runner's surgery blog, L4/5, 2008

[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

[Maria]

Runner,
I guess if screws weren't used I'd feel much better about fusion w/ADR at the level above. I was even told that screws didn't have to be used but I was afraid I might wake up with them in anyway..

The dental chair is bliss for me all the way back with almost a touch of the head being lower than the rest of the body.. then being numbed up.. it's almost sleepy time except when the drilling starts!

[runner]

Hi Maria,

Yes, we really don't know what we will wake up with because in surgery, if one thing does not work, they'll use or do something else.
I really didn't know if my surgeon would do the ADR. I was prepared to rethink what I was going to do or get a second opinion. I had all my rebuttal questions prepared.

Don't wait so long that you time yourself out from doing an ADR. Are you getting any treatments for the bone density? I have heard, too, that they will do surgery with mild to moderate facet hypertrophy and then i have read that MRIs may not be the best test to determine facet hypertrophy.
It is very controversial.

So if you were told screws did not have to be used, then they would have done an ALIF and just put in cages?

The dentist chair for me was uncomfortable, when I had them put an extra small pillow in the small of my back, it was better. However, it must have really irritated my back. It is funny, I can be laying down and not much seems wrong with my back and i will get up and walk around and start having back pain. The pain has been increasing and I notice it when the pain pills wear off. I walk slowly and carefully because of the back pain. Now, I get pain lying down, too, and not just with sitting and walking.

I am just hanging in there until the surgery date. It is surprising how fast the pain can increase, but I really should have expected this increase of pain post disco because this is what happened last time.

This time, the dentist didn't completely get the tooth numbed, but he tried. All I was thinking, was, "Come on already, get out of my mouth. Don't be such a d@@n perfectionist." I was also thinking how I could have used some nitric oxide or something. I don't know if I am hypersensitive or what but it takes a load of anesthetic to put my teeth to sleep.

I know when i had my last surgery that my surgeon thought my post-op pain levels were on the high-side. But here they cut your abdomen open, move things, scrape out your disc, rough up the endplates, and then cut into your veterbral bone to put the keels in. Yeah, that hurts.

I know you have to consider your father, but is there anyone else to temporarily look out for him while you have surgery? You say that you can function with the pain but you have to look at physiologically, and not just mentally, what the pain does to your body. Pain is not good for us.