/images/nicks-bionic-back.png

OK, ok, it's not really bionic, … yet.

On [2018-05-29] I had surgery for spinal decompression and Intradural disk herniation repair at L4-L5, anterior fusion at L4-L5, and artificial disc replacement at L5-S1. This documents some history and how I got to that point as well as my recovery.

I am frequently asked "what happened?", and I don't recall any specific event, but I wrestled in grade school and high school, and I was know for all kinds of contortions. The dehydration and twisting and bending in bad ways may have contributed to or aggravated my condition. As an adult I travel a fair amount and I have experienced a strong correlation between increased back pain and air travel. Perhaps the rapid pressure changes are detrimental to already weakened discs.

History and background

I have had low back pain on and off since the early to mid 90s. In 2010 the symptoms and pain became un-manageable. I was experiencing debilitating muscle spasms, pressure in my right leg that felt like it would blow up and pop like a balloon.

In 2010 I was diagnosed with degenerative disc disease. I consulted with several local surgeons and was told that my only option was a 2 level fusion. This would have left me with a significantly degraded bending range of motion and increase stress on the adjacent discs increasing the likely hood of failure.

I figured that there must be some better alternative and began my search. I came across ADR Support and their forums filled with stories about disc replacements, including multi-level. After much research I settled on Dr. Rick Delamarter because I could find his published research, he seemed to have a high success rate, and he was performing multi-level disc replacements. After consulting with him we decided to take a much less invasive route and do just a decompression that he hoped would get me by for about 10 years.

On [2010-10-09] at Cedars-Sinai Medical Center in Los Angeles California, I had a micro-discectomy at L4-L5.

Surgery was supposed to be 2 hours, it was 5. When he came out he told my wife that it looked like I had jumped off the empire state building and landed on my feet. He said there was tons of disc material to clean out, he was unsure how I was able to walk at all.

After surgery all of my leg pain was gone. Recovery was rough. It was difficult to get my pain under control post surgery. I continued to see improvements for about a year after surgery.

Things were pretty good for about 4 years. At the end of 2014 my symptoms started to come back. I received an epidural for pain management in January 2015 which helped to keep the symptoms under control through most of 2016. My symptoms returned in late 2016 and the downward spiral began. I had epidurals in April and August of 2017 with an MRI in August.

/images/2017-08-lumbar-mri.png

The MRI showed since 2014 that there was now SEVERE canal stenosis at the L4-L5 interspace with nerve root entrapment.

I called to schedule an appointment with the surgeon from my first surgery only to find out he had retired from active practice. I needed to find a new surgeon, but I was dragging my feet in the process.

In April of 2018 things came to a head. On a trip to Germany I ended up in the ER for pain management. Steroids helped me to complete my trip, but once I arrived home I was nearly bed ridden, only able to stand and walk for a few minutes at a time before it was too much to take and I was driven to the ground.

By this time I had already selected my next surgeon, Dr. Hyun W. Bae who practiced with my original surgeon Dr. Delamarter. I scheduled surgery for June 18th 2018 and got a new MRI.

Second Surgery (decompression L4-L5, fusion L4-L5, artificial disc L5-S1)

/images/2018-05-lumbar-mri.jpg

On May 25th I got a call from Dr. Bae to discuss the new imaging. He was very concerned, and did not think that I should wait a month for decompression. The new images were much worse. He thought it would be best to have decompression surgery immediately, and we could follow up with more permanent fixes later. Since I didn't trust any local surgerons, we (my wife) packed up and we started the long journey to Los Angeles.

Things got really scary after we crossed the Rocky Mountains into western Colorado. I found I was unable to void my bladder at a rest stop. I called Dr. Bae and he said it was emergent. We drove non-stop from Grand Junction Colorado directly to the Emergency Room at Providence St. Johns in Santa Monica California where Dr. Bae and his team were waiting for me to arrive.

I was catheterized immediately and after getting settled I was told that they were unsure if the issue in my back was a herniated disc or not. It was atypical. They wanted to do a full body MRI to see if there were any evidence that it was a tumor that had dropped down from my brain.

The updated full body MRI showed no new leads. So the plan was to do the decompression surgery, test the findings to see if they were cancerous and then evaluate for disc replacement and fusion.

I had surgery on [2018-05-29]. They did the decompression and found a rare case where the herniated disc material had torn into my dural sac. They cleaned out all the material and patched my dura. After pathology confirmed it was not cancerous they proceeded to do a fusion at L4-L5 and a synthetic disc at L5-S1 After pathology confirmed it was not cancer they proceeded to do a fusion at L4-L5 and a synthetic disc at L5-S1.

/images/fusion-device-Aero-AL.png /images/adr-prodisc-l.jpg

Recovery

[2018-06-06 Wed] First day after being released from the hospital

Released from hospital yesterday. Walking with walker is OK. I am much more stable waking with AFO, but I don't want to do anything to weaken my foot. Dr. Bae indicates the neurological damage in the right foot may be permanent.

In an attempt to improve the chances that my nerves will repair themselves so that I can regain the full use of my right foot I started myself on a coctail of various supplements that are supposed to assist in the generation of Meylen.

Meylen is a mixture of proteins and phospholipids forming a whitish insulating sheath around many nerve fibers, increasing the speed at which impulses are conducted.

[2018-06-07 Thu]

My right foot is like a piece of jelly. It's so weak it just flops around.

I walked up and down the hallway. Back achy and sore late in the afternoon and evening.

[2018-06-08 Fri]

I walked down to the pool and in front of the building this afternoon. My right foot is very numb and I can't raise my big toe at all. Well, actually, I can't raise any of them.

But the rest of my bits seem to be working pretty well.

My front incision is uncomfortable (nothing compared to the pain before surgery) and my belly and feet are still very swollen.

It was two weeks ago today that it was determined emergent and we decided we were going to make a mad dash to LA for surgery.

[2018-06-09 Sat]

[2018-07-19 Thu]

I am feeling pretty good. Ready for physical therapy to start, but I must wait a few more weeks.

I stopped wearing my brace while at home today. I will probably wear it when I leave the house until I my core has strengthened and I feel more stable.

I am still unable to raise my right foot, and a large portion of it is still very numb on the top.

I am able to walk, but I wear an AFO when I am outside of the house.

I am able to drive while wearing the AFO.

I am down to taking Tizanadine as needed (usually 4mg in the am, maybe 4mg mid-day, and 8mg before bed). I am still taking Gabbapentin 300mg 3x day.

[2022-01-27 Thu]

Things have been pretty stable since the last update. I stopped wearing the AFO completely after a couple months except for travel, then after my AFO broke while walking around the Oslo airport in 2019 I stopped wearing it all together. To be fair, all my travel stopped not long after that as we entered the COVID era.

In the last couple weeks I noticed that my foot was feeling more weak. For the last 1.5 years we have been working on an interior trim project that we finially are wrapping up. Not sure if the weakness is related to increased activity cleaning up all the mess from a 1.5 year whole house project or if it's simply regressing in some permanent way. I started wearing the AFO again. Definately right now I don't feel confident driving without it.

FAQ

How did you choose a surgeon?