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Surgery for L5 S1 disc extrusion - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
my boyfriend has l5 si extrusion..he tried everythng except surgery and the pain is nt relieved...plz suggest
Doctor :   Hi
Doctor :   How can I help you?
User :   hi
User :   my boyfriend has l5 s1 extrusion
User :   he cant walk nor he can sit for long time
Doctor :   Since when is he having the symptoms?
User :   plz suggest
User :   he tried everything except surgery
User :   1 year
Doctor :   Can you briefly describe the treatment tried before?
User :   physio therapy, injections for nerve conduction,medication,pain killer
Doctor :   Does he have any numbness, tingling sensation in the limbs?
User :   no but more of a vibration in my left sole!
User :   Hi, this the patient
User :   I m on!
Doctor :   Ok
User :   How r u doin today!
Doctor :   When was the last radio imaging done?
Doctor :   I am doing fine, thankyou.
User :   i went for an MRI scan in month of June 2010
User :   it shows Lumbar spodylosis
Doctor :   Ok
User :   Extrusion at L5 n S1
Doctor :   Do you have any problems with bowel and bladder?
Doctor :   May I know your age?
User :   no sir!
User :   23yrs
Doctor :   Can you also give me the details of your height and weight?
User :   height is 5'11 and weight was 85kgs a couple f months now i is 80kgs
Doctor :   Ok
Doctor :   Do you have any other medical illness in the past?
User :   i had an endoscopy done for duedunum redness
Doctor :   Ok
User :   and medication continued for almost a year!
Doctor :   Ok
User :   are u a neuro specialist and wer r u located?
Doctor :   let me brief you.
Doctor :   I am a general practitioner
User :   ok sir!!
User :   go ahead! i appreciate ur hepl
Doctor :   Lumbar spondylosis with disc herniation are treated by the following measures in a step wise manner.
User :   k
Doctor :   1. Adequate rest and avoiding strenous physical exercises.
Doctor :   This is the most important of the treatment
User :   i m laid up for a month now
Doctor :   Along with the lying down, I would also suggest you to use lumbar support belts.
User :   but my back has bended forward n i m limping and my left leg is bending
Doctor :   They help in restricting the back movements which aids in pain control
User :   i cnt straighten up my left leg while walking!
User :   in fact walking is impossible after 10 steps
Doctor :   I shall guide you
User :   i have been advised a surgery by all the docs
User :   they are all neurologists/ neurosurgeons!
User :   wud the surgery be painful
Doctor :   2. Conservative treatment in the form of medications, infections and physiotherapy
Doctor :   3. The next step is surgery.
User :   i some questions for u around this surgery!
User :   i appreciate ur help.
Doctor :   Yes. please proceed with your query.
User :   yes u r right! I have tried conservative treamtnt but it hasn't worked for me!
User :   would the surgery be under general anaesthesia!
User :   as in i wll be uncounsiouss during the surgery!
Doctor :   Yes, since the conservative treatment has not given you relief from your symptoms and since you have difficult in walking, it would be ideal
Doctor :   if you consider the surgical approach.
User :   i m asking u all this coz i m a little scared of all this!
Doctor :   This would be the definitive treatment.
User :   wud i be unconsciouss during the surgery!
Doctor :   The surgery would be performed under general anaesthesia and yes you would be unconscious.
Doctor :   Since you are young and you don't have any other medical illness, the complications of anaesthesia would be minimal.
User :   i used to smoke almost 10 - 15 cigarettes a day n used to drink once in a month!
User :   wud anaesthesia be effective on me or not!
Doctor :   Yes, general anaesthesia would be effective.
User :   coz i wll die of a heart attack if i m nt uncounscious during the surgery!
User :   n is it like by the time i get conscious wud be done with the surgry!
Doctor :   You will be subjected to few investigations before the surgery which will include a chest xray .
Doctor :   The complication of heart attacks are more in elderly individuals with previous medical illness.
Doctor :   Hence you need not worry about it.
User :   wud there tolerable pain post surgery!
Doctor :   The preoperative tests will be done to see your fitness for the surgery which will make sure that you come out of the surgery.
Doctor :   General anaesthesia will make sure that you are pain free during the surgery, however
Doctor :   you may have some pain following the surgery after recovery from the anaesthesia.
User :   wud pain be tolerable!
Doctor :   This pain will be different from the one that you presently have.
Doctor :   You will be on round the clock analgesics making sure that the pain is tolerable.
Doctor :   There are various forms of analgesics which will definitely make sure that your pain levels would be tolerable.
User :   wat kind f surgery i wud hve to undergo?
User :   for L5 S1 extrusion!
Doctor :   Apart from the pain, a drain may be place in the back which can be there for few days to a week.
User :   I m sure that docs wud remove the disc fragmnt or disc material whch is compressing the nerve
Doctor :   Yes, there are various forms of surgery for the condition
Doctor :   such as discetomy, laminectomy and so on.
User :   so in tht case ..the herniated will cum to original size...coz the material has cum out
User :   who wud decide as in wat kind f a surgery i wll hve to go for!
Doctor :   The main principle behind these surgeries are removal of the herniated disc and decompression the space and the nerve.
Doctor :   This will relieve the pain and the other symptoms that you have.
Doctor :   The type of the surgery will depend on the radiological findings.
User :   but disc wll never cum to it original size
User :   coz disc mataeril is out n neither the disc lining can be closed whch has teared!
Doctor :   During the surgery, the disc which has herniated will be removed, and if required fusion of the vertebrae will be done, depending on the radiological findings and the finding per operatively.
User :   y it wud be removed?
Doctor :   Yes the herniated disc(L5 and s1) will be removed.
User :   the neurologists told me tht extruded part wud be only removed!
Doctor :   Yes, herniated refers only the extruded part
User :   but u mentioned abt fusion
Doctor :   If on peroperatively a large amount of disc has herniated(extruded),
Doctor :   and the remaining amount of disc is unstable(where in there are more chances of disc protrusions again), then fusion may be needed.
Doctor :   Hence this will be decided only on peroperatively/by radiological findings done before the surgery.
Doctor :   Have you followed what I have suggested?
User :   yes ii understand wat u said! coz i hve done a lot f research around it?
User :   does smoking n sex these days worsen the situation??? or even alcohol for that matter?
User :   plz answer
Doctor :   The pain and the condition will be affected by physical exertion.
Doctor :   The severity of pain are not affected by smoking and alcohol.
User :   my questio n is in will sex weaken my nerves or back or anything of that sort??? im asking coz i dnt hve an pain while having sex
User :   n i have heard smoking can erode disc material!
Doctor :   Smoking over a period of time can lead to disc degeneration,
Doctor :   which can only be determined by radiological findings.
User :   can be verified by radiology that a person smokes!
User :   coz i wud i hve parents the time f surgery who r not aware of the fact tht i smoke
Doctor :   Its difficult to predict smoking by looking the back alone(radiologically), however chest xray can show changes which can indicate smoking.
Doctor :   But this is not a conclusive finding.
User :   k great
User :   n wat abt sex?
Doctor :   No, sexual relations doesn't lead to any changes radiologically.
User :   would it affect my nerves and back if i have it these days
Doctor :   Physical exertion can cause increase in the pain, hence if sexual act was not exerting then, not.
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