration as previously, and will always be a weak point that will bulge and cause denervation (numbeness) across the buttock and down the back of the leg, a classic sciatic nerve dermatome, whenever the pressure increases.

Classic bulging discs cause symptoms you describe and then get better for any number of reasons including less pressure, physical therapy that strenghens the longitudinal muscles supporting the spinal canal and also dehydraton of the nucleous.

As one gets older, the disc material becomes less viscous, ie hardens. Discs in older people are thinner than younger people due to the hardening phenomina. It is said that your height is shortend by one inch every thrity five years due to the narrowing of your disc spaces and probably some slouching.

With time, your discs will likewise harden and perhaps your L5-S1 space will harden in such a fashon that, even though it is protruding, it may harden just short of compromising your nerve root.

Keep in mind, that there are many herniated discs that are not symptomatic. A disc to be symptomatic must bulge or extrude in the specific direction of the nerve root as it exists the spinal canal. Herniations in any other direction are not clinically significant and you won't even know you have one unless you have back films or MRI telling you so.

My point is that your herniation might be largely missing the nerve root and only tangentially affecting it, thus any dimunition of the herniation will render you symptom free.

Do you know if you have any of the following conditions which occur after prolonged herniations in the low back resulting in long standing denervation: Reflex changes, calf atrophy or sphincter loss? Prolonged denervation does have consequences so check with your doctors regarding if any of these conditions exist in your body, hopefully not.

The bottom line is that anything short of surgery is preferable to relieve your complaints symptomatically. Remember, when refering to the specialty of your doctors, the term is orthopedic surgeon, the operative word being surgeon. They are to be complimented that they are in no rush to "practice" on you.

There is a long standing rivalry between orthos and neurosurgeons as once the disck herniates and impinges on the nerve, the neuros say you are in their specialty. It wouldn't hurt to get a consulting neuro-surgical opinion since your pain free and the denervation of the nerve is your primary long term concern.

Micro-surgery is certainly the way to go if it ever comes to that. Keeep in mind that when a surgeon operates, he leaves a trail of scar tissue that in and of itself can be sympton generating. Micro-surgery minimizes the amount of collateral damage done during the procedure.

Good luck with your future and become an expert on your condition as that is your only way of assuring that you get the best of treatment.