L4-L5 Disc Protrusion
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I had a herniated disc with severe sciatica so bad I was in the hospital several times over a period of a couple of monthes. Tried steroids, pt, etc. Ended up having a discectomy. This was 23 years ago, and I have had no back pain or sciatica since. Maybe I was lucky, but all I know is that I went into the hospital in a wheel chair and walked out upright 24 hours later pain free.
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I view surgery as a last resort. Especially back surgery, which I think is an overly prescribed remedy.
I have bulging discs, and degenerative disc disease.
I never experienced chronic severe pain, but on those occasions when my back would 'go out' the pain and incapacitation were severe.
In all cases physical therapy cured me. When scrupulously following their advice and continuing with the exercise routines I am pain free.
IMHO it's foolish to go into surgery without first trying out PT
I have bulging discs, and degenerative disc disease.
I never experienced chronic severe pain, but on those occasions when my back would 'go out' the pain and incapacitation were severe.
In all cases physical therapy cured me. When scrupulously following their advice and continuing with the exercise routines I am pain free.
IMHO it's foolish to go into surgery without first trying out PT
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Had L4 and L5 issues almost three years ago. I went to the family doc. He took X Rays and said Rheumatoid Arthritis. Mine would only give me pain (which as very intense) when I first got out of bed. I finally convinced the Doc to get me an MRI. Ended up having two synovial cysts closing the nerve channel. Had surgery to remove the cysts. Off work for 4 weeks. No Pain what so ever since.
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So being back on the bike in 4-6 weeks or less sounds reasonable, assuming no complications. With a safe spinner/trainer at home you might be able to work out within a week or two.
Hospitals are also discharging patients much earlier nowadays, in part to protect patients from nosocomial infections (which is a good thing), and in part due to pressure from insurance companies (not always a good thing). Be sure you have a plan for followup physical therapy.
So be sure you have someone available to check on you daily for the first week after surgery, both in the hospital and at home.
Regarding the surgery itself, I can't offer any suggestions. My observations of several folks who've had spinal surgeries only indicate there are too many complexities and individual differences to generalize. My grandparents both had spinal fusions in the 1970s and it didn't help much.
I'm sure there are success stories with back surgery for folks aged 50 or older, but I would decline surgery for my back and neck injuries until I've exhausted every other possibility.
Hospitals are also discharging patients much earlier nowadays, in part to protect patients from nosocomial infections (which is a good thing), and in part due to pressure from insurance companies (not always a good thing). Be sure you have a plan for followup physical therapy.
So be sure you have someone available to check on you daily for the first week after surgery, both in the hospital and at home.
Regarding the surgery itself, I can't offer any suggestions. My observations of several folks who've had spinal surgeries only indicate there are too many complexities and individual differences to generalize. My grandparents both had spinal fusions in the 1970s and it didn't help much.
I'm sure there are success stories with back surgery for folks aged 50 or older, but I would decline surgery for my back and neck injuries until I've exhausted every other possibility.
As it turns out, I also have a rupture between C6-C7. Heaven knows how I got near simultaneous injuries to my lower and upper back. But there it is. The shots have been miraculous, but I hate the Tramadol and Tylenol. I'd make a lousy opiate addict.
I've resigned myself to 4-6 weeks off the bike. This has been too painful to risk of re-injury. I'm am the model patient and following pt regimens and weight-lifting restrictions. Lot's of couch time surfing the web and looking for a used trainer on Craigslist. Don't want to buy a new one, we can generally ride year round in south Texas.
I have a stay at home spouse. She's wonderful. Driving me to appointments (I refuse to drive with any Tramadol in my system), et cetera. And will be at the hospital.
I get the idea of multiple opinions and the risk it might not fix the damage. But I somehow lucked into a referral to one of premier neurosurgeons in all of Texas. There is good healthcare here, if you can afford the bill! Between the time I've spent looking at film with the radiologist and neurosurgeon, I'm confident in their assessments and abilities. And that it will require surgery.
The technology is amazing now (versus the 1970's), small incisions and, yes, it would be day surgery (I have my doubts, but he says it's a piece of cake. Others aren't surprised). Finally, he is insisting on the shots, a few weeks physical therapy and traction. He says, "We have to try." But these are significant ruptures and I could see he doesn't believe it will heal without surgery.
I'm ready now, the weather is perfect for riding!
#30
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I have spinal stenosis primarily in the L3 - L5 region. Fortunately my spine doc is a cyclist and he recommended surgery as a LAST option. He told me to get a better bike than my 2015 Cannondale SuperSix EVO 105. Traded it for a leftover 2014 Cannondale SuperSix EVO Hi-Mod team bike (couldn't pass up on the super price). Very comfortable. He said my Litespeed was a great bike for my back. He said leaning over stretches out the spine and relaxes it. He's right!!! He also suggested I get an inversion table. Both the bikes and the inversion table work wonders on my back.
BTW: I'm 71.
BTW: I'm 71.
I understand completely, but I am selling my 2014 SS EVO 105 to pay for my new build. Love, love the Cannondale and its ride, but I ordered a custom hand-made Jaegher Super-Stiff Interceptor frame before Christmas (and all my back trouble). In concession to my tender back, I may add a few extra spacers
Last edited by Minnesota Expat; 02-04-16 at 10:51 PM.
#31
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I know what you mean about the prescription pain meds. Tramadol and cyclobenzaprine left me feeling washed out after my spine injury in a car wreck, but sometimes it's necessary to relieve the pain enough to keep functioning. The tricky part is to persist with whatever physical therapy or actiivity they recommend, even when the pain meds leave your body feeling like mush. Before I resumed cycling last year I did as much walking as I could manage, sometimes with a cane for longer walks until a couple of years ago.
If long term pain persists you might discuss Gabapentin and similar meds, if your symptoms are compatible with those meds. The side effects are few and mild. My 77 y/o mom takes it for neuropathic pain and she's doing well with it, using fewer opioids, and seems more alert, active and engaged in things she used to enjoy. I've met folks who say it's worked for their fibromyalgia and other chronic pain.
Best wishes with your recovery. Spring is coming up, although it's been so warm here in Fort Worth it's like a long autumn.
#32
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I have a co-worker that is a medical professional and has some experience and training in the neurosciences. He suggested that cycling is a possible cause of my disc herniation(s). The idea being, the cyclist is the sole shock absorber on the bike. How else can we account for two herniations, upper back and lower back, near simultaneous, and no attributable accident?
My non-medical training and instincts tell me, as your doctor says, "leaning over stretches out the spine and relaxes it". And I would add, builds a strong supporting core. I'm looking up the geometry for your Litespeed.
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I have a herniated collapsed disc at L-4, L-5.
Talked with my neurosurgeon last week .
He said there is NO Good Surgery that would guarantee that it would help Stop the pain.
Talked with my neurosurgeon last week .
He said there is NO Good Surgery that would guarantee that it would help Stop the pain.
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#34
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I'm not sure about connections between bicycle riding and spinal stress and/or injury. I do know that 30+ years ago I occasionally experienced severe neck pain and headaches from long rides with drop bars. So when I resumed cycling last year I wanted to minimize strain, since my back and neck are in much worse condition now. I got a comfort hybrid with upright bars, a simple spring suspension front fork, padded saddle, an unusually long wheelbase that probably helps soften the ride, and 700x40 tires that I keep inflated for comfort more than speed since most of my rides involve rough pavement or gravel.
So far, so good. A few neck and back spasms, usually relieved by stopping and doing some stretches. No lingering pain after rides.
I did lower the handlebars about 3" and even though they're still well above the seat level, I can tell I'm pretty close to my limit for bending over. So I'm not sure I'll be able to ride drops again. But I may rent or borrow a bike later this year to see if I can handle a few miles on a bike with drop bars and geometry for casual riding and comfort rather than speed. I've seen several designs with drop bars with the upper bar level with the seat height, so that may be workable.
So far, so good. A few neck and back spasms, usually relieved by stopping and doing some stretches. No lingering pain after rides.
I did lower the handlebars about 3" and even though they're still well above the seat level, I can tell I'm pretty close to my limit for bending over. So I'm not sure I'll be able to ride drops again. But I may rent or borrow a bike later this year to see if I can handle a few miles on a bike with drop bars and geometry for casual riding and comfort rather than speed. I've seen several designs with drop bars with the upper bar level with the seat height, so that may be workable.
#35
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Minnesota Expat,
First, good thinking about the possibility of opiate addiction, I went down that terrible path a while back, from my spinal injury, and a large number of abdominal surgeries, also. Get away from the opiate pain killers, and muscle relaxers as quickly as you can manage. Using the PT, and doing things with some common sense, will save you from some real grief down the road. Fortunately, I got off them with the support of my wonderful wife, and I found a good, conscientious Pain Management physician. Cycling played a big part in my recovery, from both the addiction to the Rx opiates, and from my spinal injury/surgery, a well as the damage from the abdominal surgeries.
Secondly, you have the right ideas about caring for your injury, I'm not a big surgery proponent, but from experience, some people do need, and benefit from a good neurosurgeon doing a skilled procedure. it made a big difference for me. And, as you said, the recent advances in procedures that have made the size of the incisions, and the amount of work inside the body much shorter, have changed the recovery time, and resulted in more successful cases. I am an example of both the results of putting things off, and the successful use of surgery.
Best of luck with your choices, and that things get worked out for you.
And, about cycling and spinal injuries, in my case the riding has helped me tremendously. I ride exclusively on drop bar bikes, never has the bicycle riding caused me any pain, or worsened things when I was still injured. Interestingly, when I was going through the counseling in preparation for my PLIF surgery, the neurosurgeon went over some dos and dont's with me, he was very adamant about not smoking, and that I had to leave recliners, or anything that had me seated in that position, or posture. I had already stopped smoking my pipes, but the recliner prohibition threw me. He explained that this posture made for trouble when you had the disks injured in the fashion that I had, and that the fusions don't take to that posture well. I asked about cycling, and returning to riding, he told me that it was fine, but no recumbents were recommended due to my spine's condition. Upright bikes such as hybrids would be fine, and If I was so disposed, a drop bar bicycle would alright, also. I found that a properly fitted bike placed my spine in the correct position, and that good core muscle conditioning played a bit part, also. This has proven to be correct, in my case, I'd be for checking with a doctor and/or a PT specialist about riding, I think that you will find that its alright, just use some common sense.
Bill
First, good thinking about the possibility of opiate addiction, I went down that terrible path a while back, from my spinal injury, and a large number of abdominal surgeries, also. Get away from the opiate pain killers, and muscle relaxers as quickly as you can manage. Using the PT, and doing things with some common sense, will save you from some real grief down the road. Fortunately, I got off them with the support of my wonderful wife, and I found a good, conscientious Pain Management physician. Cycling played a big part in my recovery, from both the addiction to the Rx opiates, and from my spinal injury/surgery, a well as the damage from the abdominal surgeries.
Secondly, you have the right ideas about caring for your injury, I'm not a big surgery proponent, but from experience, some people do need, and benefit from a good neurosurgeon doing a skilled procedure. it made a big difference for me. And, as you said, the recent advances in procedures that have made the size of the incisions, and the amount of work inside the body much shorter, have changed the recovery time, and resulted in more successful cases. I am an example of both the results of putting things off, and the successful use of surgery.
Best of luck with your choices, and that things get worked out for you.
And, about cycling and spinal injuries, in my case the riding has helped me tremendously. I ride exclusively on drop bar bikes, never has the bicycle riding caused me any pain, or worsened things when I was still injured. Interestingly, when I was going through the counseling in preparation for my PLIF surgery, the neurosurgeon went over some dos and dont's with me, he was very adamant about not smoking, and that I had to leave recliners, or anything that had me seated in that position, or posture. I had already stopped smoking my pipes, but the recliner prohibition threw me. He explained that this posture made for trouble when you had the disks injured in the fashion that I had, and that the fusions don't take to that posture well. I asked about cycling, and returning to riding, he told me that it was fine, but no recumbents were recommended due to my spine's condition. Upright bikes such as hybrids would be fine, and If I was so disposed, a drop bar bicycle would alright, also. I found that a properly fitted bike placed my spine in the correct position, and that good core muscle conditioning played a bit part, also. This has proven to be correct, in my case, I'd be for checking with a doctor and/or a PT specialist about riding, I think that you will find that its alright, just use some common sense.
Bill
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I Can Do All Things Through Him, Who Gives Me Strength. Philippians 4:13
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#36
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10 years ago I had been experiencing periodic lower back pain, sometimes severe, that I mostly kept in check with ibuprofen. One night I woke up with agonizing pain shooting down my right leg to my toe. Skip ahead a couple of weeks and MRI showed protruding L4-L-5 disc. I saw a neurosurgeon who said he could operate or I could try PT and call him again if and when I wanted the surgery. After a few weeks of intensive physical therapy, the pain was gone. I continued to do the exercises the therapist prescribed and gradually reduced that to a few stretches I'll do when the back starts acting up.
After ten years of long rides on drop bar road bikes, mountain biking on full suspension and hardtail bikes and gravel road rides on drop bar gravel bikes, I have no plans to call the surgeon. I sometimes get some lumbar pain, but it responds well to resuming a few of the exercises.
YMMV
After ten years of long rides on drop bar road bikes, mountain biking on full suspension and hardtail bikes and gravel road rides on drop bar gravel bikes, I have no plans to call the surgeon. I sometimes get some lumbar pain, but it responds well to resuming a few of the exercises.
YMMV
#37
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True, I wouldn't have traded if I didn't have spine problems, but the difference in riding comfort is well worth the money, with or without spine problems.
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I am a cyclist. I am not the fastest or the fittest. But I will get to where I'm going with a smile on my face.
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I am a cyclist. I am not the fastest or the fittest. But I will get to where I'm going with a smile on my face.
#38
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And that takes me "back" to the back problems. I just got back from my first pt appointment and clearly a slammed stem and aggressive riding posture is not in my future. Bottomline, I'm selling my EVO to build my new Jaegher and it's going to have a more relaxed geometry with some spacers
#39
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Thanks! I just got back from my first pt appointment and we talked about cycling, post surgery and riding in the drops. Her assessment was, the physical requirements of my job probably set the stage for my injury, and cycling may have been "the straw that broke the camels back". BUT, the problems with the cycling have more to do with my poor posture and she gave me lot's of great ideas for improving posture, exercises and stretching, to help.
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After I get my past mistakes fixed, THAT is where I want to be again (but smarter this time)!
#41
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Best of luck with your surgery, and the PT to follow. The new bike sounds like quite nice ride, too. It will make a nice thing to look forward to doing the build.
Bill
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#42
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not sure if you care about replies at this point in time however I've had 2 failed back surgeries and tons of treatment over the years, been on pain meds long term, and still have bulging discs at the same levels (L4 and L5S1). Started when I was 28 and I'm 62 now!
I suggest multiple opinions of course re surgery however if you've not already had some epidural injections and you've got continued pain or acute episodes you might want to go with those. The other thing I've found greatly helpful with back spasms is Toradol injections 60-90mg IM (not effective orally or nearly as effective). Spasms are probably what are causing the white knuckle experience when the disc material is leaking out on the nerves.
You may want to lay off biking for a while if you've not already. The other thing is if you don't want to do this at least make sure you ice afterwards and maybe use some non steroidal anti inflammatory meds if you can stomach them. Toradol is an Nsaid and again it works almost instantly for my spasms (and many others I know) when given IM.
I worked in Neurosurgery when I first hurt my back. All I can say is if it comes to back surgery really do your research. If at all possible and you are a candidate you might consider artificial disc replacement. The FDA limits how many levels can be done in the USA so a lot of people I know traveled to Germany and other countries to get this done (Paid cash). Price of surgery was about a 3rd of what USA prices are with insurance or less.
Anyway I wish you well and hope you are able to do without surgery. I had my last one in '92. They both failed and although I was recommended to have ADR or fusion done or a hybrid surgery by at least 6 spine surgeons I have not had any further surgery to date. I'm hanging in there and can do some biking but nothing like you probably are used to or want to do.
I suggest multiple opinions of course re surgery however if you've not already had some epidural injections and you've got continued pain or acute episodes you might want to go with those. The other thing I've found greatly helpful with back spasms is Toradol injections 60-90mg IM (not effective orally or nearly as effective). Spasms are probably what are causing the white knuckle experience when the disc material is leaking out on the nerves.
You may want to lay off biking for a while if you've not already. The other thing is if you don't want to do this at least make sure you ice afterwards and maybe use some non steroidal anti inflammatory meds if you can stomach them. Toradol is an Nsaid and again it works almost instantly for my spasms (and many others I know) when given IM.
I worked in Neurosurgery when I first hurt my back. All I can say is if it comes to back surgery really do your research. If at all possible and you are a candidate you might consider artificial disc replacement. The FDA limits how many levels can be done in the USA so a lot of people I know traveled to Germany and other countries to get this done (Paid cash). Price of surgery was about a 3rd of what USA prices are with insurance or less.
Anyway I wish you well and hope you are able to do without surgery. I had my last one in '92. They both failed and although I was recommended to have ADR or fusion done or a hybrid surgery by at least 6 spine surgeons I have not had any further surgery to date. I'm hanging in there and can do some biking but nothing like you probably are used to or want to do.
#43
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In 1987 I had exceptional pain from the L3, 4, 5 discs. All three bulging according to MRI. Immediately the recommendation was surgery, but fortunately one of my brothers had the surgery done a few years earlier with mediocre results. Then I heard of a sports doctor, went to see him at a free clinic, he referred me to a PT, and it was Lou Grant! No, not from the TV show, but the name produced a goo laugh. The guy was actually a customer of mine at the shop, so he knew bikes were my thing. For 3 months there was no riding, only upright stationary biking at low resistance, some floor exercises (get the book Back Rx), walking, and restricted sleeping positions. In 3 months I was riding an upright bike, and in 6 months I was riding my road bike with higher handlebar position(3cm higher). To this day I abide by the sleeping position rules, and the workouts in the book Back Rx. Once in a while some sciatic nerve issues pop up, but it is rare. Glad I didn't do the knife. Of course I was in my 20's then so it was doable. At 50+ the discs may be so dried and deteriorated that it may not be doable. Oh, one other thing, no more big gears. Learn to spin like a gerbil runs a wheel.
#44
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oh yeah..floating disc fragments.. surgery time. Hope you've recovered nicely. Slow and steady is what I recommend post op recovery at least to give one's self the proper opportunity for surgery to be a success the first time. Best not to have regrets that one might have contributed to the failure of the surgery by rushing the recovery. If it's a discectomy you've had especially at 2 levels you really have to watch the weakened links re more surgery in the future. Then again one has to live their life so after one goes thru the recommended recovery and PT one tends to want to get back to his or her life re exercise, fun etc. Listen to your body and good luck!
#45
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Here's what the neurosurgeon who rebuilt my neck (another thread) told me when I squirted out most of my L3 disk with a free fragment sitting on the root and my left leg feeling like it was having a frikkin' baby:
Disks are cartilage, i.e., 80% water, and fragments resorb over a period of months. The indications for surgery relate to worsening functional impairment and cauda equina syndrome (impingement on southgoing nerves) from a central herniation, which threatens bowel or bladder. Surgery also carries about a 3% risk of scarring and progressive and intractable nerve problems in the operative site.
He said he could operate next week and have me pain free, but what he would prefer to do would be to send me upstairs to the pain clinic for a transforamenal steroid injection. Perhaps I benefited from being in a non-fee for service system here. I dutifully hobbled up there, got on the fluoro table, and an anesthesiologist did the deed. It hurt like a MFer when the pressure in the foramen went up, but the lido got me happy enough to walk around that afternoon and the methylprednisolone got me down to bearable pain and back on the bike in a few days. I needed another shot in about 3 months and things gradually got better. I was able to crew in a Bermuda race at five months. I still have noticeable atrophy and fasciculations in the left medial quad, but its coming back year by year and there is no functional weakness or sensory loss.
There is pretty good literature support for this approach.
Disks are cartilage, i.e., 80% water, and fragments resorb over a period of months. The indications for surgery relate to worsening functional impairment and cauda equina syndrome (impingement on southgoing nerves) from a central herniation, which threatens bowel or bladder. Surgery also carries about a 3% risk of scarring and progressive and intractable nerve problems in the operative site.
He said he could operate next week and have me pain free, but what he would prefer to do would be to send me upstairs to the pain clinic for a transforamenal steroid injection. Perhaps I benefited from being in a non-fee for service system here. I dutifully hobbled up there, got on the fluoro table, and an anesthesiologist did the deed. It hurt like a MFer when the pressure in the foramen went up, but the lido got me happy enough to walk around that afternoon and the methylprednisolone got me down to bearable pain and back on the bike in a few days. I needed another shot in about 3 months and things gradually got better. I was able to crew in a Bermuda race at five months. I still have noticeable atrophy and fasciculations in the left medial quad, but its coming back year by year and there is no functional weakness or sensory loss.
There is pretty good literature support for this approach.
Last edited by MoAlpha; 03-10-16 at 01:45 PM.
#46
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I opted for the surgery when I herniated my disks in 1989. I went through therapy twice and only got temporary relief. The surgery took away the pain for good and I was riding short distances 3 weeks afterward. Rode our club century 3 months later with the orthopedic surgeon. I haven't had a back issue since.
#47
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If you have only a micro discectomy (shave off the extrusion) recovery will be short. I was back on the bike in a couple of weeks. If you have a fusion which seems unnecessary now but I had one 10 years after the micro discectomy and was off the bike for almost 3 1/2 mo. They let me on the trainer in 6 weeks.
#48
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While I advocate exercise my good friend, a professor of neurology, says that rest is the most under-rated treatment option available. He says he has seen amazing results from ordering one to two weeks of ABSOLUTE rest.
It it is hard for us would be athletes to accept but the body sometimes just needs a break to heal itself.
It it is hard for us would be athletes to accept but the body sometimes just needs a break to heal itself.
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Billd76
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Three years ago this coming May I had back surgery on L4 and L5. MRI showed two senovial cyst that were basically closing off the nerve canal. Pain was intense! Especially when first getting out of bed. Could barely walk for 20 - 30 minutes. 2.5 hours of surgery and 4 weeks of rest. I have had zero back pain since. For me the surgery was the best thing I ever did!!
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mgmoore7
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04-27-10 06:58 PM