I had this procedure done in 2003. It changed my life for the better! When I woke up from surgery, the pain was gone. When the sedative wore off, I found that my spinal muscles were tight from 15 years of being in mild spasm. Took about three months of stretching exercises to be back to 100 percent. I've had no relapse. I'm doing great. Life is good!
Hi @russell Crawford. Can you send some link for the what kind of rotation we have to avoid? Im in the same situation for last 15 years. Pls help. I will avoid those stretch.
@Noble Roofing & General Contracting Stretches, done carefully, are good. It is the rotating that can cause the inner, soft disc material to squeeze out and put pressure on the nerve root. I destroyed my back when I was a construction worker. Unloading a big truck. Lifting, rotating and stacking. I wish my verbal skills were better so I could explain why the rotating is so bad for the disc. Glad to try to answer any questions I can, if you care.
Wow… im speechless, dr. Thank you so much for these videos. They are so informative and visual its just unbelievable. Im dealing with herniating disks, tingling and numbness in my leg and currently going through the PT. Cortisone shots and even a surgery might be a thing in a near future. Watching these videos tremendously helped me to understand the mechanics and the complexity of the surgery. Thank you and keep up a great work
Extremely useful video. Thank you for taking the time to make it. I had a microdiscectomy five days ago. Just like you, my surgeon mentioned mild pain after and possibly not needing opioids. Given that mentality, I went home without the correct pain management plan and got stuck in bed due to extreme pain and could not move. I know everyone is different but it seems like surgeons like to optimistically downplay pain often, which in my case led to a fairly traumatic experience.
@Nao thank you for this comment. I am d deciding whether to do this surgery or not. I feel pain in my lower back from time to time but it’s never down my leg. I am only doing the surgery because it’s the only option left. I can live with the pain but 15 years from now how would I feel? What if I can’t afford it then? That’s the only issue I have. If I don’t have the surgery now what if I need it later? But from your comment. It literally depicts how my clinic is. The nurses don’t know anything and the doctor is overly positive.
Same here. Just had mines and they don't want to adequately address pain anymore because of misuse! Sad I have to sit in pain because of others actions! They know Tylenol doesn't help AT ALL!!
Surgeons downplay this operation so much. Everyone should be given meds like oxycodone and stool softener to prepare for post op pain. Have the meds and not need them vs. not have them and need them. Back surgery, even this seemingly less invasive surgery is very hard on the body. Surgeon sell this procedure because it's easy $. When they say you will only need Tylenol..... Sound too good to be true? I've had this surgery twice and I'm 35, and I've came out hurting worst both times. Be careful, it's not fun if your surgeon says it's easy. Armaghani did very well in this video. Way better than my two surgeons did for me. I appreciate this video very much because it explained the steps taken and has decent depictions of the approach and tools. Only thing is, what happens if there are complications like finding spinal fluid leaks or tears of the durnal or engorged veins. That's where the surgeons keep a tight lip and might not even tell you their findings... They're very concealing of the hard parts of this procedure and then you end with a lower quality of life forever. 10% unsuccessful rate is what they say, and I greatly disagree with that number. I'm just a person, not a doctor, it's my opinion, it's my experience from receiving this procedure twice. These surgeon (in majority) have never had the procedure done to them so how exactly could they have such confidence in post operation patient experience? I can absorb fake news all day doesn't make me have more experience on war or politics or anything of the topic. First hand experience is more powerful than a compilation of he said she said results. Most surgeon won't answer the phone or emails after the surgery, your only communication is with the nurse (who is overwhelmed and underpaid and most likely gonna give you cookie cutter answers). You'll see the surgeon for two 15 minute post op meetings and the surgeon will overly smile and giving good vibes so you don't have the chance to change the happy mood they are trying to set. If you say anything negative, they're gonna tell you, "just wait another 12 months then you'll feel better and fully healed".... If you don't feel better within the first 3 months from this simple low invasive procedure as they advertise, it's likely the results are the results. If your pain is gone then great! If it's there and morphed into something else, your likely gonna stay like that until further evaluation and rediagnosis.
@Shyam Balani I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
Having this next month. Never been so excited in my life to have a surgery. Been in debilitating pain for 6 months. I'm just ready for some relief and to start to heal even if nerves take a year to heal. Thank you for the video
@Junaid khan I got a surgery removing herniated part of disc at L4-L5. Now its been over 14weeks. I could do my sports Brazilian JiuJitsu 100%. I dont have any radiated pain or numbness anymore since the first day of surgery. Time by time I feel some stiffness on my lower back but not significantly. For my case I did a surgery 10days after the incident.
Thanks for a very informative video! I am in my 3rd week of recovery. The nerve damage caused a dropped foot, so I am already receiving physiotherapy treatment in conjunction with a daily exercise program.
This is so helpful! Your explanations are concise and clear. I’ve worked with many doctors who could do well to watch this for their patient communications. Thank you.
I had mine two weeks ago and I spend four days at the hospital. I was admitted the day before the surgery. After the surgery I had to spend the night in the ICU regardless of my condition, and I did not have any complications after the surgery. The physical therapist came to me the next day after the surgery and taught me how to get out of the bed properly , get dressed and what kind of exercise to do etc. The doctor came every morning to change the bandage and monitor the healing process. When I was discharged a medical professional changed my bandage every three days to prevent any post surgery complications. But I guess every country has different guidelines.
Excellent video all the way through! Just had surgery yesterday and am concerned of numbness now manifested on my three small toes on my left foot. Never had this before. I guess I need to give my body and nerves time to heal 🙂
@G Scranage I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
Just had this surgery also. Look after your back prevent bending. Give your back time to heal. As the Doctor says it can take up to a year for the nerve to fully heal. 🙂
Hi Dr, Thank you very much for the detail explanation - lucky to find this video , I had my surgery a week back and recovering, leg pain issue seems to have subsided majorly , however I am experiencing unbearable upper back ache along the back ribs , I have been noticing this from past 4 months , ( this pain comes early mornings after 6 hrs of continuous sleep , ) checked with lot of ppl , but no one has any answers for it 😓), any idea what this is actually . I was assuming that this upper back ache would go away with the surgery, but it doesn’t seem to be the case
Try sleeping on the floor with soft padded thin mattress. It may be uncomfortable the first day or two but you'll notice significant natural alignment from top to bottom. Let your body find it's natural comfortable sleeping positions throughout the night either on your back and switch from side to side. The firmness of the surface will allow your body to align.
Had this procedure done back in 2003 at S1/L5 and at L4/L5. It allowed me to recovery in less time than expected. I was out hooking and booking again in less than 6 months. However, I have always continued to have pain and stiffness. I am required to have regular epidural injections to help keep me functional
I’ve unfortunately had this surgery twice at L-5, S-1. 20 years apart, first surgery in my twenties, and I work in construction. Worst pain to endure is sciatica, best outcome for me, twice, was a discectomy.
Thank you so much 🙏🏻for explaining step by step my 2023 started off awful..Jan 1st felt a twitch in my back thought nothing off it ..didn’t lift anything heavy basically did nothing ...but next several days became a nightmare severe shooting pain on buttocks and right leg pain shooting and to the point my legs were buckling in and thee worst sciatica pain in my entire life in fact first time ever..went in to see doc after seeing my doctor had ordered MRI and results were L4-L5 Disk herniated 😥the pain has been unbearable..and also said curvature of the spine slightly saw orthopedic doctor yesterday and just confirmed what I already knew..however my question is I’m going to get the steroid injections to pray I don’t need surgery but doctor seemed like we may be heading that way..I’m at day 25 and my back pain has decreased and sciatica lessened but the pain is in my ankle can’t bear weight and when I walk I get very exhausted because of the pain and I have numbness side of calf feels like a Novocain injection when u get at the dentist and tingling big toe and back of ankle very painful..My walk is I’m leaning to one side and hobbling around..So I came across your video and you explained it very well and I understood ..Thank you so much 🙏🏻🇺🇸
Cannot wait till May 31st to have this done!!! I haven't slept on my back since September 2021 🤦♀️ dr. Armaghani had me crying tears of joy this past Thursday 🙌🙌🙌
Great video, thank you doc. I made microdiskectomy 2 weeks ago. I hadn't any special post surgery pains ,just have a numbness in 3 first fingers on left lag, in which I had sciatica during 1,5 year. I really tried everything-stretching spine with all possible ways, medicines, injections in my back...nothing gave a result and in the end I couldn't already move normally, even go from bed to toilet was terrible painful process and I took decision to make a surgery, I wanted to avoid it, but I really hadn't other choice. For a moment all is ok, I'm walking two times per day about 25-30 minutes in normal temp, don't take any medicines ,day by day I want to increase my daily activity, hope all will be ok.
Lucky 9 Hi bro. don't worry, it's normal. seems you also suffered much before surgery. as I understood, hernia demages nerves and its recovering takes many time. Sorry bro, I'm not a doctor to say to you about your situation and what kind of help do you need, but I think good kine and physiotherapy will make good job for you. don't worry bro, you aren't alone, we all have same fkn' probleme and we have to solve it. in your situation I think will be better to take IRM scanning to see what's up. but I think and hope that it needs just time and you'll be ok. sometimes I also feel hurt in my back, in something moment I just have to lay down and I don't care where I'm, I just do it😁for a moment I'm sitting in a cafe, I have a little hurt in my low back, so I have to change my position, I have to walk, if will be need, I will lay down... it's ok😉
Hello. I'm better. after 3 months I started again my work, where I need to walk about 20 km in day. At first all my back muscles were hurting, now it's better. more difficult is sitting, I need to change my pose every 15-20 minutes, other way I feel pain in my low back. sometimes in a time of walking I feel little pain in left leg-always in different places, but it gous fast. when I had stronger pain, I was finding a place for have a 5 minuts relax at bench. now it doesn't need. I still trying to not lift heavy things, but I live alone, so it's not always possible. but if I'm taking something heavy, immediately back gives me reminder, so that's sure, lifting heavy things can send me again at surgery table, so will be better not to do it. I didn't make any sport, even nor just light jogging, I think my walking is enough. maybe in several months I will start to training lightly with my own weight, about gym and heavy weights I forget and don't want to turn back,it doesn't worth it... voila😁that's all my news for a moment... ah, yes, 3 first fingers at my left leg still in same condition, maybe just a little bit better, but I'm not sure. Good luck and health to everyone 🤞
it's a marathon not a sprint. recovery can be very up and down. hang in there and make sure to keep you follow-ups with your surgeon to keep them aware of what you are experiencing.
Glad to hear! 6 weeks is about how long it takes for the hole where the disk extruded to fix scar over. The affected nerve, though, takes almost a year to heal as much as it can heal.
I am about 9 months from surgery - the operation was successful, but recovery has been a lot slower than I expected. While the nerve pain is gone, I am still suffering from significant muscle pain - physio is helping, but it is a slow process. I would still recommend microdiskectomy surgery, but be prepared for a length recovery time.
Well said. Nerve pain we are very good at alleviating. But muscle pain from the back can still remain or be a side effect of the incision that was required to free up your nerve. Working with physios is the best remedy for that. Good luck!
Great information. Currently I had an ortho recommend surgery and a neuro suggested epideral or remaining PT. I've been in pain for four months and PT for 2 months. The disc takes 4 to 6 months to fully reabsorb. I want to avoid all procedures and stay on PT considering long term effects.
I think you did the right thing, Anthony. You got a couple opinions and weighed the risks and benefits yourself and came up with a decision that you are most comfortable with for you and your family. Surgery is always an option at the end and some people come to that decision quicker than others (and sometimes people never reach that threshold).
Great video and i don't even have any questions because i found my answers in the comments you replied to. Thanks for the video and for answering everyones' questions. I was just referred to a surgeon yesterday by my pain management doctor and am waiting for a call from them. I have not 1 but 2 severely bulging discs. One affecting my left and the other my right side, plus synovial cysts and arthritis 😬🤦♂️
Hi Doctor, your vedio is very helpful and so clear. I should have watch your vedio before my surgery. So, I can very careful post surgery. But I just found out now. I had done decompressive hemilaminectomy with discectomy on rigjt L5/S1 six weeks ago. As soon as I had surgery my right leg feels free but the little numbness left. After 4weeks I did normal activity and drive the car. But I started feel pain burning sensation from the butt through the leg and numbness on the little toe. I am worry now. What can happen to me? Do I need another surgery? I feel like my happinest took away now. Plesase advise what should I do? Does disc herniation again? Thanks! for your vedio.
Had this done L5/S1 valentines days this year 2022 .. no initial complications.. was up and walking that night.. Ended up back in for round 2 a few weeks later due to a re-herniation.. probably due to me taking too literally “you can resume some normal activity after this many days..” and then ended up living on my back for two weeks because I was unable to sit or stand.. so if you’re getting this done.. be careful and don’t push it.. give it the time it deserves.. Coming up for 6months post op in about a week.. I’m still walking everyday.. I still get into / out of bed and the car slowly and carefully.. and way more conscious of my overall posture when sitting or standing.. I still get a few ‘grabbing’ sensations here and there mainly with strange angles of movement.. or bending down.. but I only feel now that I’m ready to undertake some more vigorous strength and fitness training.. I was advised to not do any impact related movements for about 6 months due to the degree of initial herniation and the revision.. so been playing it very cool.. the upside is my overall fitness has improved and so has my diet. Feeling all the better for it.. was a worthy wake up call in my life to not take things for granted..
@hills That sux.. But think about your pain, if it’s centralised and has come up rather than still down the leg then it has worked.. but avoid sitting for more than a few mis where ever possible.. After two surgeries I wasn’t taking any chances.. and wanted to keep the back as straight as possible.. sitting for an hour? Not a chance.. I would have been standing/walking around or laying on the floor.. sitting tilts the pelvis and puts pressure square on the L5/S1 joint.. which is only going to encourage more disc to potentially leak out before it’s had the chance to scar over.. and I would sleep on my side with a thin pillow between my legs. Walking every day within reason (for me that helped).. I never really found the pain meds to do much for me.. would only take them at night when I had perhaps stressed it.. I found celecobix (I think that’s what it’s called) was beneficial to me.. (think an anti inflammatory or a neuropathic thing).. Nerve pain is the worst possible pain.. I’d also encourage you to consult with your GP regarding medications.. and any neurologist worth their salt would understand the degrees of pain.. and I doubt they think you’re just after meds if you don’t need them.. they should have a nurse on staff you could make an appt with rather than the neurosurgeon.. I met mine twice before the surgery.. and he told me unless there is a major issue, to cancel his 3 month appt.. I don’t know dude, just keep in contact with them and if you get another scan and it comes up clear then you know it’s just residual nerve pain.. there are no guarantees that these surgeries will leave you pain free.. and if you feel you need a second opinion, then seek that out..
After my surgery the first time. I was pain free for about 3 month's and then had surgery 6 month's later on October 3rd 2022. The pain is lower center back pain, not at incision site. Went to my 2 week post op appt that I didn't want to go to because the pain from sitting makes it worse. My Dr told me to come in due to the pain and was basically a wasted trip, I had to sit for over a hour to see my neurosurgeon. I got a shot of toradol and tramadol, not helping. Still in pain today and seems walking makes it worse. My 1st discectomy recovery was way easier and I didn't have this pain at 3 week's. I explained to my neurosurgeon that I'm having left side lower back pain. I left feeling like he thought I was asking for pain meds!
@hills everyone’s case is going to be different.. how long you had the severe pain before surgery , and the severity of that pain.. where the pain was, how bad the herniations were, where they were snd if there was more than one.. and the activities and condition of your body that led up to the disc issues.. for me it was a generally inactive lifestyle (I mainly sit for my job) and then I was doing quite hard labor with lots of digging and lifting from doing the paving around my house and shifting copious amounts of sand and soil over the last two years.. which clearly did some damage.. When it went really bad for me I had the surgery within 48hrs.. so recovery was faster.. I didn’t need meds after 3/4 days besides the anti inflammatory meds.. and then took something ever now and then when I felt a flare up.. or had done a bit too much that day.. just use those meds (within reason) to help.. nerves have pain memory.. and if the pain is localised to your back and not in your leg or butt then that’s a positive step.. make sure you keep the walking a couple times a day.. do the squats, leg lifts and calf raises.. don’t sit too long.. and if it’s honestly still really bad then say something.. ask for another MRI referral and if that shows an all clear then you know it’s just nerve memory.. the spinal nerves are pretty serious nerves. And they heal slowly.. really slowly.. same with discs.. and don’t forget they drilled away some of the bone in order to access the disc.. simple operation sure.. but still a very serious one. There have been times when I thought it’s happening again.. even still I feel it grabbing when standing after I’ve been sitting for a while.. but it’s lessening.. just be honest with yourself and your pain, do the work you need to do to recover.. and speak to them.. questions don’t cost anything to ask..
I'm on my 3rd week after my 2nd discectomy. I'm in so much lower back pain, not even in the area of the surgery. Did you have this pain 3 week's post op?
I had it done 3 weeks ago what a relief just healing now the pain was so great I screamed to sit or walk ..had my surgery done at riverside hospital columbus ohio
Hi I got disceptomy too a month ago. I used to train brazilian jiu jitsu everyday. After OP, my leg pain was immediately gone. Some numbness lingers still. I do lots of air squats. I hope to go back to Tatami soon.
Very informative video thank you doctor. I have a mild herniated disc slight bulge. I have leg pain it was as 9 out of 10. I was offered to get a steroid epidural injection or this surgery I choose the injection the pain went down to a 6 now. I was told to do lots of cardio lose weight and stop lifting for 6 weeks but the million dollar question is the doctor nurse won't tell me if it will heal on its own or how long will It take to heal but they offered surgery but I'm really trying to avoid it. But I'm very glad u been very specific on this surgery because I'm starting to consider it.
Thank you so much for such detailed demonstration! I wonder, why surgeons choose to remove a part of bone in order to reach to the herniation, just like your demonstration in this video, but not to use minimally invasive way by using circular retractor tube to remove the herniation?
Good question! Whether you use a tube or another retractor, you still need to remove bone in most cases to access the spine and nerves to move them over and remove the disk herniation.
Thank you! I'm scheduled to see a neurosurgeon in 2 weeks. MRI shows I have 2 hernia disks and a bone spur on l5. How long would that take to for you to fix, and also how long till I can work again. God bless your work💯
Having a portion of a disc removed, does it regain mass over time or would you be living with a disc smaller than all the others. If so how does that disc hold up over time? Thanks so much very informative video
Great question. Unfortunately we are not able to regenerate disk material. Most of the time when we do this surgery we can remove anywhere from 5-15 or even 20% of the disk. Normally that is ok but sometimes if a patient has another disk reherniation and we have to remove more disk there is so little left that they end up getting back pain from the lack of cushion and fusion is sometimes needed. The chance for reherniation for most people is about 10% lifetime.
What are your thoughts on encountering significant engorged venous plexus veins when performing this procedure. Is it something you would try to diagnose immediately and try to shrink the veins to make room for the nerve root or maybe would it require a different surgery? Thanks.
@Armaghani Spine If you could, please give any advice to a patient, how to approach my doctor/neurosurgeon to check for engorged veins that may possibly be significant enough to pinch my nerves to get surgery approved by insurance? For example my MRI doesn't show major disk herniation (only mild), but the symptoms and pain is real and very debilitating causing my quality of life to fall apart and even more so mentally when no one believes the level of pain I'm having. I just can't figure out why my sciatica and nerve(s) are burning and shoot so painfully sharp all day from my lower back down my left leg and tingling and numbness to the feet. Every doctor has said I'm too young to be having this problem, 35. I'm well educated as an Engineer and I can research all day but I can't self diagnose. I'm not fit work, I can barely sleep.
Good question. We do occasionally see large veins running along side the fluid filled sack that holds the nerve rootlets. Fortunately, we have a took called a bipolar electrocautery which we can basically pinch the vein and then we can coagulate it with a small amount of heat which then prevents it from bleeding and decreases the size significantly.
Sir I had back injury l5-s1 almost 19 years ago and I was managing with it since then.There was no problem until this year October-2021 except mind pain occasionally but now weakness and pain in legs hips and burning sensation.Epidural injection didn’t heal.Doctor suggested for microdiscectomy surgery.My question is my nerve is compressed since long , what is your suggestion on this ?
I have been having this pain for about 11 years now, after my MRI scan the result showed. L4/5 and L5/S1 posterior disc bulges with bilateral neuroforaminal stenosis. What should i do Dr?
Really great video ! Suffering from stenosis for 3 years now and still not sure. Although my Mobility improved a lot I still have burnings frm buttocks to both legs. This presentation helped me to accept having this laminectomy surgery. I'm just 67 still very active so worth it to try. Average cost ?
Very helpful video Dr. Armaghani. I noticed you didn't comment on Coflex as part of this procedure. Is this not something you do as part and parcel of a micro-discectomy. I'm due for micro-discectomy in two weeks for L4-L5 herniation but the neurosurgeon wants to put the Coflex Interlaminar stabilisation device in also. I'm reading the empirical research on this at the moment as it has been around since 1994 but I know of at least one surgeon who reported them as a "failure". Would be interesting to hear your perspective on this.
@Jaymeirish I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
@Armaghani Spine Thanks for your response. Do you place any mass in any of the interspinal devices? Separately, whats the feeling regarding 'DiscSeel' in the spinal-surgery community?
@freestyle bully I have a bulging disk and a ruptured disk I'm still waiting on surgery but I have found a surgeon he said I need a discectomy on two disk and a laminectomy on the same two s1 l5 l5 l4 he discovered I need stents put in both legs before I can get my back surgery also discovered I have a aneurysm in one of my legs main arteries so I guess it could have saved my life I'm waiting on a phone call from a vascular surgeon to get the stents put in before I can get the back surgery but the surgeon said it should not be a problem to fix my back, good luck with yours.
@Richard Turner I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
@Armaghani Spine Thank you for your response, as long the decision to go forward or not is the patients decision, you are one of the very few neurosurgeon's in America who still alow that.
Thank you, Mr. Turner. I try to be as upfront and clear with expectations as possible since there is really nothing "routine" about spine surgery. My philosophy is to lay out all the risks and allow the patient to make the best decision for themselves given the risks and benefits. The risk/benefit ratio varies greatly from patient to patient.
Hello and thank you for your Illustrations. Just a question: if a patient has two herniated disc in 2 consecutive levels ( L4/L5 and L5/S1) can microdiscectomy on both discs be performed on one operation setting? Is it also possible to perform 2 laminotomies on these 2 different levels or will it cause spinal dynamic instability which requires a fusion operation in the very first place? Thanks in advance for your response.
Great question. Yes, both can be addressed in the same setting if they are both causing symptoms. Sometimes one is much bigger than the other and we just operate on the one we believe is symptomatic. Doing a unilateral laminotomy doesn't affect stability too much. The chances of reoperation following a laminotomy and diskectomy runs about 10-20% lifetime so it isn't too risky in terms of reoperations.
Hello Doctor. I had a surgery (laminectomy) 20 years back . After a few yrs, I started having severe pain again, then my doctor gave me an epidural. Then I was ok, except for some pains that I could cope with. Lately, 3 years back, I started having acute pain again. Doctor prescribed many painkillers, but nothing worked. Then I had another epidural. Since then I got some relief, but unfortunately the pain is back now. Doctors prescribing painkillers again, but no relief. So, can u ,please, Doctor suggest any treatment or advice for me?
What happens to the part of the disc that was raptured and caused leaking/herniation? Does it get sutured or something like that or does it heal over time on its own (i.e., closes)?
Good question. The part of the disk that came out is removed completely off the nerve. Unfortunately, that part of the disk can't be reformed though. The hole where the part of the disk herniated out takes about 6 weeks to scar over and that is why we limit bending and twisting for the first 6 weeks after surgery. People have tried suturing or other devices to close the hole but none have worked any better than just letting the hole close on its own.
I just got this procedure 01/11/23. Couple days post surgery. As expected I’m experiencing pain around the incision site, but I am also experience pain around the right side of my hip and my calves feel like they are going to tear every time I walk. Is this common? Wondering why or if this pain will go away.
people experience strange pains around their legs following surgery within the first month or so. i always encourage patients to just let the dust settle.
Saying severe compression of lumbar nerves may cause 'discomfort' wins the understatement of the year award. 👨🦼 ♿ Outstanding videos, helped me finally understand a 20 yo surgery and one they want to do next.
I did not mean to say "discomfort" to downplay symptoms. I use the word "discomfort" because it can cover a lot of things that patients may experience such as numbness, tingling, burning, stabbing etc. I used to use "pain" early in my career but realized that patients would frequently say no it doesn't hurt it tingles (for example). I've found that "discomfort" covers all those basis and allows the patient to describe better for me what they are feeling. The discomfort from a disk can be quite brutal and bring even the toughest ppl to the hospital!
This was an extremely helpful video. Thank you very much. My question is, my doctor recommended and sent a referral to a Neurosurgeon for this surgery and not a Orthopaedic surgeon. Who should I be seeing?
@Anthony P I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
Very common question. The techniques employed by orthopedic spine surgeons and neuro spine surgeons are the same. There is no difference in technique just subtle differences in training. There are fantastic ortho spine surgeons and fantastic neuro spine surgeons. There are also ones from both sides that aren't so great. Go with whoever you feel most comfortable with as there is no difference in techniques.
Very interesting procedure and video, Shame that he is in Fla. and I am in Pa. I have had 4 previous back surgeries, two were to repair the Dura due to a spinal fluid leak. Currently, I have another disc herniation with 24 hr non-stop pain, it actually feels like I'm walking on a broken hip which extends into the groin and leg, I haven't had any quality of life in two years. Hopefully, this technology will expand and becomes a procedure that more surgeons adopt.
sorry to hear but good luck to you. A good friend of mine Dr. Jesse Bible works in Hershey, PA and is excellent if you are looking for a second opinion.
Hey doctor. I have an extrusion of about 12mm. Diagnosed by mri. Since it is an extrusion would the disc normally be healing back "behind" the extruded portion already (like closing a flood gate after releasing some water)? Or does the extrusion sort of hang on to the inner "jelly" ?
Thanks for responding! Curious on the go or no go timeline for surgery. I'm at about 6 weeks and no real sign of improvement other than I can lay around most of the day and not be in horrible pain. Standing it gets bad in the foot within 10 min and sitting I'd rather have my fingernails pulled off. Most say 3-6 months but the downtime is killing me work and lifestyle wise.
both can actually occur. if the disk is described as "sequestered" that means the flood gate has closed. either way about 75% of patients will improve without operative intervention.
How long does it take to cause nerve damage from not repairing a compressed nerve? I've left mine for 3 years and now want the surgery but fear nerve is already damaged...
every person is different but in general it takes about 1 year from when the compression is removed to heal as much as it can. the longer it is compressed, the less likely it is to heal fully although it is possible. several factors come into play with this.
Good question. The amount of bone removed is no bigger than a nickel and it is 4-5cm deep at least. The hole remains forever but it does not cause any problems later on unless too much bone is removed.
Hi sir. I'm Naresh from India. I had L4 - laminactomy 12 days before. Now I'm walking slowly still I have pain little bit right to spine. But my hip is bending towards right little bit during walk n stand. Is that alright after recovery., or it remain s permanently... Please clear my dout.... Sir
Hello doc, if the herniation is in both left and right side, then the bone needs to be drilled at both side? If yes, doesn't it make the bone very weak and more prone to injury and getting back the normal as before
only on the side that has pain. if both sides have pain then yes. bone will not grow back but it is very deep in the body and doesn't cause problems by not being there.
I have back stiffness which lasted now for more than 7 weeks after microdiskectomy. I can not pick up any thing belwo the level of my knees. I can not pend forward but I can bend backward. Also I still have back pain. I have abnormal posure anterior pelvic tilt. Is this part of the natural history of recovery or I should seek medical advice.
Most important things to ask usually have to do with return to activity level or work and at what time. Also asking what % improvement in both back and leg pain and at what time points is important too. I tell patients that how you feel at 1 year is about how youll feel long-term but you get most of your recovery within the first 10-12 weeks of surgery. I also tell my patients they can return to all prior activities 6 weeks after surgery. Every surgeon is different and specifics of your case can alter those answers.
The bone does not grow back. In all, it is probably about the size of a nickel of bone that we actually remove to see the nerve. Generally the muscles in the back take about 6 weeks to heal but the nerve can take up to a year to heal up to it's fullest extent. Patients are cleared to return to their normal activities at 6 weeks though.
fantastic question. those situations can occur if the pain has been there for an extended period of time (>1 year). Nerves take about 1 year to fully heal once compression is gone (either surgically or non surgically)
How do you replace the bone that you have removed? Will my spine be weaker as a result of this surgery? My injury is in L5 S1. No pain, however right toe does not lift, right leg is weak, and numbness on outer, upper right side of leg. In my case, is it worth it to have the surgery?
The bone isn't replaced as it is just a small piece that is removed. Usually no bigger than the size of a coin. It is also about 4-5cm at least deep under the skin so it has plenty of protection from muscle and soft tissue.
Hi, your videos as very informative and helpful. Just want to know when u said dura, u mean also thecal sac? I also watched ur video regarding TLIF. Thankyou very much for all ur videos and sharing ur knowledge
@freestyle bully I'm so sorry I didnt see your reply till now. How are you doing? Have you avoided surgery? I do have several complications going on after surgery, although I no longer have the terrible sciatic pain. I hope you are feeling better.
@Chitrani Perez I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Are you having any complications after surgery?
@Mei-Lin Knetsch I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
My surgeon just told me (1 month post microdiscectomy L5S1) that the thecal sac is still rubbing/impinging on my nerve. It has not sprung back into it's proper position. This is to explain why I still have terrible pain when I sit (no more than 2 mins) stand or walk. Great videos Dr, thank you.
I just had this survey on 3/6/23 A herniated disk on my sciatic nerve boy. I was in pain for a few months but I have this done 10 years ago I asked if could it come back and it did after 10 years I was having pain from my back to my toes. I couldn't feel my toes my calf also was numb and I couldn't feel anything. Today is march 7th and Of course, there is pain because the meds are wearing off but I was given muscle relaxers, and pain medicine the good thing is I can feel my toes now and there's no numbness in my calf as well, And no pain from my back to my butt. I just have to move slowly around and You will feel the pain as a doctor stated in the video by them using these instruments to hold back your muscles and bone etc for the most part I know I will feel better after a few days my butt bone is what hurts the most right now. You will need help from your family or friends for a while and you shouldn't drive at all until it is safe to do so and don't lift anything more the 5lb or a gallon of milk and don't pull or push anything until you doctor tells you it is ok you don't want to have to go through another surgery or herniated disk on your nerve again. Good luck if you have to have this surgery.
This is the most helpful and easy to understand video regarding this procedure. Thank you so much. I do have a question or two. The disc is bulging due to a tear or weakness in the annulus wall, right? So when the bulging material is removed, will the disc continue to leak and press against the nerve? And will the disc degeneration get even worse for that disc because part of it is missing now? It just seems like this procedure damages the disc even more so.
@Deepred Dawg thanks for responding my aunt has several disc herniations since 2016 her back and legs hurt 24/7 she said she got 1 shot each year the past few years she said her shot relief lasts a year the first 3 times and only 2 months the last. time its temporary relief I want permanent relief lol I hope u have a speedy recovery
@freestyle bully HI. I had/have a bulge in the same area. But haven't had any pain issues since I got an epidural spinal injection. It's not major surgery. Just a steroid shot in your spinal canal to shrink the swelling and help with the pain.. Never had major back surgery. That should be your last resort. Good luck bro.🙂
@Deepred Dawg I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
And remember when your surgeon whistles with big eyes when he looks at your MRI you know its gonna be a long ride lol. Im a 41 y.o. male and Had this done L4-L5,L5-S1,great explanation video tyvm Dr.
Month out and I feel a little relief but my drop foot on my left is going to be permanent unfortunately .Surgeon said fusion was probably going to happen but he wanted to do this procedure first.He did left and right sides .I have degenerative disc disease so im not a candidate for replacement surgery.These videos are very informative and helpful when I have questions during follow-up. Thank you again Dr wish you were here in Las Vegas your help would be greatly needed in this city.
The recovery process does tend to be a 2 steps forward 1 step back sort of recovery especially early on within the first few months. After that time period things tend to calm down and you have steady improvements. How you feel at 1 year is how you feel long term. Chance of reherniation runs about 10% and is most likely to happen within the first 6 weeks.
Good question. The amount of bone that is removed is only about the size of your thumb nail, if that. It is also pretty deep under the surface of your skin - at least 4-5 cms. When we are done with the case, we close up the muscles over the bony defect in multiple layers and that provides ample protection to the spine and nerves. I haven't seen an injury to the spine from a direct blow to the back in my entire career.
correct! sometimes just removing the bone is enough to decompress the nerve. that procedure is called a hemilaminectomy. that is usually done in situations where there is more bony narrowing that is causing nerve compression instead of a disk. if a disk is also causing compression we remove it at the same time. goal of surgery is to make sure there is no pressure on the nerve.
Hi dr. Your videos are so helpful. I just want know. i had disc bulge l5S1 and had microdiscactomy surgery. Its been more than 6 weeks . still i have tingling numbness in my both cuff and feet burning sensations on both side as before surgery. Or it might be stenosis . What should i do . Please suggest me. Thank you
In general, nerves take a long time to recover after surgery. Up to a year. During that time patient's can feel many different things during the course of their recovery. I'd discuss the concerns with your surgeon but hang in there!
I'm curious about how the bone that was shaved off regrowth? A few of the videos I watched didn't explain that process. Dr., can you help explain that for me?
Question? I have been having Cervical Radiculopathy pain for two 1/2 years with three MRIs down and many tests. I've been told that the MRIs show small bilateral disc bulge around C5 C6 with osteophyte complex. I've been avoiding any type of surgery and have gotten mildly better but symptoms are just not resolving. So with my third MRI I went to a Neurosurgen this past Monday who said that my neck is good and the bulge is not pressing on nerves. He didn't mention the osteophytes complex and I forgot to bring it up because I got emotional as 'nothing' was shown to cause my pain. He mentioned that my symptoms may be arthritis in the spine and then I went on my way. The question is can a Neurosurgen not see if arthritis/bone spurs/osteophytes are pinching nerves? My PCP is now trying to get me to see an Orthopedic Surgeon. Just confused on this. I'm hoping an Orthopedic Surgeon can see the pinched areas because now if gives me the feeling like I will never find the cause of this even though it was previously noted on the MRIs but apparently not coming from a disc bulge. Sorry for how long this is. I appreciate your input!
Typically an MRI that shows a bulge can also be called an osteophyte complex as well it just depends where the compression is coming from. Getting opinions is important though. Good luck!
I used to get the pain , when I make long bike rides and now the pain is not so severe and more often no pain at all, do you think a person should go for surgery if he doesn't have pain but owing to such surgeries at young age is much easier than old age?
i would advise not to. my trigger for patients is when they feel they can't do the activities they enjoy doing because of the pain they get. If they can - don't do it.
If my disc is herniated on the left and on the right with central canal stenosis, would the left side only be removed if that is the side where my pain is? I have no pain on the R side.
Excellent question. This is a surgeon to surgeon choice. I like to address areas where the patients are experiencing symptoms. If you have bilateral narrowing but only left sided symptoms, I almost always would do just the side that is giving you problems because once you remove that problem, the symptoms improve and usually the compression on the other side can improve too since you can reach to at least midline to remove disk material.
The bone doesn't grow back but the size of bone that is removed really only amounts to the size of your thumb nail and this defect in the bone is 4-5cms deep to the skin surface at least.
I like to thin out the superior lamina of the level below about 3mm from the tip. I then remove bone from the lamina above up to the point where i see epidural fat peaking out from under the ligament. I then use a curved curette to develop that plane between the under surface of the lamina above to release the ligament from that under surface and then when i am in that plane, i flip the curette 180 degrees so that it is now facing caudal towards the superior lamina of the level below. I then move the curette towards that superior lamina creating a rent that goes cranial to caudal within the ligamentum flavum. When i get to the undersurface of the superior lamina of the level below i am able to break through that small thinned portion and that releases the ligament caudally. with the ligament now released cranially as well as caudally, I can pull it towards me and i use a kerrosin to complete the resection laterally.
@freestyle bully Hi, I have L5-S1 herniation to the right side. It was causing very bad leg pain all the way to my foot to the point I couldn’t sit or stand longer than 10 minutes. It sounds like your symptoms are quite different to mine. I am now 11 months later since the start of symptoms and I would say I am 75% better. I just have pain if I sneeze or cough and like you if I sit a long time I get stiff. What helped me was getting injections. I had one intradiscal ozone injection combined with a steroid injection. I have seen my MRI and the disc bulge has reduced by half the size now. If you do not improve after a few months of physio I would recommend looking into the injections but they take a few weeks/months to work. It is possible I might still need surgery to get to 100% better but I am going to give it a bit longer to see if I can heal completely without it.. personally I didn’t find physio very helpful although I would recommend reading the book back mechanic by Stuart mcgill. Good luck!
@Joe Lawrance I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Are you having any complications after surgery?
I have facet joint syndrome and am experiencing intense pain in my lumbar and mid spine,I have a slipped disc at L4 but have osteoporosis, would this be helpful and could it be done in people with osteoporosis?
I don't think I'm a candidate for this surgery yet but I'm not sure I have L4 L5 herneated and some stenosis. Along with degenerative disk but that's probably because I'm in my mid forties. It's been 7 months on and of butt and leg pain. Don't want to go the surgical route but steroids physiotherapy and chiropractor did nothing
I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get better since u commented a month ago? Are you having any complications after surgery?
I had this procedure done in 2003. It changed my life for the better! When I woke up from surgery, the pain was gone. When the sedative wore off, I found that my spinal muscles were tight from 15 years of being in mild spasm. Took about three months of stretching exercises to be back to 100 percent. I've had no relapse. I'm doing great. Life is good!
I just did my surgery today I feel so much better.
What exercise you recommend to me I am in my mid 32!
Thank you
Hi @russell Crawford. Can you send some link for the what kind of rotation we have to avoid? Im in the same situation for last 15 years. Pls help. I will avoid those stretch.
@Noble Roofing & General Contracting Stretches, done carefully, are good. It is the rotating that can cause the inner, soft disc material to squeeze out and put pressure on the nerve root. I destroyed my back when I was a construction worker. Unloading a big truck. Lifting, rotating and stacking. I wish my verbal skills were better so I could explain why the rotating is so bad for the disc. Glad to try to answer any questions I can, if you care.
Wow… im speechless, dr. Thank you so much for these videos. They are so informative and visual its just unbelievable.
Im dealing with herniating disks, tingling and numbness in my leg and currently going through the PT. Cortisone shots and even a surgery might be a thing in a near future.
Watching these videos tremendously helped me to understand the mechanics and the complexity of the surgery.
Thank you and keep up a great work
How can i be able to reach the Dr.
You're most welcome. Good luck!
Extremely useful video. Thank you for taking the time to make it. I had a microdiscectomy five days ago. Just like you, my surgeon mentioned mild pain after and possibly not needing opioids. Given that mentality, I went home without the correct pain management plan and got stuck in bed due to extreme pain and could not move. I know everyone is different but it seems like surgeons like to optimistically downplay pain often, which in my case led to a fairly traumatic experience.
@Nao thank you for this comment. I am d deciding whether to do this surgery or not. I feel pain in my lower back from time to time but it’s never down my leg. I am only doing the surgery because it’s the only option left. I can live with the pain but 15 years from now how would I feel? What if I can’t afford it then? That’s the only issue I have. If I don’t have the surgery now what if I need it later? But from your comment. It literally depicts how my clinic is. The nurses don’t know anything and the doctor is overly positive.
Same here. Just had mines and they don't want to adequately address pain anymore because of misuse! Sad I have to sit in pain because of others actions! They know Tylenol doesn't help AT ALL!!
Surgeons downplay this operation so much. Everyone should be given meds like oxycodone and stool softener to prepare for post op pain. Have the meds and not need them vs. not have them and need them. Back surgery, even this seemingly less invasive surgery is very hard on the body. Surgeon sell this procedure because it's easy $. When they say you will only need Tylenol..... Sound too good to be true? I've had this surgery twice and I'm 35, and I've came out hurting worst both times. Be careful, it's not fun if your surgeon says it's easy. Armaghani did very well in this video. Way better than my two surgeons did for me. I appreciate this video very much because it explained the steps taken and has decent depictions of the approach and tools. Only thing is, what happens if there are complications like finding spinal fluid leaks or tears of the durnal or engorged veins. That's where the surgeons keep a tight lip and might not even tell you their findings... They're very concealing of the hard parts of this procedure and then you end with a lower quality of life forever. 10% unsuccessful rate is what they say, and I greatly disagree with that number. I'm just a person, not a doctor, it's my opinion, it's my experience from receiving this procedure twice. These surgeon (in majority) have never had the procedure done to them so how exactly could they have such confidence in post operation patient experience? I can absorb fake news all day doesn't make me have more experience on war or politics or anything of the topic. First hand experience is more powerful than a compilation of he said she said results. Most surgeon won't answer the phone or emails after the surgery, your only communication is with the nurse (who is overwhelmed and underpaid and most likely gonna give you cookie cutter answers). You'll see the surgeon for two 15 minute post op meetings and the surgeon will overly smile and giving good vibes so you don't have the chance to change the happy mood they are trying to set. If you say anything negative, they're gonna tell you, "just wait another 12 months then you'll feel better and fully healed".... If you don't feel better within the first 3 months from this simple low invasive procedure as they advertise, it's likely the results are the results. If your pain is gone then great! If it's there and morphed into something else, your likely gonna stay like that until further evaluation and rediagnosis.
@Shyam Balani I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
How do you feel now? I am planning to have the same next week.
Having this next month. Never been so excited in my life to have a surgery. Been in debilitating pain for 6 months. I'm just ready for some relief and to start to heal even if nerves take a year to heal. Thank you for the video
@김천재 thank you so much
@Junaid khan Yes. If you feel it, you should try it. Do not worry so much. You will get better!🥰
@김천재 that's good. Happy for you. i think i tried every thing now i should go for surgery
@Junaid khan I got a surgery removing herniated part of disc at L4-L5. Now its been over 14weeks. I could do my sports Brazilian JiuJitsu 100%. I dont have any radiated pain or numbness anymore since the first day of surgery. Time by time I feel some stiffness on my lower back but not significantly. For my case I did a surgery 10days after the incident.
@김천재 So you
have had surgery what was the result what are you feeling now
Thanks for a very informative video! I am in my 3rd week of recovery. The nerve damage caused a dropped foot, so I am already receiving physiotherapy treatment in conjunction with a daily exercise program.
This is so helpful! Your explanations are concise and clear. I’ve worked with many doctors who could do well to watch this for their patient communications. Thank you.
Thank you so much, Jessica.
I got the discectomy surgery 2 months ago. Great informative video. Thanks so much Dr. Keep up your hard work. Appreciate it!
How did it go?? Feeling better? My sciatica is hell right now
Much appreciated!
Thank you for making me fell better about getting this surgery. Dealing with extreme pain for 15+ years. Can’t take it anymore.
You're most welcome
Thanks so much for explaining this! I’ve only had pain 2 months 34F and can’t wait for my procedure. I feel more comfortable knowing all the info.
Glad it was helpful!
I had mine two weeks ago and I spend four days at the hospital. I was admitted the day before the surgery. After the surgery I had to spend the night in the ICU regardless of my condition, and I did not have any complications after the surgery. The physical therapist came to me the next day after the surgery and taught me how to get out of the bed properly , get dressed and what kind of exercise to do etc. The doctor came every morning to change the bandage and monitor the healing process. When I was discharged a medical professional changed my bandage every three days to prevent any post surgery complications. But I guess every country has different guidelines.
Excellent video all the way through! Just had surgery yesterday and am concerned of numbness now manifested on my three small toes on my left foot. Never had this before. I guess I need to give my body and nerves time to heal 🙂
Nerves can take up to 1 year to heal..!
@G Scranage I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
Just had this surgery also.
Look after your back prevent bending.
Give your back time to heal.
As the Doctor says it can take up to a year for the nerve to fully heal. 🙂
Hang in there!
Thank you Dr. This presentation was so easy to understand. Keep up the good work
Glad it was helpful!
Hi Dr, Thank you very much for the detail explanation - lucky to find this video , I had my surgery a week back and recovering, leg pain issue seems to have subsided majorly , however I am experiencing unbearable upper back ache along the back ribs , I have been noticing this from past 4 months , ( this pain comes early mornings after 6 hrs of continuous sleep , ) checked with lot of ppl , but no one has any answers for it 😓), any idea what this is actually . I was assuming that this upper back ache would go away with the surgery, but it doesn’t seem to be the case
Try sleeping on the floor with soft padded thin mattress. It may be uncomfortable the first day or two but you'll notice significant natural alignment from top to bottom. Let your body find it's natural comfortable sleeping positions throughout the night either on your back and switch from side to side. The firmness of the surface will allow your body to align.
Had this procedure done back in 2003 at S1/L5 and at L4/L5. It allowed me to recovery in less time than expected. I was out hooking and booking again in less than 6 months. However, I have always continued to have pain and stiffness. I am required to have regular epidural injections to help keep me functional
Thanks for sharing. That is not an uncommon thing to have maintenance shots years after surgery.
Excellent to finally see what my surgeon did! Very informative information! Thank you.
Glad it was helpful!
I just had this done at L4/L5 last week. My surgeon was good, but didn’t explain in as much detail as this. Thank you
How u feeling?! Who was your doc?
I’ve unfortunately had this surgery twice at L-5, S-1. 20 years apart, first surgery in my twenties, and I work in construction.
Worst pain to endure is sciatica, best outcome for me, twice, was a discectomy.
Sciatica can bring even the most tough individual to their knees. It is not pleasant in any way. I'm glad you've got your issue fixed.
Very informative!
The recovery part well explained.
Thank you
Glad it was helpful!
Thank you so much 🙏🏻for explaining step by step my 2023 started off awful..Jan 1st felt a twitch in my back thought nothing off it ..didn’t lift anything heavy basically did nothing ...but next several days became a nightmare severe shooting pain on buttocks and right leg pain shooting and to the point my legs were buckling in and thee worst sciatica pain in my entire life in fact first time ever..went in to see doc after seeing my doctor had ordered MRI and results were L4-L5 Disk herniated 😥the pain has been unbearable..and also said curvature of the spine slightly saw orthopedic doctor yesterday and just confirmed what I already knew..however my question is I’m going to get the steroid injections to pray I don’t need surgery but doctor seemed like we may be heading that way..I’m at day 25 and my back pain has decreased and sciatica lessened but the pain is in my ankle can’t bear weight and when I walk I get very exhausted because of the pain and I have numbness side of calf feels like a Novocain injection when u get at the dentist and tingling big toe and back of ankle very painful..My walk is I’m leaning to one side and hobbling around..So I came across your video and you explained it very well and I understood ..Thank you so much 🙏🏻🇺🇸
hang in there. most people can improve over 3 months. thank you for the kind words.
Cannot wait till May 31st to have this done!!! I haven't slept on my back since September 2021 🤦♀️ dr. Armaghani had me crying tears of joy this past Thursday 🙌🙌🙌
you'll do great!
Great video, I found this to be helpful and informative 👍
thanks much!
Great video, thank you doc. I made microdiskectomy 2 weeks ago. I hadn't any special post surgery pains ,just have a numbness in 3 first fingers on left lag, in which I had sciatica during 1,5 year. I really tried everything-stretching spine with all possible ways, medicines, injections in my back...nothing gave a result and in the end I couldn't already move normally, even go from bed to toilet was terrible painful process and I took decision to make a surgery, I wanted to avoid it, but I really hadn't other choice. For a moment all is ok, I'm walking two times per day about 25-30 minutes in normal temp, don't take any medicines ,day by day I want to increase my daily activity, hope all will be ok.
Lucky 9 Hi bro. don't worry, it's normal. seems you also suffered much before surgery. as I understood, hernia demages nerves and its recovering takes many time. Sorry bro, I'm not a doctor to say to you about your situation and what kind of help do you need, but I think good kine and physiotherapy will make good job for you. don't worry bro, you aren't alone, we all have same fkn' probleme and we have to solve it. in your situation I think will be better to take IRM scanning to see what's up. but I think and hope that it needs just time and you'll be ok. sometimes I also feel hurt in my back, in something moment I just have to lay down and I don't care where I'm, I just do it😁for a moment I'm sitting in a cafe, I have a little hurt in my low back, so I have to change my position, I have to walk, if will be need, I will lay down... it's ok😉
Hello. I'm better. after 3 months I started again my work, where I need to walk about 20 km in day. At first all my back muscles were hurting, now it's better. more difficult is sitting, I need to change my pose every 15-20 minutes, other way I feel pain in my low back. sometimes in a time of walking I feel little pain in left leg-always in different places, but it gous fast. when I had stronger pain, I was finding a place for have a 5 minuts relax at bench. now it doesn't need. I still trying to not lift heavy things, but I live alone, so it's not always possible. but if I'm taking something heavy, immediately back gives me reminder, so that's sure, lifting heavy things can send me again at surgery table, so will be better not to do it. I didn't make any sport, even nor just light jogging, I think my walking is enough. maybe in several months I will start to training lightly with my own weight, about gym and heavy weights I forget and don't want to turn back,it doesn't worth it... voila😁that's all my news for a moment... ah, yes, 3 first fingers at my left leg still in same condition, maybe just a little bit better, but I'm not sure. Good luck and health to everyone 🤞
How r u now?
it's a marathon not a sprint. recovery can be very up and down. hang in there and make sure to keep you follow-ups with your surgeon to keep them aware of what you are experiencing.
That was great explanation. I finally found the answer about the time when disc itself heals (6 weeks). Thanks
Glad to hear! 6 weeks is about how long it takes for the hole where the disk extruded to fix scar over. The affected nerve, though, takes almost a year to heal as much as it can heal.
I am about 9 months from surgery - the operation was successful, but recovery has been a lot slower than I expected.
While the nerve pain is gone, I am still suffering from significant muscle pain - physio is helping, but it is a slow process.
I would still recommend microdiskectomy surgery, but be prepared for a length recovery time.
@Armaghani Spine Thank you - that's the plan 👍
Well said. Nerve pain we are very good at alleviating. But muscle pain from the back can still remain or be a side effect of the incision that was required to free up your nerve. Working with physios is the best remedy for that. Good luck!
Great information. Currently I had an ortho recommend surgery and a neuro suggested epideral or remaining PT. I've been in pain for four months and PT for 2 months. The disc takes 4 to 6 months to fully reabsorb. I want to avoid all procedures and stay on PT considering long term effects.
I think you did the right thing, Anthony. You got a couple opinions and weighed the risks and benefits yourself and came up with a decision that you are most comfortable with for you and your family. Surgery is always an option at the end and some people come to that decision quicker than others (and sometimes people never reach that threshold).
Great video and i don't even have any questions because i found my answers in the comments you replied to. Thanks for the video and for answering everyones' questions. I was just referred to a surgeon yesterday by my pain management doctor and am waiting for a call from them. I have not 1 but 2 severely bulging discs. One affecting my left and the other my right side, plus synovial cysts and arthritis 😬🤦♂️
Glad I could help! Good luck!
Hi Doctor, your vedio is very helpful and so clear. I should have watch your vedio before my surgery. So, I can very careful post surgery. But I just found out now. I had done decompressive hemilaminectomy with discectomy on rigjt L5/S1 six weeks ago. As soon as I had surgery my right leg feels free but the little numbness left. After 4weeks I did normal activity and drive the car. But I started feel pain burning sensation from the butt through the leg and numbness on the little toe. I am worry now. What can happen to me? Do I need another surgery? I feel like my happinest took away now. Plesase advise what should I do? Does disc herniation again? Thanks! for your vedio.
Had this done L5/S1 valentines days this year 2022 .. no initial complications.. was up and walking that night..
Ended up back in for round 2 a few weeks later due to a re-herniation.. probably due to me taking too literally “you can resume some normal activity after this many days..”
and then ended up living on my back for two weeks because I was unable to sit or stand..
so if you’re getting this done.. be careful and don’t push it.. give it the time it deserves..
Coming up for 6months post op in about a week..
I’m still walking everyday.. I still get into / out of bed and the car slowly and carefully.. and way more conscious of my overall posture when sitting or standing..
I still get a few ‘grabbing’ sensations here and there mainly with strange angles of movement.. or bending down.. but I only feel now that I’m ready to undertake some more vigorous strength and fitness training..
I was advised to not do any impact related movements for about 6 months due to the degree of initial herniation and the revision..
so been playing it very cool..
the upside is my overall fitness has improved and so has my diet. Feeling all the better for it..
was a worthy wake up call in my life to not take things for granted..
@hills
That sux..
But think about your pain, if it’s centralised and has come up rather than still down the leg then it has worked.. but avoid sitting for more than a few mis where ever possible.. After two surgeries I wasn’t taking any chances.. and wanted to keep the back as straight as possible.. sitting for an hour? Not a chance.. I would have been standing/walking around or laying on the floor.. sitting tilts the pelvis and puts pressure square on the L5/S1 joint.. which is only going to encourage more disc to potentially leak out before it’s had the chance to scar over.. and I would sleep on my side with a thin pillow between my legs. Walking every day within reason (for me that helped)..
I never really found the pain meds to do much for me.. would only take them at night when I had perhaps stressed it.. I found celecobix (I think that’s what it’s called) was beneficial to me.. (think an anti inflammatory or a neuropathic thing)..
Nerve pain is the worst possible pain..
I’d also encourage you to consult with your GP regarding medications..
and any neurologist worth their salt would understand the degrees of pain.. and I doubt they think you’re just after meds if you don’t need them.. they should have a nurse on staff you could make an appt with rather than the neurosurgeon.. I met mine twice before the surgery.. and he told me unless there is a major issue, to cancel his 3 month appt..
I don’t know dude, just keep in contact with them and if you get another scan and it comes up clear then you know it’s just residual nerve pain.. there are no guarantees that these surgeries will leave you pain free.. and if you feel you need a second opinion, then seek that out..
After my surgery the first time. I was pain free for about 3 month's and then had surgery 6 month's later on October 3rd 2022. The pain is lower center back pain, not at incision site. Went to my 2 week post op appt that I didn't want to go to because the pain from sitting makes it worse. My Dr told me to come in due to the pain and was basically a wasted trip, I had to sit for over a hour to see my neurosurgeon. I got a shot of toradol and tramadol, not helping. Still in pain today and seems walking makes it worse. My 1st discectomy recovery was way easier and I didn't have this pain at 3 week's. I explained to my neurosurgeon that I'm having left side lower back pain. I left feeling like he thought I was asking for pain meds!
@hills everyone’s case is going to be different.. how long you had the severe pain before surgery , and the severity of that pain.. where the pain was, how bad the herniations were, where they were snd if there was more than one..
and the activities and condition of your body that led up to the disc issues.. for me it was a generally inactive lifestyle (I mainly sit for my job) and then I was doing quite hard labor with lots of digging and lifting from doing the paving around my house and shifting copious amounts of sand and soil over the last two years.. which clearly did some damage..
When it went really bad for me I had the surgery within 48hrs.. so recovery was faster..
I didn’t need meds after 3/4 days besides the anti inflammatory meds.. and then took something ever now and then when I felt a flare up.. or had done a bit too much that day..
just use those meds (within reason) to help.. nerves have pain memory.. and if the pain is localised to your back and not in your leg or butt then that’s a positive step.. make sure you keep the walking a couple times a day.. do the squats, leg lifts and calf raises.. don’t sit too long..
and if it’s honestly still really bad then say something.. ask for another MRI referral and if that shows an all clear then you know it’s just nerve memory.. the spinal nerves are pretty serious nerves. And they heal slowly.. really slowly.. same with discs.. and don’t forget they drilled away some of the bone in order to access the disc.. simple operation sure.. but still a very serious one.
There have been times when I thought it’s happening again.. even still I feel it grabbing when standing after I’ve been sitting for a while.. but it’s lessening.. just be honest with yourself and your pain, do the work you need to do to recover.. and speak to them.. questions don’t cost anything to ask..
I'm on my 3rd week after my 2nd discectomy. I'm in so much lower back pain, not even in the area of the surgery. Did you have this pain 3 week's post op?
Thank you for sharing. Best of luck!
I had it done 3 weeks ago what a relief just healing now the pain was so great I screamed to sit or walk ..had my surgery done at riverside hospital columbus ohio
hope you did well!
Fantastic explanation, thank you 🙏
You're very welcome!
Hi I got disceptomy too a month ago. I used to train brazilian jiu jitsu everyday. After OP, my leg pain was immediately gone. Some numbness lingers still. I do lots of air squats. I hope to go back to Tatami soon.
Typically most surgeons let patients get back to their normal activities after 6 weeks. good luck!
Very informative video thank you doctor. I have a mild herniated disc slight bulge. I have leg pain it was as 9 out of 10. I was offered to get a steroid epidural injection or this surgery I choose the injection the pain went down to a 6 now. I was told to do lots of cardio lose weight and stop lifting for 6 weeks but the million dollar question is the doctor nurse won't tell me if it will heal on its own or how long will It take to heal but they offered surgery but I'm really trying to avoid it. But I'm very glad u been very specific on this surgery because I'm starting to consider it.
Get this surgery asap to avoid permanent nerve damage!
Thank you so much for such detailed demonstration! I wonder, why surgeons choose to remove a part of bone in order to reach to the herniation, just like your demonstration in this video, but not to use minimally invasive way by using circular retractor tube to remove the herniation?
Good question! Whether you use a tube or another retractor, you still need to remove bone in most cases to access the spine and nerves to move them over and remove the disk herniation.
Thank you! I'm scheduled to see a neurosurgeon in 2 weeks. MRI shows I have 2 hernia disks and a bone spur on l5. How long would that take to for you to fix, and also how long till I can work again. God bless your work💯
generally no lifting more than 20-30 lbs for 6 weeks then no restrictions. desk work is ok after a week or 2
Having a portion of a disc removed, does it regain mass over time or would you be living with a disc smaller than all the others. If so how does that disc hold up over time? Thanks so much very informative video
@Armaghani Spine ty
Great question. Unfortunately we are not able to regenerate disk material. Most of the time when we do this surgery we can remove anywhere from 5-15 or even 20% of the disk. Normally that is ok but sometimes if a patient has another disk reherniation and we have to remove more disk there is so little left that they end up getting back pain from the lack of cushion and fusion is sometimes needed. The chance for reherniation for most people is about 10% lifetime.
Really great video! It answered a lot of my questions. TY!
You're welcome!
Had this surgery today now watching it this was the worst pain of my life hopefully I’ll full make a recovery n go back to my normal life
This video is very useful. Thank you Dr.
You're welcome!
What are your thoughts on encountering significant engorged venous plexus veins when performing this procedure. Is it something you would try to diagnose immediately and try to shrink the veins to make room for the nerve root or maybe would it require a different surgery? Thanks.
@Armaghani Spine If you could, please give any advice to a patient, how to approach my doctor/neurosurgeon to check for engorged veins that may possibly be significant enough to pinch my nerves to get surgery approved by insurance? For example my MRI doesn't show major disk herniation (only mild), but the symptoms and pain is real and very debilitating causing my quality of life to fall apart and even more so mentally when no one believes the level of pain I'm having. I just can't figure out why my sciatica and nerve(s) are burning and shoot so painfully sharp all day from my lower back down my left leg and tingling and numbness to the feet. Every doctor has said I'm too young to be having this problem, 35. I'm well educated as an Engineer and I can research all day but I can't self diagnose. I'm not fit work, I can barely sleep.
Good question. We do occasionally see large veins running along side the fluid filled sack that holds the nerve rootlets. Fortunately, we have a took called a bipolar electrocautery which we can basically pinch the vein and then we can coagulate it with a small amount of heat which then prevents it from bleeding and decreases the size significantly.
Sir I had back injury l5-s1 almost 19 years ago and I was managing with it since then.There was no problem until this year October-2021 except mind pain occasionally but now weakness and pain in legs hips and burning sensation.Epidural injection didn’t heal.Doctor suggested for microdiscectomy surgery.My question is my nerve is compressed since long , what is your suggestion on this ?
I have been having this pain for about 11 years now, after my MRI scan the result showed. L4/5 and L5/S1 posterior disc bulges with bilateral neuroforaminal stenosis. What should i do Dr?
Most helpful video i have watched. Thanks Doc
you're most welcome
Really great video !
Suffering from stenosis for 3 years now and still not sure. Although my Mobility improved a lot I still have burnings frm buttocks to both legs.
This presentation helped me to accept having this laminectomy surgery. I'm just 67 still very active so worth it to try.
Average cost ?
My insurance covered it. $90,000
Very helpful video Dr. Armaghani. I noticed you didn't comment on Coflex as part of this procedure. Is this not something you do as part and parcel of a micro-discectomy.
I'm due for micro-discectomy in two weeks for L4-L5 herniation but the neurosurgeon wants to put the Coflex Interlaminar stabilisation device in also. I'm reading the empirical research on this at the moment as it has been around since 1994 but I know of at least one surgeon who reported them as a "failure". Would be interesting to hear your perspective on this.
@Jaymeirish I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
@Armaghani Spine Thanks for your response. Do you place any mass in any of the interspinal devices? Separately, whats the feeling regarding 'DiscSeel' in the spinal-surgery community?
I am not a believer in the utility of the coflex device
I think you are the only honest neurosurgeon I have ever heard speak, thank you.
@Richard Turner thanks for replying I hope you have a speedy recovery 😊
@freestyle bully I have a bulging disk and a ruptured disk I'm still waiting on surgery but I have found a surgeon he said I need a discectomy on two disk and a laminectomy on the same two s1 l5 l5 l4 he discovered I need stents put in both legs before I can get my back surgery also discovered I have a aneurysm in one of my legs main arteries so I guess it could have saved my life I'm waiting on a phone call from a vascular surgeon to get the stents put in before I can get the back surgery but the surgeon said it should not be a problem to fix my back, good luck with yours.
@Richard Turner I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
@Armaghani Spine Thank you for your response, as long the decision to go forward or not is the patients decision, you are one of the very few neurosurgeon's in America who still alow that.
Thank you, Mr. Turner. I try to be as upfront and clear with expectations as possible since there is really nothing "routine" about spine surgery. My philosophy is to lay out all the risks and allow the patient to make the best decision for themselves given the risks and benefits. The risk/benefit ratio varies greatly from patient to patient.
Hello and thank you for your Illustrations.
Just a question: if a patient has two herniated disc in 2 consecutive levels ( L4/L5 and L5/S1) can microdiscectomy on both discs be performed on one operation setting? Is it also possible to perform 2 laminotomies on these 2 different levels or will it cause spinal dynamic instability which requires a fusion operation in the very first place?
Thanks in advance for your response.
Great question. Yes, both can be addressed in the same setting if they are both causing symptoms. Sometimes one is much bigger than the other and we just operate on the one we believe is symptomatic. Doing a unilateral laminotomy doesn't affect stability too much. The chances of reoperation following a laminotomy and diskectomy runs about 10-20% lifetime so it isn't too risky in terms of reoperations.
thank u!! i did the surgery yesterday and still on the hospital bed :)
Good luck!
Great video Doctor, thanks!!!
My pleasure!
Hello Doctor. I had a surgery (laminectomy) 20 years back . After a few yrs, I started having severe pain again, then my doctor gave me an epidural. Then I was ok, except for some pains that I could cope with. Lately, 3 years back, I started having acute pain again. Doctor prescribed many painkillers, but nothing worked. Then I had another epidural. Since then I got some relief, but unfortunately the pain is back now. Doctors prescribing painkillers again, but no relief. So, can u ,please, Doctor suggest any treatment or advice for me?
after failing conservative measures, i typically like to get a new, updated MRI to see what is going on.
What happens to the part of the disc that was raptured and caused leaking/herniation? Does it get sutured or something like that or does it heal over time on its own (i.e., closes)?
Good question. The part of the disk that came out is removed completely off the nerve. Unfortunately, that part of the disk can't be reformed though. The hole where the part of the disk herniated out takes about 6 weeks to scar over and that is why we limit bending and twisting for the first 6 weeks after surgery. People have tried suturing or other devices to close the hole but none have worked any better than just letting the hole close on its own.
I just got this procedure 01/11/23. Couple days post surgery. As expected I’m experiencing pain around the incision site, but I am also experience pain around the right side of my hip and my calves feel like they are going to tear every time I walk. Is this common? Wondering why or if this pain will go away.
people experience strange pains around their legs following surgery within the first month or so. i always encourage patients to just let the dust settle.
Tuve esa cirugia en el 2014 y la hernia salio de nuevo del otro lado y desde ahi mi vida a sido un infierno de dolor.🥺🥺🥺🥺🥺🥺🥺🥺😭😭
Thank you for the comments.
My weeks of googling all answered in one video and much better👍
Glad it helped!
I was in the hospital for four days. And I started physical therapy right afterwards.
Hope you are feeling better, Ryan!
Saying severe compression of lumbar nerves may cause 'discomfort' wins the understatement of the year award. 👨🦼 ♿
Outstanding videos, helped me finally understand a 20 yo surgery and one they want to do next.
I did not mean to say "discomfort" to downplay symptoms. I use the word "discomfort" because it can cover a lot of things that patients may experience such as numbness, tingling, burning, stabbing etc. I used to use "pain" early in my career but realized that patients would frequently say no it doesn't hurt it tingles (for example). I've found that "discomfort" covers all those basis and allows the patient to describe better for me what they are feeling. The discomfort from a disk can be quite brutal and bring even the toughest ppl to the hospital!
This was an extremely helpful video. Thank you very much. My question is, my doctor recommended and sent a referral to a Neurosurgeon for this surgery and not a Orthopaedic surgeon. Who should I be seeing?
@Anthony P I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
@Armaghani Spine thank you so very much for replying. I truly appreciate you. Thank you so much. Happy Holidays. God bless
Very common question. The techniques employed by orthopedic spine surgeons and neuro spine surgeons are the same. There is no difference in technique just subtle differences in training. There are fantastic ortho spine surgeons and fantastic neuro spine surgeons. There are also ones from both sides that aren't so great. Go with whoever you feel most comfortable with as there is no difference in techniques.
Very interesting procedure and video, Shame that he is in Fla. and I am in Pa. I have had 4 previous back surgeries, two were to repair the Dura due to a spinal fluid leak. Currently, I have another disc herniation with 24 hr non-stop pain, it actually feels like I'm walking on a broken hip which extends into the groin and leg, I haven't had any quality of life in two years. Hopefully, this technology will expand and becomes a procedure that more surgeons adopt.
sorry to hear but good luck to you. A good friend of mine Dr. Jesse Bible works in Hershey, PA and is excellent if you are looking for a second opinion.
Hey doctor. I have an extrusion of about 12mm. Diagnosed by mri. Since it is an extrusion would the disc normally be healing back "behind" the extruded portion already (like closing a flood gate after releasing some water)? Or does the extrusion sort of hang on to the inner "jelly" ?
Thanks for responding! Curious on the go or no go timeline for surgery. I'm at about 6 weeks and no real sign of improvement other than I can lay around most of the day and not be in horrible pain. Standing it gets bad in the foot within 10 min and sitting I'd rather have my fingernails pulled off. Most say 3-6 months but the downtime is killing me work and lifestyle wise.
both can actually occur. if the disk is described as "sequestered" that means the flood gate has closed. either way about 75% of patients will improve without operative intervention.
Thank you so much for great explanation
Glad it was helpful!
What happened to the bone remove? Does it have effect in the future?
How long does it take to cause nerve damage from not repairing a compressed nerve? I've left mine for 3 years and now want the surgery but fear nerve is already damaged...
every person is different but in general it takes about 1 year from when the compression is removed to heal as much as it can. the longer it is compressed, the less likely it is to heal fully although it is possible. several factors come into play with this.
Doesn't this weaken the bone structure? Does the bone heal eventually or will the hole remain there forever?
Good question. The amount of bone removed is no bigger than a nickel and it is 4-5cm deep at least. The hole remains forever but it does not cause any problems later on unless too much bone is removed.
05:20 在有症狀側做椎板開孔，其切除範圍，要能完全看到該節區的黃韌帶全部,切開拿淨該位置的黃韌帶後，便進入其下層的被壓迫神經組織的深度,接下來用特殊器械將神經組織剝向一旁避免傷及，並可使更深層的凸出部椎盤露出,吸取鼓出部份,達到減壓目的。
Thank you Doctor, my surgeon showed be huge screws that would be used to hold the discs into place and that scared me that i did go back for the op.
@Armaghani Spine thank you for replying.
The screws can be big but are necessary to realign the bones if needed. good luck!
Hi sir. I'm Naresh from India. I had L4 - laminactomy 12 days before. Now I'm walking slowly still I have pain little bit right to spine. But my hip is bending towards right little bit during walk n stand. Is that alright after recovery., or it remain s permanently... Please clear my dout.... Sir
Hello doc, if the herniation is in both left and right side, then the bone needs to be drilled at both side?
If yes, doesn't it make the bone very weak and more prone to injury and getting back the normal as before
only on the side that has pain. if both sides have pain then yes. bone will not grow back but it is very deep in the body and doesn't cause problems by not being there.
And does that bone regrow or?
Thank you for video. The video was excellent. Great job.
Glad you enjoyed it!
Thanks for the video I’m getting this surgery in two days. Will post videos on my channel about the experience 🤞🙏
How it go?
Good luck!
What if the disc herniation is on both sides? Is this procedure still appropriate or would that remove too much bone?
we can remove bone on both sides if that's what it takes to fully get the pressure off the nerves and if patients are having pain on both legs.
I have back stiffness which lasted now for more than 7 weeks after microdiskectomy. I can not pick up any thing belwo the level of my knees. I can not pend forward but I can bend backward. Also I still have back pain. I have abnormal posure anterior pelvic tilt.
Is this part of the natural history of recovery or I should seek medical advice.
Hello Doctor,
What questions should I ask the surgeon after the procedure?
Most important things to ask usually have to do with return to activity level or work and at what time. Also asking what % improvement in both back and leg pain and at what time points is important too. I tell patients that how you feel at 1 year is about how youll feel long-term but you get most of your recovery within the first 10-12 weeks of surgery. I also tell my patients they can return to all prior activities 6 weeks after surgery. Every surgeon is different and specifics of your case can alter those answers.
Does the bone that’s removed grow back? and how long does it take for that part to heal?
The bone does not grow back. In all, it is probably about the size of a nickel of bone that we actually remove to see the nerve. Generally the muscles in the back take about 6 weeks to heal but the nerve can take up to a year to heal up to it's fullest extent. Patients are cleared to return to their normal activities at 6 weeks though.
What happens if during the procedure a herniation is no longer seen and the pain is caused by nerve damage from the now healed herniation?
fantastic question. those situations can occur if the pain has been there for an extended period of time (>1 year). Nerves take about 1 year to fully heal once compression is gone (either surgically or non surgically)
How do you replace the bone that you have removed? Will my spine be weaker as a result of this surgery? My injury is in L5 S1. No pain, however right toe does not lift, right leg is weak, and numbness on outer, upper right side of leg. In my case, is it worth it to have the surgery?
The bone isn't replaced as it is just a small piece that is removed. Usually no bigger than the size of a coin. It is also about 4-5cm at least deep under the skin so it has plenty of protection from muscle and soft tissue.
Hi, your videos as very informative and helpful. Just want to know when u said dura, u mean also thecal sac? I also watched ur video regarding TLIF. Thankyou very much for all ur videos and sharing ur knowledge
@Chitrani Perez sorry to hear about your complications. What complications are u having. And no I havnt gotten surgery yet
@freestyle bully I'm so sorry I didnt see your reply till now. How are you doing? Have you avoided surgery? I do have several complications going on after surgery, although I no longer have the terrible sciatic pain. I hope you are feeling better.
@Chitrani Perez I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Are you having any complications after surgery?
@Mei-Lin Knetsch I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
My surgeon just told me (1 month post microdiscectomy L5S1) that the thecal sac is still rubbing/impinging on my nerve. It has not sprung back into it's proper position. This is to explain why I still have terrible pain when I sit (no more than 2 mins) stand or walk. Great videos Dr, thank you.
I just had this survey on 3/6/23 A herniated disk on my sciatic nerve boy. I was in pain for a few months but I have this done 10 years ago I asked if could it come back and it did
after 10 years I was having pain from my back to my toes. I couldn't feel my toes my calf also was numb and I couldn't feel anything. Today is march 7th and Of course, there is pain because the meds are wearing off but I was given muscle relaxers, and pain medicine the good thing is I can feel my toes now and there's no numbness in my calf as well, And no pain from my back to my butt. I just have to move slowly around and You will feel the pain as a doctor stated in the video by them using these instruments to hold back your muscles and bone etc for the most part I know I will feel better after a few days my butt bone is what hurts the most right now. You will need help from your family or friends for a while and you shouldn't drive at all until it is safe to do so and don't lift anything more the 5lb or a gallon of milk and don't pull or push anything until you doctor tells you it is ok you don't want to have to go through another surgery or herniated disk on your nerve again. Good luck if you have to have this surgery.
well said!
This is the most helpful and easy to understand video regarding this procedure. Thank you so much. I do have a question or two. The disc is bulging due to a tear or weakness in the annulus wall, right? So when the bulging material is removed, will the disc continue to leak and press against the nerve? And will the disc degeneration get even worse for that disc because part of it is missing now? It just seems like this procedure damages the disc even more so.
@freestyle bully (
@freestyle bully thanks 😊 same for you.
@Deepred Dawg thanks for responding my aunt has several disc herniations since 2016 her back and legs hurt 24/7 she said she got 1 shot each year the past few years she said her shot relief lasts a year the first 3 times and only 2 months the last. time its temporary relief I want permanent relief lol I hope u have a speedy recovery
@freestyle bully HI. I had/have a bulge in the same area. But haven't had any pain issues since I got an epidural spinal injection. It's not major surgery. Just a steroid shot in your spinal canal to shrink the swelling and help with the pain.. Never had major back surgery. That should be your last resort. Good luck bro.🙂
@Deepred Dawg I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get surgery? Are you having any complications after surgery?
And remember when your surgeon whistles with big eyes when he looks at your MRI you know its gonna be a long ride lol. Im a 41 y.o. male and Had this done L4-L5,L5-S1,great explanation video tyvm Dr.
Month out and I feel a little relief but my drop foot on my left is going to be permanent unfortunately .Surgeon said fusion was probably going to happen but he wanted to do this procedure first.He did left and right sides .I have degenerative disc disease so im not a candidate for replacement surgery.These videos are very informative and helpful when I have questions during follow-up. Thank you again Dr wish you were here in Las Vegas your help would be greatly needed in this city.
You are most welcome!
Why is not the thumbnail bone placed back ? Would it fuse with the rest of the bone using the proper method?
Hi your video was so helpful thank you, I was wondering if you do surgery in Sydney?
Thank you for the kind words. Only Orlando, FL area.
Is it normal to have recurrent pain throughout the recovery? How can we know if we've reherniated?
The recovery process does tend to be a 2 steps forward 1 step back sort of recovery especially early on within the first few months. After that time period things tend to calm down and you have steady improvements. How you feel at 1 year is how you feel long term. Chance of reherniation runs about 10% and is most likely to happen within the first 6 weeks.
What happens to the bone area that is removed? Is it left as is or filled up with something else?
Good question. The amount of bone that is removed is only about the size of your thumb nail, if that. It is also pretty deep under the surface of your skin - at least 4-5 cms. When we are done with the case, we close up the muscles over the bony defect in multiple layers and that provides ample protection to the spine and nerves. I haven't seen an injury to the spine from a direct blow to the back in my entire career.
Hallo dr
I had Microdiscectomy surgery about 10 days ago .. I have now more pain in leg then before the surgery surgery ..
How are u feeling now?
Does the act of removing the bone itself in the laminotomy ease the pressure off the pinched nerve regardless of the microdiskectomy process?
@Armaghani Spine Thank you.
correct! sometimes just removing the bone is enough to decompress the nerve. that procedure is called a hemilaminectomy. that is usually done in situations where there is more bony narrowing that is causing nerve compression instead of a disk. if a disk is also causing compression we remove it at the same time. goal of surgery is to make sure there is no pressure on the nerve.
Hi dr. Your videos are so helpful.
I just want know. i had disc bulge l5S1 and had microdiscactomy surgery. Its been more than 6 weeks . still i have tingling numbness in my both cuff and feet burning sensations on both side as before surgery. Or it might be stenosis . What should i do . Please suggest me.
Thank you
In general, nerves take a long time to recover after surgery. Up to a year. During that time patient's can feel many different things during the course of their recovery. I'd discuss the concerns with your surgeon but hang in there!
I'm curious about how the bone that was shaved off regrowth? A few of the videos I watched didn't explain that process. Dr., can you help explain that for me?
@Armaghani Spine good to know. Hopefully there's no issue with that bone done the road.
After the bone is shaved off it does not grow back. We really only end up taking about the size of a coin so it isn't much.
Question? I have been having Cervical Radiculopathy pain for two 1/2 years with three MRIs down and many tests. I've been told that the MRIs show small bilateral disc bulge around C5 C6 with osteophyte complex. I've been avoiding any type of surgery and have gotten mildly better but symptoms are just not resolving. So with my third MRI I went to a Neurosurgen this past Monday who said that my neck is good and the bulge is not pressing on nerves. He didn't mention the osteophytes complex and I forgot to bring it up because I got emotional as 'nothing' was shown to cause my pain. He mentioned that my symptoms may be arthritis in the spine and then I went on my way. The question is can a Neurosurgen not see if arthritis/bone spurs/osteophytes are pinching nerves? My PCP is now trying to get me to see an Orthopedic Surgeon. Just confused on this. I'm hoping an Orthopedic Surgeon can see the pinched areas because now if gives me the feeling like I will never find the cause of this even though it was previously noted on the MRIs but apparently not coming from a disc bulge. Sorry for how long this is. I appreciate your input!
Typically an MRI that shows a bulge can also be called an osteophyte complex as well it just depends where the compression is coming from. Getting opinions is important though. Good luck!
I have osteoporosis and spine injuries,I have slipped discs,would a microdiscectomy help me
I used to get the pain , when I make long bike rides and now the pain is not so severe and more often no pain at all, do you think a person should go for surgery if he doesn't have pain but owing to such surgeries at young age is much easier than old age?
i would advise not to. my trigger for patients is when they feel they can't do the activities they enjoy doing because of the pain they get. If they can - don't do it.
Great presentation.
Thank you!
Doctor does the bone from the laminectomy regenerate? Does the bone loss cause instability?
Thank you for your response. Your videos have been so helpful and convinced me to have surgery.
great question. bone doesn't regenerate. about 5-10% of the time too much bone removal can cause instability later on but is rare.
If my disc is herniated on the left and on the right with central canal stenosis, would the left side only be removed if that is the side where my pain is? I have no pain on the R side.
Excellent question. This is a surgeon to surgeon choice. I like to address areas where the patients are experiencing symptoms. If you have bilateral narrowing but only left sided symptoms, I almost always would do just the side that is giving you problems because once you remove that problem, the symptoms improve and usually the compression on the other side can improve too since you can reach to at least midline to remove disk material.
Doctor, I want to know about the bone after the surgery. Will it heal and be back to normal? Or it stay that way.
@Armaghani Spine thank you very much, doc!
The bone doesn't grow back but the size of bone that is removed really only amounts to the size of your thumb nail and this defect in the bone is 4-5cms deep to the skin surface at least.
I just had this surgery a week ago. Does having this procedure done prevent me from getting a disc replacement should I need it in the future?
good news is that in most cases it does not prevent you from getting a disk replacement in the future.
Please demonstrate safe way of removal of ligamentum flavum. Any tip and trick. Will be helpful if you can show in live surgery or cadever. Thank you
I like to thin out the superior lamina of the level below about 3mm from the tip. I then remove bone from the lamina above up to the point where i see epidural fat peaking out from under the ligament. I then use a curved curette to develop that plane between the under surface of the lamina above to release the ligament from that under surface and then when i am in that plane, i flip the curette 180 degrees so that it is now facing caudal towards the superior lamina of the level below. I then move the curette towards that superior lamina creating a rent that goes cranial to caudal within the ligamentum flavum. When i get to the undersurface of the superior lamina of the level below i am able to break through that small thinned portion and that releases the ligament caudally. with the ligament now released cranially as well as caudally, I can pull it towards me and i use a kerrosin to complete the resection laterally.
Is the disc stitched up after to aid with healing and prevent reherniation?
@freestyle bully no problem man 👍
@Joe Lawrance thanks for replying homy
@freestyle bully Hi, I have L5-S1 herniation to the right side. It was causing very bad leg pain all the way to my foot to the point I couldn’t sit or stand longer than 10 minutes. It sounds like your symptoms are quite different to mine.
I am now 11 months later since the start of symptoms and I would say I am 75% better. I just have pain if I sneeze or cough and like you if I sit a long time I get stiff. What helped me was getting injections. I had one intradiscal ozone injection combined with a steroid injection. I have seen my MRI and the disc bulge has reduced by half the size now. If you do not improve after a few months of physio I would recommend looking into the injections but they take a few weeks/months to work. It is possible I might still need surgery to get to 100% better but I am going to give it a bit longer to see if I can heal completely without it.. personally I didn’t find physio very helpful although I would recommend reading the book back mechanic by Stuart mcgill. Good luck!
@Joe Lawrance I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Are you having any complications after surgery?
@Armaghani Spine thank you for the info!
I have facet joint syndrome and am experiencing intense pain in my lumbar and mid spine,I have a slipped disc at L4 but have osteoporosis, would this be helpful and could it be done in people with osteoporosis?
@Armaghani Spine That is what Iam dealing with
Typically this surgery really only reliably helps patients with buttock and leg pain.
I don't think I'm a candidate for this surgery yet but I'm not sure I have L4 L5 herneated and some stenosis. Along with degenerative disk but that's probably because I'm in my mid forties. It's been 7 months on and of butt and leg pain. Don't want to go the surgical route but steroids physiotherapy and chiropractor did nothing
3 weeks post op from this surgery and I’m worse. Surgeons just like “oh well”. Kill me please.
I just found out I have a L5 s1 disc bulge to the left. I have back pain when I sit but no leg pain. Do u have a disc bulge/ back pain or only leg pain. Also I only hurt when I sit not when I'm trying to sleep. Did you heal up completely? If so how long did it take and what did u do to heal ? Please help 😊🙃 also my back used to get tight when I lay down for bed but since I started back exercises 4 weeks ago. It doesn't get tight when I lay down only when I drive or sit. Are u 100% healed or do u still have back pain? Did u get better since u commented a month ago? Are you having any complications after surgery?
Hi does the hole in bone get recover back ?