Herniated discs are a significant cause of low-back pain, which in turn is one of the most common medical complaints in the US. Chances are good that you’ve experienced low-back pain at some point in your life – you might be dealing with a herniated disc right now. Even if you haven’t personally had a herniated disc, it’s almost a certainty that you know someone living with low-back pain.
Three years ago, I was one of those people. My low-back pain made it difficult to sit for long periods of time, which made my desk job – and driving to and from it – almost impossible feats. After a few weeks of chiropractic therapy and very high doses of narcotics (for the pain) and muscle relaxants, I had experienced no improvement. Gradually, it was becoming difficult to walk or even stand. In fact, my back pain, which was caused by not one, but two, herniated discs compacting my sciatic nerve, was so severe that I had back surgery – a laminectomy and discectomy.
This is my experience.
Sunday, February 23, 2003
The left side of my lower back has really been aggravating me. The pain feels like the muscle down the back of my leg is being pulled like a rubber band – some days it pulls so terribly that I wonder if it would help to sever my hamstring muscle. Today is one of those days.
Saturday March 15, 2003
My chiropractor recommended that I get an MRI, since my back pain is just getting worse despite therapy. The hospital fit me in this morning, so now I just have to wait for my primary-care doctor to get the results back. When the MRI was supposed to be done, the technician said to me, “I just need to get a few additional images of your spine.” I don’t know how many more she took, but all I could think was that needing more images can not be a good sign.
Friday March 21, 2003
My MRI results are back. Apparently I have two herniated discs that are bulging out and pressing on my sciatic nerve on the left side. My primary-care doctor says it’s the bottom two discs in my spine – called L4-L5 and L5-S1. The good part is that at least I have a diagnosis now, and I also have stronger drugs for my back (naproxen, steroids, Tylenol with codeine, and muscle relaxant). Hopefully the stronger drugs will start working soon.? ?Saturday March 22, 2003
I am having a bad pain day. It’s not just my back – it’s also my entire sciatic nerve, from where it exits the spinal column, all the way down to my toes, which are completely numb (as is the rest of the bottom of my foot). I had a chiropractor appointment at 9:15 this morning, and driving there almost killed me, because the pain is so bad when I sit. I take naproxen and Tylenol with codeine as soon as I get up, but not the muscle relaxant if I know I’m driving somewhere. And apparently it’s the combination of the three drugs that keep the pain manageable, although the pain never goes away, not even for a short period of time.??The pain has actually become the primary focus of my every waking moment, an overlay obscuring everything else in my life, my mind, my body. Above everything I do, my overriding awareness is of pain. First, last, and always.??The pain started as searing sharp pain in my lower back, and has spread into unrelenting, burning, pulling, aching pain down the entire length of my left leg, from my hip to my toes. The sole of my left foot is numb, a sensation which ranges from pins-and-needles to a cold, dead feeling.??No drugs, no position – sitting, standing, or lying down – alleviates the pain. I’ve been able to subdue it some days, but never to eliminate it. Even when I’m lying perfectly still, in the most comfortable position I’ve found (flat on my stomach, leg extended fully), the pain is still there.??My body is betraying me. That’s what I feel. But then I know, logically, that my body is trying to save itself, to tell me that there is something wrong, something that needs to be fixed right away. I know this. And I am doing everything I can, taking every opportunity presented, and it’s not enough. I’m willing to have needles jabbed into my spinal column, steroids injected directly into the herniated discs. I’m willing to have surgery, to be cut open, as long as the surgery can cut out the source of this pain.??I have an appointment at the back clinic for April 7. Which isn’t that far off, and it’ll allow me to finish the 12-day course of oral steroids that my primary-care doctor prescribed. I really want the drugs to help, but it’s seeming less and less likely.
Monday, March 24, 2003
I had another doctor appointment today, because the pain is just not getting better. And when I got there, I finally hit the wall, so to speak.??I got to the doctor’s office and was in so much pain that I asked the receptionist if I could go right back to a room and lie down, since that was the only comfortable position. She said “Well, I don’t really know if there’s a room open,” at which point I made some kind of noise that was equal parts frustration/pain/giving up, and I hit the floor on my knees so fast that another patient who was waiting jumped up and took my arm to help me.??I said (trying to not cry) “I can’t…just don’t…I’m sorry, I can’t get up, okay? It’s my back, it’s so bad…” and I basically sat on the floor on my hands and knees until the receptionist got up, rushed around, and found a room for me.??I hit the examining table, laid down on my stomach, and started sobbing uncontrollably. And I could not stop. This was actually the first time since I hurt my back that it made me cry. Seriously. Eventually, though, I stopped crying, and the doctor came in. (It should be said that I have a great relationship with my doctor and always have, since the first time I saw him, 10 years ago. He’s very good, and has a wonderful bedside manner – very caring, and very funny and easy to talk to.) As soon as I looked at him, I burst into tears again.??When I told him my appointment at the back clinic wasn’t until April 7, he said he would call them to see if I could get my appointment moved up at all.??Long story short, he prescribed percoset for me – he said it’s the strongest thing he can give me, and if there’s no improvement by tomorrow, he’s going to admit me to the hospital for pain management and then call in a neurosurgeon from the back clinic.??So. I am full of percoset and muscle relaxants right now, and I am praying that it’ll help. However, a big part of me just wants to go to the hospital tomorrow, have surgery, and be done with it. Because this is sheer agony. I can’t even describe it.??I just want this pain to be gone.
Tuesday, March 25, 2003
I am being admitted to the hospital today – mostly for pain management, but also so that the neurosurgeon can see me sooner than my April 7 appointment at the back clinic. I don’t like hospitals at all, but my primary-care doctor said that they can give me morphine to manage the pain I’m in, and right now it seems like I need a drug that’s that powerful, because nothing else is working. I have no idea how long I’ll be in the hospital, but I’m willing to stay as long as it takes for me to be fixed.
Wednesday, March 26, 2003
I’m home from the hospital – for now. My primary-care doctor was right: morphine really did help. The pain isn’t gone, but it’s not quite as unbearable as it was a few days ago. While I was there, I saw the neurosurgeon, and he got to see my MRI films, and we talked about what the best next step would be.
Here’s the scoop: the neurosurgeon says I am a “textbook case” of herniated discs, meaning that surgery will be straightforward and easy. Since I haven’t been responding to drug treatment, he feels that injecting steroids into the discs might not have any effect, or – at best – will have only a short-term effect. ??He told me that once the disc herniates, you can’t put it back in place, apparently. The comparison he used was a jelly doughnut – the doughnut is the disc, and the jelly inside is squishy disc material that cushions the vertebrae. If the jelly squirts out of the doughnut, you really can’t put it back in the doughnut. So when my discs were injured, they actually ruptured, and the squishy material inside – the “jelly” – protruded from the disc. From there, it compressed the nerves that come out of the spinal column, and that’s causing all this pain. He said that the best treatment is to go in and remove the disc material that protruded out of the discs and are pressing on nerves. And the best way do do that is surgery.??He says I’m a good surgical candidate because I’m young and healthy. The typical patient goes home the day after surgery and can be back at work (if it’s a desk job) within a week. The only downside is that I’m awfully young to have back surgery, and because any surgery permanently weakens the back structurally, it’ll be that way for the rest of my life. ??However, there really is no option for me, given the levels of pain I’m dealing with. I’d rather deal with a back that’s somewhat weakened structurally than try to figure out how to live with this pain. So, I’m home for now, and I meet with the neurosurgeon early next week to discuss the surgery so that I’m fully informed before I do it. The actual surgery will probably be in two weeks. So until then, I just keep managing my pain with drugs and just taking it easy. ??
Monday April 7, 2003
I had an appointment today with the neurosurgeon to discuss surgery. He said that all other treatment options don’t remove the herniated disc material, so in 95% of the cases, the pain recurs. With the surgery, there’s only a 5% chance of recurrence per disc.??But he went over the risks – he’s required to, before the patient can officially agree to surgery – even the long-shot, one-in-a-thousand risks, which are pretty scary. Like paralysis, like cutting a nerve, like cutting an artery and me bleeding to death, etc.??I realize those are all very very VERY remote possibilities. I know at least five people who have had this surgery and not only sailed through it beautifully, they’re living like real humans who can walk, and sit, and play sports, all pain-free.??Still. It wasn’t until he told me about all the risks that it hit me that this is SURGERY. I’m going to be unconscious, and he’s going to cut me open, remove part of my vertebrae, poke pointy things into my SPINAL COLUMN, and then cut bits of me out.??I’m 31 years old. I should NOT be cut open like a biology-class frog.??Thursday April 10, 2003
Look. I really don’t want to have surgery. The risks scare me, even though they’re long-shot risks. I don’t want to be cut open – it’s very invasive. I don’t want part of my SPINE to be CUT OFF FOREVER. I don’t want to be under general anesthesia. That scares me in a sort of existential way – one minute, there I’ll be, on the table, counting backwards, and the next thing I know, I’ll be in recovery. A whole chunk of time missing. That really weirds me out. (Obviously, I know it’s necessary to be under general anesthesia for surgery, and I certainly wouldn’t want to be awake if that were even a possibility, which it isn’t – that’s not my point. It’s just weird.)??But my pain levels keep going up and down. Mostly up. I’m so tired of being in pain. I’m tired of not being able to do things. I’m tired of taking drugs. As interesting as percocet is, I’m not a junkie and I don’t want to become one, and I also don’t like the side effects of the percocet (dry mouth, hot flashes, and lack of pooping, which maybe you didn’t need to know).??So, okay. I don’t like it, and I’m freaked out by it, but let’s do it. Slice me open, cut things out, put me back together, and give me the good drugs. Just fix me.??Five days to go.
Monday April 14, 2003
Twenty-four hours to go.
So this is how it’s supposed to be. Once I’m under general anesthesia and on the table, the neurosurgeon cuts open the skin on my back, exposing the muscles. He doesn’t cut the muscles; they are pulled apart like opening a curtain and held in place with clamp-like things. That exposes my spine, which I don’t like even thinking about.
Then he removes some of the bony part of the vertebrae, called the lamina, so that he can get to the area where the disc has herniated. Removing that bone is called a laminectomy. Then he’ll remove the herniated disc material that is pressing on my sciatic nerve, AND apparently he’s going to remove some of the disc material that’s still where it should be, because that will further reduce the risk of a herniated disc later on. That’s called a discectomy. People who have all of their disc removed need to have their vertebrae in that area fused together, which is called a spinal fusion – fortunately, from what the neurosurgeon said he could see on my MRI, I will NOT have to have that. I guess that’s something to be thankful for. When all that’s done, he makes sure everything is clean and sterile, unclamps my back muscles from where they were being held apart, and stitches me up. (Actually, he said it’s more likely that they’ll use medical staples. Staples! I’m going to be like Frankenstein’s monster!) ??I can’t shower or take a bath until the stitches or staples are out, which won’t be for a week after the surgery. I am allowed to sponge-bathe, but that’s never the same. And my hair! I won’t be able to wash my hair! People have been suggesting ways my Mom (or someone) could wash it for me, but the biggest problem is that I’m not allowed to bend at the waist.??Essentially, I will be a stinky creature for a week. But, hopefully, a stinky creature who has no more back pain. I hope. God, I really really hope.??Wednesday April 16, 2003
I’m home!!! I’m not in pain, exactly – I’m very very VERY sore and very very very stiff. ??The pain that was in my back and shooting down my leg seems to be gone. Actually, as soon as I woke up in recovery, I realized that the pain was gone. I almost cried from sheer relief. However, my foot is still numb. The neurosurgeon says that’s normal, because my sciatic nerve was absolutely squashed by the two herniated discs. He says the numbness should go away over the next few weeks as the nerve recovers. ??The surgery went very quickly, with no complications, according to the doctor, and he says there’s no reason I won’t have a complete recovery. The next few days might be tough, with the incision pain (it’s at least 6 inches; possibly longer, and it’s closed with metal staples), and the stiffness and soreness. ??However. It’s done, I have no pain for the first time in weeks, and I’m home and ready to recover.
Thursday April 17, 2003
Home, Day 2
Lots of people have told me that Day 1 home after surgery is actually not bad, because you still have anesthesia in your system, and it’s almost like your body doesn’t quite realize what a major thing it just went through. They said that Days 2 and 3 home can be bad, because it all catches up to you.??They’re right.??I feel like a truck hit me. Granted, probably a small pickup truck, like an import, not even a Chevy, and certainly not like a delivery truck. But I feel worse than yesterday. Just very exhausted, a low fever, no appetite (which is completely out of the ordinary for me), and general aches. But still, this is nothing compared to the awful back pain I had when I collapsed in my primary-care doctor’s waiting room. This is just very very sore. And the incision stings a little.??But I’ve been taking very short, slow walks up and down the hall (2-3 minutes; the surgeon says it’s good to do that every hour, to keep the back muscles from getting stiff and tight around the area that was operated on), and there’s no pain when I do that – actually, no pain at any time – so it seems like the surgery really did what it was supposed to.
Monday, May 5, 2003
My left foot is finally NOT numb!!!??It’s been three weeks since the surgery, and I’m still ridiculously exhausted. I’m beginning to understand why they recommend not going back to work for 4-6 weeks. (Alas, I am single and do not have a nest egg to rely on, so I’m back at work anyway, working half-days and working at home as I’m able to.)??However, the numb foot was the last holdout from the pre-surgical symptoms – the surgeon told me that, because the nerve root was compressed for so long by the herniated discs, it would take at least a few weeks for the nerve to recover and regenerate.??And he was right. ??So, I feel very good about my progress.
Today, three years later
The surgery did exactly what it was supposed to, and I had a 100% recovery. All the pain was gone, and hasn’t recurred. My back still gets stiff and achy if I overdo the exercise, or if I sit in a position that’s not exactly back-friendly, but that happens to most people. I was able to go back to doing everything I did before the surgery – work, exercise, carry in my groceries – I don’t have any medical limits on what physical activity I can do.
Most people with low-back pain – even those with herniated discs – will never need surgery. Nearly 90% of patients recover from low-back pain with rest, physical therapy, and/or medication. I was in a small percentage of patients who didn’t get any relief from non-surgical treatments. Facing the prospect of surgery was scary. I admit that. But compared to living with the level of pain that prevented me from doing almost everything except lying in bed, I was willing to do anything, no matter how scary.
Reference:
- Spine-Health.com, an online back pain medical journal for patients: www.spine-health.com North American Spine Society: www.spine.org
