runner's surgery blog, L4/5, 2008

[treefrog]

Originally Posted by runner

Well,

It looks like i am facing surgery again.
My doctor did listen to me and I am either going to have surgery in June or early July. I am still kind of in shock even though I knew this was a possibility.
I haven't quite wrapped my mind around this.
The first thing I thought when I got home was, "Do I need this?"
Then I had back pain tonight and the knee pain from the discogram seems to be raising its ugly head and i know I had to eventually do something.
So it looks like ADR at L5/S1.

Runner

New news! Well, I have to say that it probably is good news. Normally having to have surgery would not be considered good news. But when you have pain that won't go away, the prospect of surgery can be good news, as you know.

I hope, now that some time has passed for the news to sink in, that you are looking at surgery as a good thing. It gives you hope that your pain will be resolved. And you've been through this before, though I'm sure you thought at that time that it would be the end of your pain.

It must be very frustrating to have developed this pain, after just having surgery. It's a real shame they didn't catch the L5/S1 level at the time, so you could have done them in one surgery.

Who is doing your surgery? Is insurance going to cover it?

I really hope this is it for you.

[runner]

I hope so, too. Cathy.
The news is beginning to sink in as I have my first pre-op appt with my primary doctor tomorrow so I can be medically cleared for the surgery.

Now I am worrying about how I am going to get this paid for and covered.
I cannot consciously do fusion when I know ADR is the better surgery in terms of outcome, recovery, adjacent disc disease, etc...

I got my surgery date today and it is later than I wanted but maybe it will be for the best. It will be on July 7th.

So fireworks, my husband's b-day and then surgery. Yeh!!!
It comes out to eight weeks of waiting.

I think the L5/S1 problem just was under the radar. The only indication was a pain response at L5/S1 in my 2007 discogram. Then, it was thought to be referred pain from L4/5.
Since I first felt that awful,, familiar pain in late August, 2008, it has been eight months of increasing pain and that other stuff, numbness and sciatica. Today was not good.

It just seems like you do the discogram and things go downhill.

My mood should be good but besides the thought of undergoing a second major surgery is the worry about getting ready for it.
My hope is that after this surgery I will be able to go back to work and live my life like it should be led.

My surgeon is a very talented neurosurgeon in my area.
Yes, he did my first surgery and he placed the Disc right on the money. It is working great. I love it when the doctors marvel at my range of motion but that is what you get with motion-preserving technology.
The vascular surgeon assisting him is a well-renowned doctor and so nice. I will probably even get the same anesthesiologist.
It will be like old home week in the OR.

There are pluses. My PM doc said last week that I still have a lot of strength left in my legs and feet, although it is not what I have had in the past. There is the possibility that the numbness might go away. Hopefully, the sciatica will be erased for forever. I know my reflexes are not good but they might get better. Who knows.

I have thought of delaying the surgery and then realize that will not be a good idea because if this just gets worse it might preclude me from having a disc. I don't want to be in pain and just deteriorate. From last time, I realized they cannot tell you how bad the DDD is before they operate.

So I try to get my house in order before the big event. And I figure out the logistics. Must of spent three hours or more on the phone today.

You are coming up pretty soon, aren't you, Cathy?

Runner

[treefrog]

Yes, I am leaving for Germany a week from Thursday, and my surgery is on Tuesday May 26.

Is your doctor going to do ADR at the L5/S1, or fusion? I was a little confused by two different things you wrote.

I know you know this already but....because you have the ADR at L4/5, even if you have fusion at L5/S1, you won't have to worry about adjacent segment degeneration. The segments adjacent to L5/S1 below are fused segments, and above is the ADR which will protect the levels above that. But I understand preferring to have ADR if possible.

And you reminded me that I want to go out and buy all the greeting cards I will need over the next several months. Just one little thing I won't have to worry about, if I have difficulty getting around. With everything that has been going on with me, I've forgotten two birthdays in the past couple of months . I know they understand, but I felt bad when I realized I had forgotten.

[runner]

Cathy,

I am having ADR.

There is an adjacent segment underneath L5/S1 and that is your SI Joints. Unfortunately, from what I have read, fusion puts a lot of loading pressure on the SI joints. If you have SI joint dysfunction, you basically have a problem.
I have a history of having problems with my SI joints. They do go out of place and can cause SI joint pain.

Also, although, they do not say there is much motion at L5/S1, there is some motion and motion-preserving technology is the best available right now for the patient that meets the criteria.

I spoke to my physical therapist today and he agreed with me.
Also with fusion, there are potentially more problems. Fusion will take longer to recover from and then you might need an additional operation to take out the hardware. I have a fair number of friends who have needed their hardware removed. That is one more surgery. One person I know had fusion and one level didn't fuse. That person also had the BMP used in the fusion, work too well, and encapsulate her nerve roots.

From all my reading, fusion overall success rate ranges from 50-60 percent. Now, some people do perfectly well with fusion. I think I made up my mind if this was going to come to pass that I would want ADR if available, when I met two people waiting for injections at the surgery center last month. They were husband and wife and he was there getting an ESI, I believe. He had two-level fusion and still had major problems with gait, mobility. She also had had a two level fusion but had a spinal cord stimmulator put in.
Their doctor was the same doctor I have. That opened my eyes.
I have a problem but it is not related to the disc I have.
Wow, you are having surgery pretty soon. Yeah, as much as you can pre-plan ahead the better. I didn't go as far as b-day cards though. I think people kind of realize that you have your hands full with your recovery.

The most surprising thing after surgery is how stiff I was. I couldn't put on my own socks. It was quite different. Now, I can put on my own socks now but I am still not as limber as I was before surgery.
I wish someone had told me how you might feel after surgery. You realize that you can not bend, lift and twist (BLT) but you don't expect your muscles to be different.
But, boy waking up from surgery and having the pre-surgical pain gone and waking up with no numbness in my legs, that was priceless.

Take care in Germany.

[treefrog]

I totally agree that ADR is the way to go (even at L5/S1), and I was very happy when Dr. Bertagnoli told me two level ADR instead of a hybrid. I have a partially lumbarized S1 (which the Germans are calling L6), and I thought there might be a possibility that they might want a fusion there, to account for possible extra movement because of the transitional anatomy.

But like you, I know that fusion is much harder to recover from, and lots of people have problems with the hardware. I want to avoid fusion if at all possible. Which is why I am going all the way to Germany, and spending my own money to have ADR.

I think you are wise to fight to have ADR. I really hope you are able to get insurance to pay. Did they pay for your first surgery?

[Maria]

edited as necessary

[runner]

Cathy,

When I am finished this year, I will look like you, ADR-wise.
We paid for my surgery.
It is a long story.
I still consider myself in a fight with my insurance. I won't stop fighting until they are eliminated from this earth.
They can go sell and administer policies on Mars, for all I care. When i can get different insurance, I will.
They are the worse of the worst.

Maria,

I think you have a good idea going to Dr. B as the surgeons here do not seem to have ADR experience with osteopenia/osteroporosis bone density.

I had a lot of pain before surgery and I know I lost disc height, because, duh, i lost height period. So before the surgery, I had to sign a consent for fusion and went into surgery praying that i got ADR.
I just would NOT surrender to get fusion. I knew the odds of adjacent disc disease and i knew that in the right people, ADR was the way to go. I understand that it is better for certain people to go with fusion (people with stenosis, spondylolethesis, advanced facet hyperthrophy, etc...).

Well, got my tooth fixed yesterday and woke up this morning with right knee pain again. So i was thinking and realized it must have been that two hours in the dentist chair yesterday. I was reclining and put a pillow behind my back but my disc is not a happy camper. I am disappointed because the PM doc said the knee pain should go away.
Like maybe after surgery?
I am laying low, again. At least, surgery is only seven weeks and some days, away.

(was a) runner