I have spent the past two years of my life working hard at attaining what I consider an elevated level of health and fitness. To be precise, I took off 60 LBs, lowered my blood pressure and cholesterol and increased my stamina and strength. A big part of my life has been the reintroduction of athletic activities. I love to golf, run, play basketball and practice a martial art (Ju Jitsu). I also like my strength and conditioning program which has included weight and core training.

About 9 weeks ago I ruptured my L5/S1 disk while lowering my 8 month old into his stroller. It was a momentary lapse of focus since I have had back pain in the past and I am very cognizant of proper technique for lifting. Within a minute or two intense sciatica radiated down my right leg and into my foot. I was incapacitated for a day and immediately sought medical attention. The sciatica was diagnosed as a suspected disc herniation. I did not have an MRI right away but was prescribed physical therapy and some chiropractic care. After examination by the Physical Therapist and a Pain Management Doctor, I was found to have some loss of motor function in my right big toe.

The PT worked wonders. Within a week I was able to walk and move about for relatively long distances without pain. Within a few more weeks, my range of motion and intensity of movement improved dramatically. At that time (about 4 weeks into my treatment) I had an MRI which revealed I actually had two herniations: one at L3/L4 and one at L5/S1 which was extruded. There is a migrated fragment with the extruded disc.

Since then my condition has continued to improve. I have regained much, but not all, motor function in the big toe. The numbness is relegated only to the big toe and has decreased significantly. I have great range of movement in my back before any sciatic pain appears.

I have conservatively increased my fitness program and can now run 5K at about 85-90% of the pace I was at before the injury. I am able to lift weights at 90-95% of the weight I was at pre-injury, although I am sticking to the machines and have not tried free weights yet. I do all this pain-free.

The doctors and therapist are thrilled with the results and we have ruled out many treatment options besides the conservative care treatment I have been doing. However the migrated fragment still leaves the question of a laminectomy open.

If I want to live without some of my pre-injury activities, then surgery is clearly not recommended. But I want to return to my activities, all of them. So here is where I am unsure of how to proceed and I am seeking advice.

There are risks and benefits to the two courses of action I can take:

-Stick with conservative care - it is always good to avoid surgery. I can avoid the risk of something going wrong with the surgery as unlikely as that may be. I stand to lose less disc height. I won’t have to have any bone removed and any spinal instability that may result. I avoid post-operative recovery and care. The fragment remains which means I may never recover any disability I am experiencing now. And with my activities I could cause the fragment become an acute problem, which means I’m looking at the knife anyway.

-Get the laminectomy – This gives me the best chance to recover fully enough to resume all my activities. But, I will lose more disc height and will now be further at risk for disc herniations in the future. I will lose bone and there is the potential for spinal instability. Then there is the post-operative recovery.

My inclination is to avoid surgery, but considering the lifestyle I wish to retain I am caught in a dilemma. I am soliciting advice and opinions. And if anyone has further factors I should be considering, I am all ears.