Mending my Back: Injections, Pros and Cons of Surgery

by Mary on October 9, 2016

I’m still off the ice trying to mend my back injury. I had an epidural steroid injection that helped some, enough to get me off a cane. Even after the injection, though, the only exercise I could tolerate was an exercise bike. I still couldn’t walk in the pool for exercise as my PT had suggested.

At my visit with Dr. A., my sports medicine doctor, he agreed that this level of function was not acceptable. Without being able to exercise more I wouldn’t be able to progress in PT. So we decided I should get a second steroid injection.

In addition to my sports medicine doctor I consulted a physiatrist (rehab specialist), Dr. H. Working with two different doctors for the same problem can be awkward, though in this case Dr. H is explicitly onboard with working alongside my sports medicine doctor and has sent him his notes. It’s great when the two agree: hard when they don’t.

Luckily they agree on the broad features of what’s going on, that my pain and weakness is along the path of the L5 spinal nerve and that the large disc extrusion sitting on that nerve easily explains that. And they agree on the general plan: PT, steroid injections as necessary, and if those don’t work, then surgery.

There are some differences between them. Dr. H thinks that if my nerve weakness hasn’t improved by when I see him again next week, I should get surgery soon, certainly by five months after the injury. He thinks if the nerve is compressed for too long the weakness could become permanent.

I’m not sure that Dr. A. believes that. While he thought I should find a surgeon so I’d have one I’m comfortable with in case I need surgery, he didn’t think it was urgent. He sent me to an orthopedist who told me that there’s no scientific proof that surgery will help heal the nerve, that it’s only reliable for getting rid of the pain.

While both docs thought I should get a second injection, Dr. H. considered it “more for surgical planning than anything else.” He wanted the injection done close to the affected nerve to prove that the pain was coming from that level. That type of injection (transforaminal approach) is slightly riskier than the injection I had the first time (interlaminar) but also thought by many to be more effective.

It certainly was more difficult to receive but it’s been worth it. It really helped the pain on the left, which has now become my less painful side.

It’s been a hard project for me to sort through the pros and cons of my options. Everyone agrees that herniations that are causing severe or progressive neurological symptoms need surgery, but for a mild nerve problem like mine opinions are mixed. Some studies suggest that outcomes are just as good without surgery if you wait long enough. Others, like the largest randomized controlled trial (RCT), the Sport Trial, show a better outcome for surgery.

I’ve been through enough medical decisions by now that I just sigh when I read that more research and particularly more randomized clinical trials are needed. There’s so little study of surgical outcomes compared to the extensive investigations required to put a new medication on the market.

I’ve done my best to read some of the relevant literature, things like how likely my ankle weakness would be to recover after surgery. It looks like my chances are pretty good on that front, especially since the weakness is not that bad (the involved muscles have a strength of 4 on a 1-5 scale, with 5 normal).  I’ve also tried to research whether or not surgery produces a better outcome for recovery of muscle strength.

I’ll be further grilling my own doctors and any other surgeons I see on those points. The main reason for me to have surgery, in my mind, is if it’s going to give me a better chance of full neurological recovery. As far as pain, it’s improving and I’m probably over the worst, so I wouldn’t have surgery for that reason alone.

I’ll see both Dr. A and Dr. H. next week and see what they say. Meanwhile I’m riding the exercise bike and trying (with only intermittent luck) to stay patient and keep up hope that I’ll be able to skate again eventually.

{ 10 comments… read them below or add one }

Eva October 9, 2016 at 3:12 pm

Even with all the doctors’ recommendations and suggestions, only you will know what is right for you, Mary. I know you’ll listen to your body and do what is right for your situation. Sending you healing thoughts!
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Mary October 11, 2016 at 5:08 am

Thanks, Eva, I hope so. I can be an overthinker even if it’s just to justify my intuitive idea of what to do. It took me two months to accept the injection for my back, but once I got to feeling like I needed it I had no doubt. It would be great if my future decisions were as clear.


Jo October 9, 2016 at 5:30 pm

Mary, I’m sorry to hear about the continuing pain and weakness. It sounds like you are getting lots of information but no assurances except for the pain management part of it. That nerve damage stuff is SOOO tricky. But your training and dedication as an athlete will definitely help no matter what the outcome.

I myself have a lot of faith in long-term recovery. I’ve had injuries from years ago that I’m only now taking stock of and correcting (rather than just compensating for). First are a number of torn ligaments in my right ankle and associated weakness from an injury 20 years ago. Second is a severed ulnar nerve in my left arm that had to be surgically put together again, along with severed tendons and artery, from a terrible kitchen accident (will spare you the details) 7 years ago. Third is the hip misalignment that I’ve been writing about ad nauseam in this blog. With the third issue, this was initially diagnosed 16 years ago as a nerve impingement in my back. I had shooting pains in my leg and hip, which lessened after two years of PT, though they would come back occasionally. But the hip stiffness, weakness, and lack of balance on my left side was never really addressed until two years ago, when I developed severe pain in my left foot and couldn’t walk. After sessions with two PTs (and this past year working with Sarah, who does postural restoration and works with a lot of dancers) I feel better than I have in years. Even my left hand, which was compromised by the severed nerve, is getting better, and it has been seven years. I’m even playing the clarinet again. Wow!

So while it is sad when there are no quick fixes, I’m hoping that you’ll take comfort in long term recovery. I’m thinking that this process of making my body stronger will take a lifetime, but at least those moments when I thought “it’s all over” are just a blip now in this longer process of healing. And I thought skating was hard! Count me in as one of your fans–cheering you on!
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Mary October 11, 2016 at 5:05 am

Wow, Jo, that is an amazingly detailed and encouraging comment, I really appreciate it. I think you have mentioned the knife injury in passing. I know how hard the ulnar problems caused by excessive computer use can be, I can only imagine how much worse it would be from an injury like yours (severed artery! yikes, scary!). I’m glad that hand is still improving even after seven years. And the hip injury does sound tricky and easily confused with a back problem. I know so many people (including myself) who have previous poorly addressed ankle injuries that come back to bite them. At least our passion for skating and for staying active in general motivates us to address our various issues and keep on trying to stay strong and functional. Thanks for sharing about your healing journey and your support of mine.


Melissa October 10, 2016 at 3:35 pm

Mary, what a difficult situation. I am so sorry you are going through this. It sounds like you’ve got really good doctors, and you’re very good at researching. And it sounds like whatever decision you make will be a good decision either way – just with different pros and cons. I am glad that you’re over the worst of the pain – sending you healing thoughts and prayers to help as you decide what to do. Hugs!


Mary October 11, 2016 at 4:56 am

Aw, thanks Melissa, hugs back to you! I hope I can think of it as a good decision either way, I know that’s true but it can be hard for me to do! I have a tendency to think that I can research and understand my way out of problems but that’s not really how a lot of problems work. Sometimes it’s more of a process that has to unfold or even a rolling of the dice.


Marcia October 10, 2016 at 11:58 pm

I’m so sorry to read this, Mary. How did this back injury happen? Hoping everything works out and you can get back to skating and being painfree.
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Mary October 11, 2016 at 4:54 am

Thanks for the good wishes Marcia. Ironically, it happened doing a physical therapy exercise. I feel like the exercise was ill-advised and caused this, but my sports medicine doctor said it was from wear and tear. I’ve had bulging discs for a very long time, perhaps the exercise was the final straw on rupturing this one.


George A. October 12, 2016 at 8:23 pm

Mary: All I can say is wow. The others above have said more and better than I’m capable of putting into words. My various mis-adventures pale in comparison to what you are enduring. I’ll close by saying that I’m hoping for a good outcome–one which permits you to return to your favorite activity.


Mary October 14, 2016 at 1:42 am

Hi George. I’m not going to trade my misadventures for yours– though let’s both just try to avoid scoring any more in that contest OK? Thanks for the good wishes, I certainly hope for that good outcome too! I will keep you posted.


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