I visited both my doctors for my back last week, and as I feared they disagreed about what I should do next. Dr. A. said we are “still in limbo” on deciding whether I should have surgery to decompress the spinal nerve that’s taking pressure from an extruded disc. He said I could wait and see if I get further improvement from the second steroid injection I had or whether it wears off. Then I could get a third shot if necessary. He wants me to exhaust the conservative options for treatment before moving on to surgery.
The orthopedist Dr. A. had sent me to ordered a second MRI, which showed no change. The extruded disc is not reabsorbing naturally, at least not yet. Sometimes they reabsorb and sometimes they don’t. I’ve read that most of the absorption tends to happen within the first three months, so hearing that it was unchanged was disappointing.
Dr. A. asked what my takeaway had been from my orthopedist visit. I relayed how the orthopedist had told me that surgery would not necessarily help the nerve recover, I should only choose surgery to relieve pain. (The orthopedist may have been referencing this study.)
The orthopedist also told me that since the weakness had been going on for three months it would likely continue for a long time even if I had surgery. My own reading did not support that. It seems that surgery can produce quick improvement in strength. Usually most of the improvement comes within the first six weeks.
Dr. A. seemed to indicate that he disagreed with the note the orthopedist had sent him after seeing me. He said that “I must have seen him on a really good day.”
I asked Dr. A. what affects the nerve’s chance to recover. He said it’s based on the degree and length of time of the compression. But he doesn’t want me to go to surgery too quickly because it doesn’t always have a good outcome, and he doesn’t want me to have any regrets in case I don’t do well.
Dr. H. on the other hand thinks I should go directly to surgery without further waiting or trying a third injection. He says the chance of the nerve recovering starts to diminish at 4-6 months after the injury, and is definitely worse after six months. Four months from the injury is only a week and a half away for me.
He was pretty insistent with me that he’s not comfortable with my situation considering that I’m active and want to be able to do sports. My hip abduction is pretty weak on the left, as is ankle dorsiflexion and the strength of the big toe. He says he’s seen me three times and there’s been no improvement in my strength, no slope of gradual healing.
He sent a referral for me to a neurosurgeon and I’ll arrange to see that doctor as soon as I can, probably in a couple of weeks. I’m also going to see a second orthopedist. I told Dr. H. he was making me nervous that it could already be too late for the nerve to recover. He said it could be. At the end of the visit he said that he has strong opinions but of course I’d have to make my own decision.
So it’s down to the risks of surgery versus the risks of putting surgery off while waiting for more improvement. The offending disc matter is not reabsorbing, not taking the pressure off the nerve, so that’s a point against waiting. I need to understand better the negative surgical outcomes that Dr. A is concerned about. I imagine the problems stem from removing the cushioning action of the disc.
I’ve tried to read on it a little and I see that there are two ways to surgically treat this problem: aggressive removal of the disc matter, and removing only the part of the disc that is extruded (sequestrectomy). My instinct would be to go for the sequestrectomy and keep as much of the cushioning disc as possible, and my reading seems to support that. I don’t know which technique the surgeons I’ve been referred to favor.
I’ll report back again when I can.