Surgical or Conservative Treatment for Disc Herniation?

Patient

Q: I'm a 21 yr old college student and have been very active all my life. 3yrs ago I started experiencing major calf tightness and my entire foot would go completely numb after running. Eventually I couldn't walk half a block uphill without severe tightness in my calf, but I somehow managed to run a half marathon. A month and a half after, I couldn't get out of bed one morning. I had muscle spasms, radiating and shooting pain in my hips, up my back, down my legs, decreased sensation, and weakness when walking up stairs or doing calf raises. MRI showed a degenerative L5,S1 disc with a large paracentral protrusion. Mass effect on S1 nerve and prominent right lateral recess narrowing. Osteophyte formation and moderate bilateral neural foraminal narrowing. Moderate narrowing of the central canal. Also, small disc bulge and annular fissuring at L4,L5 level. I'm six months out of the injury, chose conservative treatment and have done physical therapy. I'm still consistent with core exercises and just started to increase my running mileage. But I'm getting numbness again and my therapist said I'm still probably sensitive to compression. The treadmill, bike, and elliptical cause numbness after about 20 minutes. I would swim, but it's hard to access a pool and carve out enough time for it. I feel like I've run out of options for cardio, and the lack thereof is really impacting my quality of life, both mentally and physically. I'm afraid I'll aggravate and injure it the way I did the first time and be handicapped for weeks. I miss working out like I used to but don't want this to be a problem in the future. A spine surgeon I saw initially recommended a discectomy but I was against surgery at the time. My main issue is the numbness and fear of another herniation, along with the extended recovery time. How long should I wait to heal with nonsurgical treatment and will there be any permanent damage if I continue to exercise in spite of the numbness? Or what should I keep in mind if I'm in a position to consider surgical options?

Doctor

A:   I think you should consider surgical treatment for your problem. You are a young, active individual for whom conservative treatment has not be successful (six months is adequate time to see improvement in symptoms). If the disc herniation continues untreated you could end up with permanent disabilities. I urge you to see your spine surgery and discuss the various surgical options available. Surgery will allow you to get back to your sporting activities.

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