My L4/5 foraminotomy story (RL sciatica)

This was originally posted to in 2018. The forums no longer exist, so posting here for posterity.

I am about two weeks out from an L4/5 laminoforamintomy for right leg sciatica.  The short version is that I achieved instant, near-complete relief of symptoms.

I’m cautious about being too optimistic early in recovery, but this forum has been very helpful to me in researching this surgery and a prior surgery, so I wanted to share my story ASAP.  Despite all of our best intentions, I think sometimes this forum ends up biased toward the difficult recoveries or surgical disasters, because the success cases so often want to get back to living our lives and not worrying about surgery.  But when we’re at low points and considering surgery, we need success stories more stories of caution and concern, so I encourage everyone with success stories to come back and post!

I am a 40-year-old male; I have had one prior disc surgery (C5/6 laminoforaminotomy in 2016, discussed in another post).  That surgery was a rocky recovery for a few weeks, but overall a complete success.  In the time between then and now, I’ve been at full activity, running about a half-marathon a month, swimming, etc.  I had made some lifestyle adaptations to keep my neck healthy – most notably a standing desk – but overall, life was normal…

…until November of last year (2017), when right-side lower back pain emerged with no particular trigger.  After a couple weeks, I saw a PT, who suspected a bulging disc, but (correctly) stated that most bulges resolve with time and activity, so I started on PT.

Before I talk about the degradation of this case, a bit about the underlying causes… for a while I racked my brain about what exactly caused both of these disc issues – posture, too much activity, not enough activity, something that happened on a playground 30 years ago, etc.  And while all of those things may be contributing factors, in this case, I’m about 99% sure that the root cause is genetic, and that if anything I’ve been lucky to have as few issues as I’ve had, at only two surgeries by age 40.  My family history of disc disease is simply bonkers, with 4 out of 6 adults on one side of the family having had surgery, for a total of 22 (!!!) discs operated on, with zero risk factors across the entire family.  So, I no longer dwell too much on causes, and focus on what I can do to make the most of my genetic hand.

Back to my story… PT started in December of 2017, and after about two weeks, the back pain was gone, and was replaced by two symptoms in my calf, which would get worse over the next few months, but basically would be the same in their overall description.  The two symptoms were:

  1. Pain.  I had an ache in my calf that would initially set in around 5pm every day, then it became 4pm, etc., until eventually it was about 9am.  It would always resolve when I lay down, so I could sleep, but after a few months, I had to lie down about once an hour in my office to make it through the work day.
  2. Tingling.  When we say “tingling” to folks who haven’t had serious disc issues, it sounds innocuous… but many folks on this forum will know that when I say “tingling”, or “foot falling asleep”, those are just the best words we have, but “feels like my foot is on fire from the inside” is maybe more accurate.  This would happen for me only when I stood up from sitting for more than about five minutes, so I basically didn’t sit down for six months.  This would also happen to a lesser degree when I stood up in the morning.  It would only last 10-30 seconds in either case, but this was rough, and scary.

MRI in January confirmed a bulge at L4/5 and possible tiny bulge at L5/S1.

Here are all the things I tried over the course of six months:

  1. PT.  I tried various forms of PT, including McKenzie-style postural exercises, nerve flossing, etc.  None particularly helped.  If I had to choose one that seemed to provide some mild benefit, I would choose the nerve flossing, but overall, PT was unsuccessful.
  2. Meds.  The aching responded pretty well to a combination of Tramadol and Tylenol, so I stuck with that.  But there was a period near the end when I was on a totally unsustainable dose of Tylenol.  A brief experiment with gabapentin was a total disaster, which severe withdrawal after only a few days of a very mild dose.
  3. Acupuncture.  No response.
  4. Injections.  I had three different visits for L4/5 injections, one of which included also included an injection at L5/S1.  The last injection gave me about three days of glorious relief, but it was really the cumulative effect at L4/5, not the addition of the L5/S1 injection.  But overall, I did not respond to injections.

I wasn’t exactly miserable during this period.  The Tramadol had no side effects for me, and I was able to swim and generally stay active.  I was working at probably 75% productivity.  But I was on an unsustainable dose of Tramadol and Tylenol, the pain was creeping earlier and earlier in the day, and I had given up all sitting-based activities, e.g. playing the piano.  Right at the end, even swimming became a challenge, with calf ache creeping in after a few minutes. So I started to consider surgery, and unlike my last experience where I talked to five doctors who gave four different surgical recommendations, this time I went straight to the surgeon who did my C5/6 foraminotomy two years earlier, and he recommended an L4/5 foraminotomy.  For those unfamiliar with this procedure, my layperson’s summary is: the surgeon goes in and removes a little bit of bone and other tissue to decompress the nerve.  The disc stays where it is.  This leads to faster recovery (no bone plates to heal) and no change to spinal mechanics.  The downside is that you’re still living with a bulging disc, so it’s possible that you’ll end up back in surgery later if the disc keeps moving.

The surgery was on a Monday afternoon.  Sunday I took my usual combination of a zillion Tylenol and a half-zillion Tramadol to get through the day.  Since I didn’t take any meds the day of the surgery, I was a little unhappy when I arrived for surgery.  But everything went smoothly, and I woke up at 5pm basically symptom-free, other than some mild incision pain.  I’ve been around the block now enough to know that this relief could have just been the local anesthetic at work, so I didn’t make much of it.  I worked a bit from home that evening, and went to bed on schedule.  Standing up the next morning and not feeling my foot on fire was a good sign.  I was back at work and feeling basically 100% that day, other than pain in my throat from intubation, which was a good problem to have as my worst problem.  But still, I knew this could be the cortisone at work.

Three days later I had to travel, which I expected to be unbearable.  I had a prescription for Oxycodone that I filled just in case.  But not only did I not take any painkiller – not even Tylenol – I was symptom-free on the flight, and walked miles on a hot day in Philadelphia with my family during the trip.  Complete relief!  I could still feel a “ghost” of some of the tingling, and every once in a while I would bump the incision and groan, but basically, life was good.  Traveling home gave me some mild incision pain, but no nerve pain.  After just under two weeks of nearly-symptom-free, totally-painkiller-free time, I started swimming again (the incision had healed very quickly).

And now I’m just over two weeks out, with almost no symptoms, and I still haven’t opened the bottle of Oxy.  I wouldn’t say I’m near 100%: I can tell that if I went running, or did a bunch of push-ups, it would be a total disaster.  Yesterday I sat a little too much in meetings (I usually stand), and I could feel the tingling a little bit in the afternoon.  I also know from my previous surgery that there will be a little waxing and waning over the next few weeks.  But I’m at 100% productivity, and life is… finally… normal!

So, to everyone suffering from sciatica, (1) there is hope, and (2) please post your success stories here!

And on a more nuts-and-bolts level, I’m not a doctor, but I really believe we’ll start seeing more and more foraminotomies as alternatives to fusion over the next few years, so ask your doctors about it.  There will always be a need for fusion, and when the disc is soft and still moving, a foraminotomy is not going to solve the problem.  But now that technique has advanced so far, I expect we’ll see more and more minimally-invasive foraminotomies as at least a first approach to addressing bulging discs, when non-surgical therapies fail.

2.5-months-post-op update

Update @ ~2.5 months out.  Pain continues to be at zero.  The recovery from tingling symptoms plateau’d somewhat after about a month, so I’d say I have 100% pain alleviation and 60% non-pain (tingling) alleviation.  Overall a huge success, though the remaining symptoms are frustrating, and still prevent me from sitting for extended periods in some postures, and still prevent me from running, which is making me a little crazy.  Still, I can’t complain.

2020 update (two years post-op)

Nearly two years symptom-free! Well, symptom-free within reason. I still almost completely avoid prolonged sitting, and when I have to be in a car for a long time, for example, my right leg still feels… fatigued? Not quite pain, but not pleasant. But in the grand scheme of things, this is very rare, and otherwise life is totally normal. Fully active, no problem lifting heavy things (including dogs and kids, because, you know, sometimes your large dog doesn’t want to go where you want her to go), so cautiously optimistic that things are stable.

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