Treatment of lumbar disc herniation?

[flanajb]

I don't usually post medical related questions, but on the occasion I seem somewhat impelled to do so. MY wife has been identified with a herniated disc, and after 10 weeks (ouch) she is finally going into hospital. Now the worrying thing, is that the consultant is not making the choice regarding the procedure, but instead is saying you can either have a epidural or a discectomy. My Wife and I are obviously looking at him being the expert for the best way forward.

Is this usual practice?

Do most people who have a herniated disc end up to go on to have a discectomy anyway?

Any experiences of this would be most helpful


Thanks

 

[CHJ]

...... Now the worrying thing, is that the consultant is not making the choice regarding the procedure, but instead is saying you can either have a epidural or a discectomy. .

This statement does not seem to make sense.

1. epidural:- refers to local anaesthetic in the spine area.
2. discectomy:- refers to the removal of the disk, a procedure that can be done under a local anaesthetic

 

[RogerBoyle]

Ok
The epidural is a series of injections that can help patients manage their pain and in some cases it can stop the pain. this option has the least risk attached to it
The discectomy is where they actually remove the damaged part of the disc that is compressing the nerves . Again this option is usually regarded as a low risk option.
With the injections results are quicker and you have no surgery as such to contend with but they may well need repeating on a regular basis
With the discectomy you usually notice an improvement after the operation with the pain getting less over the next several weeks /months

I was also given the same choices when I was diagnosed several years ago with Degenerative Disc Disease but I was also told that I would eventually need to get a spinal fusion. this is a much higher risk operation.
So I decided to wait until I got to the point where It was totally unbearable before I opt for the Spinal fusion

HTH
Roger

EDIT
I should add as Kalimna has said they are all high risk surgeries but strictly within the bounds of back surgery they are what I have been told

 

[Kalimna]

Not wanting to get too deep here, especially as the particulars of your wife's illness is, but I am making the assumption that the two procedures outlined above are to alleviate back/leg pain.
Firstly, if this is the case, then they may both achieve the same result, I.e. Resolution of pain. The difference being that one is invasive and permanent, the other may be temporary and is an epidural.
Secondly, I am not familiar with a discectomy being performed under local anaesthetic, only general. Also, epidural relates to an anatomical area, not necessarily the use of local anaesthetic on the spine - there are other drugs that can be used.
Thirdly, if the consultant is giving you a choice, then it probably isn't too important which route is taken for resolution of symptoms.
Fourthly, spinal surgery or similar interventions are a fairly specific area of pain treatment and I would be wary of both giving and receiving advice on an Internet forum.

I wish you and your wife well in making the decision, and would be happy, with the above provisos, to answer any questions you may have.

Cheers,
Adam

P.s, noting Rogers' post, I would echo his points, the only difference being that I would personally consider no spinal surgery to be of a 'low risk' nature.

 

[flanajb]

Thanks Chaps. The Wife has been pretty much bed bound for the last 1.5 weeks. Terrible sciatic pain and pins and needles down one leg. She can only stand for about 2 minutes before having to lie down again.

She is petrified of having to have surgery, but the MRI apparently should the disc fluid to have leaked out and some debris. It is obviously pressing down on the sciatic nerve.

I just don't want her to be in the same position in a few weeks time

 

[Ring]

Hi i have been forced to into early retirement at he ripe old age of 52 after 21 years as an Ambulance driver I injured my back moving an obese patient, scans showed degeneration on two discs on my left side and a bulging disc on my right side i am now on morphine daily and get 2 spinal epidural injections a year[2 is the max because of my age and the steroids they use] the effect of the injections in my case last 6/7 weeks i only wish i had the chance of surgery for me the risks would be worth it.
Jim

 

[finneyb]

http://www.nhs.uk/Conditions/Slipped-di ... tment.aspx

Video might be useful to you.
After the video scroll down to get more info on the operation.

I assume the offer of an epidural is to relieve the pain sufficiently to allow your wife to exercise/have physio and strengthen her back muscles sufficiently to take load off the damaged disc thereby reducing the pain.

HTH

Brian

 

[JandK]

I was in a similar position 4 years ago and after careful consideration and with a lot of input by the consultant I opted for the surgical route (the consultant favoured surgery in this instance). In my case the keyhole surgery was a huge success, I was free of pain within days after the procedure.

But each and every case is different and I would have thought that the consultant would give your wife guidance to help her to come to a decision.

I hope it will work out well for her.

 

[WellsWood]

All surgery carries risks, and spinal surgery is no exception. In no small measure because discectomys are often performed in conjunction with a procedure called a laminectomy - where a part of the bony arch called the lamina is removed from the spine. Pain and numbness such as your wife is experiencing is often caused by a prolapsed (or herniated) disc pressing the nerve root against the inside of this arch. The reasons, as far as I understand from having had this done twice, are twofold; firstly by removing the structure there is nothing for the nerve to be pressed against, and secondly it affords better access to the offending disc protrusion.

If what you are being offered is a choice between long-term (read "indefinite") use of painkillers including epidurals, and removing the source of the problem via surgery in my opinion it's a no-brainer - I'd take the surgery every time. As surgery goes these days it's a fairly routine procedure, with a very good record of success. Of course your wife's age, general health, physical condition etc., along with the exact location and severity of the disc extrusion, will all have a part to play in the decision making progress (as well as any decision about the method of anesthesia, which as Chas says may include a local such as an epidural).

Disclaimer: I have offered information and advice based on considerable first hand experience of similar problems, but every case and person is different. Your consultant should be explaining all this to you, along with informing you of the implications and likely prognosis of the different options. If he is not perhaps you should politely insist that he does, or try to find someone else (with appropriate qualifications of course) who will. After all it seems to me quite unreasonable to expect you to make this decision unless you have all the pertinent information - without it you may as well draw straws.

 

[flanajb]

Well, I can report that the operation went well and the Wife is due home later today

The surgeon gave us the choice, but based on conversations we had she decided to go for the micro disectomy. The surgeon came into see my Wife this morning and said that it was the correct course of action. The fragments he removed where too large to have broken down on their own, and the nerve area had turned white and it took 5 minutes for it to return to a healthy pink colour. I assume from that he means it was be starved of blood. Maybe explains the terrible pain.

So fingers crossed the pain has gone and no long term damage has been done. Still fuming as to why private healthcare made here continually attend physio for 10 weeks before they agreed to do a scan. Shocking.

 

[RogerBoyle]

Best wishes to you all for the speedy recovery of your SWMBO

Roger

 

[flanajb]

Best wishes to you all for the speedy recovery of your SWMBO

Roger

Thanks. Had to google that acronym