L1-L2 Disc Herniation and Surgical Options for Nerve Compression

Herniated discs at the L1 and L2 levels are compressing the nerves?

Hello, Doctor: I am 45 years old.
I started experiencing pain near the left sciatic area in April 2015.
Initially, I thought it was a sports injury causing a muscle strain.
After about two months of treatment with injections and medication at a clinic, there was no improvement.
I then underwent acupuncture and electrotherapy with traditional Chinese medicine, X-rays and nerve tests from a neurosurgeon, and epidural steroid injections from a pain management specialist, all without success.
The pain gradually extended from the sciatic area to the outer thigh and calf.
Later, at a large hospital in Kaohsiung, an MRI revealed that I had a herniated disc at L1-L2 compressing the nerve.
By this time, I had endured about 10 months of suffering, and the doctor recommended surgery as a solution.
The doctor mentioned that I could get out of bed the same day and be discharged in three days, with the implant being a type of porous titanium metal.

Subsequently, I sought a second opinion at another large hospital in Tainan, where the doctor also recommended surgery, but the hospital stay would be 4 to 5 days.
The surgery options included minimally invasive techniques on both sides or a traditional approach from the center.
Post-surgery, I would need to wear a back brace (out-of-pocket cost of about NT$10,000), but the doctor was reluctant to disclose the cost of the implant.
The two hospitals had different approaches and lengths of stay, with a cost difference of about NT$20,000 (the Kaohsiung hospital being slightly more expensive).
This discrepancy has left me somewhat confused, and I would appreciate your advice, Doctor.

Shen, 40~49 year old female. Ask Date: 2016/03/23

Dr. Lai Zhaokang reply Neurosurgery

Hello, based on your description, it seems you have lumbar nerve compression.
Since L1-L2 is a higher level nerve, there are potential risks associated with surgery, and it is recommended that you have an experienced neurosurgeon perform the procedure.
Regarding your description of the technique and costs, it can be simplified to: the surgery involves entering to relieve the compression (decompression) and then using artificial materials to reconstruct your spine.

The differences lie in: whether it is a minimally invasive small incision or a standard incision, or a traditional large incision; the type of implant used, whether it is made of cobalt-chromium, titanium, or plastic (as per insurance review), or other materials (such as new dynamic materials); whether the screws used are standard insurance screws, minimally invasive screws, or if screws are even necessary.

A smaller incision typically allows for earlier mobilization and discharge, while a larger incision may delay discharge for better wound care.
The choice of materials will affect the costs.
The appropriate surgical method will depend on the surgeon's familiarity with the procedure, your specific condition, and your budget.
If I were to perform these surgeries, I wish you a speedy recovery.
Dr.
Lai Chao-Kang, Chief of Spine Neurosurgery, Changhua Hospital.

Reply Date: 2016/03/23

More Info

When dealing with L1-L2 disc herniation and the associated nerve compression, it's essential to understand both the condition itself and the surgical options available. Based on your description, you have been experiencing significant pain and discomfort for an extended period, which has not responded to conservative treatments. This situation can be quite frustrating, especially when the pain radiates down your leg, indicating nerve involvement.

Understanding L1-L2 Disc Herniation
L1-L2 disc herniation is relatively uncommon compared to lower lumbar disc herniations (like L4-L5 or L5-S1). However, when it occurs, it can lead to symptoms such as lower back pain, pain radiating to the groin, and potentially neurological symptoms like numbness or weakness in the legs. The pain you are experiencing near the sciatic region could be due to irritation of the nerve roots that exit the spinal column at the L1-L2 level.

Surgical Options
Given that conservative treatments have not provided relief, surgical intervention may be warranted. The two primary surgical options for addressing L1-L2 disc herniation include:
1. Microdiscectomy: This minimally invasive procedure involves removing the portion of the disc that is pressing on the nerve. The benefits of this approach include a shorter recovery time, less postoperative pain, and a lower risk of complications compared to traditional open surgery. Patients often report significant relief from symptoms shortly after the procedure.

2. Open Discectomy: This traditional approach involves a larger incision and more extensive manipulation of the surrounding tissues. While it may be necessary in certain cases, it typically requires a longer recovery period and may involve more postoperative pain.

Postoperative Recovery and Considerations
After surgery, most patients can expect to begin walking within a day, and many are discharged within a few days, depending on their overall health and the specific surgical technique used. The use of a back brace post-surgery is common to provide support and limit movement during the initial healing phase.

Cost and Material Differences
Regarding the differences in costs and materials between the two hospitals you visited, it's not uncommon for surgical centers to have varying protocols, materials, and pricing structures. The choice of implant materials, such as porous titanium, can influence the cost and may also affect the surgical outcome. It’s essential to discuss these options with your surgeon, as they can provide insights into the benefits and risks associated with different materials.

Seeking a Second Opinion
Given the complexity of your case and the variations in recommendations from different hospitals, seeking a second opinion is a prudent approach. It can provide you with additional perspectives on your condition and treatment options. When consulting with another surgeon, bring all relevant medical records, imaging studies, and previous treatment details to facilitate a comprehensive evaluation.

Conclusion
In summary, L1-L2 disc herniation can lead to significant discomfort and may require surgical intervention if conservative treatments fail. Understanding the surgical options, recovery expectations, and cost considerations is crucial in making an informed decision. Always feel empowered to ask questions and seek multiple opinions to ensure that you choose the best path for your health and well-being. Your recovery is paramount, and with the right approach, there is a good chance for significant improvement in your symptoms.

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