Spinal fusion

Right verses bilateral L2-3 Laminectomy, Medial Facetectomy, Foraminotomy, Nerve Root Decompression, Right L4-5 Laminectomy, Foaminotomy, Medial Facetectomy, Nerve Root Decompression, Right L4-5 Transforaminal Lumber Interbody fusion/Instrumented Posteriolateral Spinal Fusion, Autograft, neuro monitoring, Cell Saver, bone Morphogenetic Protein, Robotic Assisted.

I wanted to share my first experience with Spinal Surgery, in hopes of helping others prepare for theirs, and maybe stack the deck in their favor as I did. Because I was able to pick my doctor, pick my procedure, and the hospital it would be done in, and had 8 months of preparation time, all this and then some helped me be successful (so far) far beyond my most positive expectations. Obviously not all the things I did can be done by others, and who knows how much they each contributed to the outcome, but when it's your life and livelihood on the line, always make it your best shot!!

So now I had 8 months to wait for the surgery, and I researched on-line that walking, and strength of back and core muscles would be key to a successful recovery. So I went from 3 to 6 miles per day walking, and added to my morning workout additional exercises for back and core. Every time I thought of skipping a day, I reminded myself that I had to have a quick recovery, to help around the house, and get back to work, and if that one or two days a week I skipped proved a difference, whose fault was that?

I had had progressively worse pain through the years, with 3-6 level pain in my lower back, especially when I stood still, and 2-5 level pain down my right leg. I had also had a torn rotator cuff several years back, and as the doctor that fixed that worked in an orthopedic clinic that did spines, that's where I went. I first started with a PA who gave me Celebrex, which took some of the edge off, but obviously was not a fix. So I saw Dr Halperin, whom I researched on-line, and we first went with spinal injections (2 actually), which really didn't do much for me. The X-ray and later MRI showed how my L4 vertebrae was pushed out of alignment, and the other points where my nerves were being contstricted. Knowing now that I had a mechanical problem, I talked to the Doc about a mechanical fix, i.e. surgery. He initially suggested that we do the TLIF for L4-5, and then see, and if I still had pain, go back in and do all the (insert above medical jargon here) to L2-3. I stressed that I would prefer to do this once, and get it all fixed, and he agreed (another sign of a great Doc, one who listens to their patients!!).

The week prior to surgery was getting all the big (read heavy) jobs around the house done, stocking up on heavy items like dog and cat food, getting a special leader leash for our dog so she cant pull as much when I would would her post-surgery. Also getting things like iron supplements to take for blood loss, Tylenol and Tylenol PM for post-surgery, since I couldn't take any NSAIDs from one week before till 4 months after, calcium supplements to help with the bone re-growth, long (8 inches) band-aids for the soon to have scar etc.. Also we had a chance to talk with both Dr Halperin and his PA, being briefed on what to expect, answering our questions, a very helpful time! I found out that my weight limit for lifting after surgery was up to 30 Lbs, more then I thought. I regularly worked with 60, so that wasn't going to be a problem.

So surgery day, I was very calm, I felt that I had done everything I could to prepare, and knew I had a good surgical and hospital team! Of course having no coffee that morning was a trying thing, but in every life some caffeine must fall. All the array of people came in one at a time, the nurses, anesthesiologist, doctor, pain management, all wonderful and very professional people! On with the show!! My surgery was to be assisted by the Globus Excelsius GPS robotic system, the newest entry in the Robotic Spinal Assistant. My doctor was the first to use this system at the hospital in January of this year. BTW my bone graft was using bone from what they removed from my spine during the procedure.

And then I woke up from what felt like a great nap in PACU (post anesthesia care unit)!! But I could tell that they had worked on me while I slept, I had a wound drain in, and a catheter in.

They asked my how I was feeling, and checked me out, and Doctor Halperin came in, and told me everything had gone very well, he and his team had worked on me for over 4 hours. I thanked him, and soon after was wheeled up to my room. Not long after getting up there, they wanted to see if I could get out of bed and walk. They showed me how to roll out of bed so as not to twist my newly re-build spine, and with one nurse holding my drain pack and catheter, the other arranging my gown to limit my southern exposure, I stood up into my walker. And I had no problem walking (with my assistants in tow) all the way down the hall!! I was pleased, they were impressed, so a good start! To celebrate I had a turkey sandwich and my first coffee in a day and a half!!

Now sleeping in hospitals (my first time) was not easy, always someone coming in to check on me or my roommate, so after I got my catheter out (ouch!!!), and proved to the nurses that I could get up correctly and use my walker, I did my best Forrest Gump impression and started walking every chance I got!! Two things Dr Halperin said to me, one was that walking was the quickest way to recovery, and that a surgeon friend of his had the same surgery, and walked 10 miles during his hospital stay. So I was determined to do better!! Round and round the floor I went (the nurses all encouraging and somewhat in awe), 25 laps to a mile as I found out!! So before I was discharged on Saturday morning, I had done 275 laps (11 miles).

Now going home, and the week after, I did much of the same, adding my workout and epicycle routine to my 6+ miles per day, now on half the Oxycontin then when I was in the hospital. So I soon found out that sitting too long was now my biggest pain (actually the getting up from sitting too long part). We followed the Drs orders, changing the band-aid after showering, not putting anything on the wound. But the one error I made, was wearing my back-brace all the time!! If I wasn't in bed or in the shower, I wore it, as I had read too many stories of twisting/bending meant having a screw loss (my wife says that boat has long sailed!!), so I was over cautious!! And I developed a very irritating rash from all the sweat, even though I always wore a t-shirt under the brace! So if the Dr tells you only wear it for comfort, wear it as little as possible if you can!!!!

I had my 2 week followup visit to my doctor, got my xray, doc said eveything was great, and I now have NO restrictions!! I was very pleasantly surprised at this to be sure. Took out my staples (like pulling hairs, smarts but necessary). Now I can take baths, don't need band-aids etc..

So anyway, I continue to do my workout, do my walks now as quickly or quicker then before my surgery. My pain that I used to have just standing still is completely gone, I feel a slight pain in my lower back walking, my biggest pain really is getting out of a chair if I sit too long. So I try to not do that, which is probably a good thing anyway. I hope through stretching and time that too will go away. Oh, and I still have trouble bending to put socks on, so on the advice of my Occupational Therapist, I got a “sock aid”, 10 bucks on Amazon, a marvelously simple device that makes putting on socks easy!!

I'm at 4 weeks out from surgery, and that's where I'm at. I have a follow-up in 3 months, take 4 tylonel daily, have about a level 3 ish pain getting out of a chair/car after sitting/driving for more then 30 minutes, some pain bending, but getting better. Hopefully this helps others in their decision to go ahead with similar surgery, I have absolutely zero regrets so far. But I need to stress this, get your body ready before surgery as much as you can fitness wise, choose your doctor carefully, listen to them, and follow through afterward by walking walking walking!!