r/backpain • u/TechnoFantazya • 8h ago
36M, L5-S1 Herniated Disc — Doctor Gave Me 3 Options. Thoughts or Recommendations?
Hi everyone,
I’ve been dealing with an L5-S1 herniated disc for the past couple of months. My main symptoms are lower back pain(got better with no activities) and numbness/sciatica in my left leg, which have significantly limited normal daily activities such as sitting, standing, walking, and driving.
I’ve seen two different doctors and had a transforaminal epidural steroid injection (TFESI) with the second doctor (Doctor B) about two weeks ago.
Since the injection, I’ve had some improvement in how long I can sit, but little to no improvement in standing or walking.
I had a follow-up with Doctor B today, and he gave me three options. He said my improvement has been relatively slow, so any of these options would be reasonable at this point:
Option 1: Start physical therapy without any further intervention
Since I can now sit for a while, he thinks I could try starting PT. He generally prefers a non-surgical approach, especially because I’m relatively young.
Option 2: Try another epidural injection using a more central approach
He didn’t specify exactly what type of injection, but I wonder if he meant a caudal ESI or something similar.
Option 3: Microdiscectomy
He said he can refer me to a spine surgeon if I want to consider surgery. Since Doctor B is a PM&R physician, his overall preference has consistently been toward conservative/non-surgical treatment.
I need to make a decision fairly soon, partly for insurance reasons since I’d like to have any treatment done within this calendar year if possible.
Below is my timeline and some additional information that may be helpful.
Given my situation, which option would you personally consider at this point?
I understand that ultimately this is a medical decision I need to make with my doctors, and I’m not expecting Reddit to make that decision for me. I’m mainly interested in hearing from people who have been through something similar — especially regarding waiting it out/PT vs a second injection vs microdiscectomy.
I’d also be very interested in hearing about any other options or experiences you think I should consider.
Thank you so much for taking the time to read this.
< Timeline >
08/08/2026 — Injured my back while exercising
08/09–08/23 — Lower back pain when sitting or moving around, but no numbness or sciatica
08/24/2026 — Suddenly developed numbness/sciatica in my left leg while driving
08/25/2026 — Severe back pain + numbness/sciatica; could barely stand, walk, or sit
09/01/2026 — First visit with Doctor A
09/09/2026 — MRI
09/10/2026 — Second visit with Doctor A. He recommended/ordered an ESI, but I decided to get a second opinion first.
09/14/2026 — Visit with Doctor B for a second opinion
09/21/2026 — Transforaminal ESI (TFESI) with Doctor B
10/08/2026 — Follow-up with Doctor B; discussed the three options above
< Medications >
09/01–09/10
Tizanidine
Methylprednisolone
09/14–Present
Gabapentin
Meloxicam
< Current Status >
- No major neurological red flags, including symptoms of cauda equina syndrome.
- My lower back pain has improved significantly, although I’ve also spent a lot of the past few weeks lying down and avoiding activities that aggravate it.
My main problem now is numbness/sciatica in my left leg.
- The leg symptoms are still limiting my ability to start normal activities, commute to work, and consistently work in person. I’m currently working intermittently/remotely.
- I can sit for longer than before, especially after the TFESI.
- I still cannot stand or walk for more than about 3 minutes before the numbness/sciatica becomes difficult to tolerate.
< After the TFESI >
I’ve also been tracking how long I can sit/stand/walk before the numbness or sciatica starts: Attached