Spinal Fusion Surgery - Part II
On 4-5 June 2020, I had spinal fusion surgery in my lower lumbar spine (L2-S1). I wrote extensively about that surgery during my recovery:
The results of that surgery were excellent. It was painful for a few weeks, and I had to undergo physical therapy for several months to retrain my body to adapt to the new spinal configuration and regain function. It took a full year to recover completely, meaning that the bones were completely fused and I was able to resume all normal activities.
At one of my last post-operative follow-up visits, the PA told me that because all of the mobility (thus the stress and pressure) formerly spread across my entire lower lumbar spine had now been transferred to the joint between L1 and L2, every activity that I engaged in from that point forward would constitute a decision on "how to invest my remaining cartilage."
I understood the message, and I knew just how I intended to make that investment. Almost exactly a year after the surgery, I was once again backpacking in the wilderness, as I had dreamed of doing for years:
Since that time I have had four wonderful years of activities I would have been completely unable to engage in before the surgery, including many trips into the remote backcountry of Idaho and the surrounding states. It made the surgery totally worth the initial pain and the enforced discipline of limited activity during my recovery.
During 2024, the time came to pay the price for these activities, as I began to feel increasing pain in my lower back. I went back to the same person who did my first surgery - Dr. Daniel Blizzard at Axis Spine Center in Coeur d'Alene. I am tremendously fortunate to have such an advanced medical practice with top-tier doctors located so close to my home.
X-rays and MRIs confirmed that the disk between L1 and L2 was essentially gone, and my movement in that joint was bone-on-bone (I could feel the grinding). The doctor told me that surgery at that point was optional, but certainly indicated, and that it would eventually become necessary in order to prevent permanent nerve damage. I elected to do it sooner rather than later, hoping that a surgery early in the year would enable me to recover sufficiently to have at least some capabilities during the summer of 2025, although I knew full recovery would again take a year. So we scheduled it for January.
In these cases, rather than simply fuse the next one or two vertebrae, their procedure is to fuse the rest of the lumbar spine and the first few vertebrae in the thoracic spine. The reasoning is that transferring all the motion from L1-L2 upwards to the disk between T12-L1 would simply result in a repeat a few years later. By fusing T10-L2, they extend the fusion upwards into the thoracic spine, where the vertebrae are further stabilized by their connection to the rib cage.
I was told that in the end, I should not lose much flexibility in terms of bending, but that I will lose a great deal of rotational flexibility, as my entire lumbar spine will now be one big bone, all fused together. This seemed to me a small price to pay, with no other real alternative that would allow for continued outdoor activity.
They also did one other procedure at the same time, fusing my sacroiliac (SI) joints. This was not strictly necessary now, but could well have become necessary in the future. I thought "Why go through all of this twice?", and elected to have them do that operation as well, all at the same time.
Unlike the first surgery, they did not have to go through my abdomen. They made one incision on my right side to insert a spacer between L1 and L2, just as they had previously done for L2-L3 and L3-L4.
The really invasive and painful part of the surgery was that they had to open up my entire back, both to inspect the previous fusion and hardware to ensure that it could serve as a solid foundation for the extended fusion, as well as to insert the screws into T10-L1. As it turned out, the bone fusion was good and all of the previous screws were solidly in place. So they removed the rods that went through the existing screws, and then inserted longer rods that would continue to stabilize the previous fusion and also extend it upwards to T10.
Now my spine looks like this:
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| Anterior X-ray view of my T10-S1 Revision. You can also see the long screws angling up from each side at the bottom, stabilizing my fused SI joints. |
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| Lateral X-ray view of the T10-S1 Revision |
The most painful aspect of this surgery has been due to the fact that they had to stretch the heck out of my back muscles and ribs to get them out of the way. The doctor told me to expect it to "hurt a lot for several weeks". So far he's been right. Although I am starting to feel better, I am definitely quite sore and don't expect that to change too much for awhile.
I was very happy to take the full dose of the prescribed narcotic pain medication (Oxycodone), but have started to wean myself off of it, as I really do not like the mental fog that it produces. I want to be able to concentrate better so that I can do the readings and participate in the classes I am auditing at ARU (separate post later on that topic).
Now that the pain and swelling from the incision is subsiding, one of the hardest parts is the pain in my lower rib cage, especially on the right side. They told me they wouldn't know until they got in there whether they'd have to cut my rib out of the way or perhaps even enter my chest cavity. As it turned out, they did not have to penetrate the chest, and they only retracted the rib out of the way ("We don't think we broke it, but it's going to hurt.") This has made wearing the back brace they gave me fairly uncomfortable.
I was prescribed the same electronic bone growth stimulator as last time, and will use it for two hours daily for the next year:
The back brace they gave me, however, is different than last time, as it has to extend further upwards to stabilize my entire back rather than just my lower lumbar spine:
I had this back brace fitted before my surgery, and could tell that it would be very effective. The central panel on the back is stiff, and the backpack straps help to keep it pulled tight against your back and keep you upright without bending while the bones heal. I am supposed to wear this at all times when I am up and around, for something like the first three months. I thought it was great, until the first time I put it on after my surgery. A look at my back will give an indication of why:
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| The incision on my back, with the sterile dressing. The small patch of gauze is where they had inserted the tube to drain the blood for the first few days. They kept me in the hospital for one extra day until the bleeding subsided, then removed the drain and let me come home. |
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| My incision after removing the dressing. The shorter scars from my previous fusion are visible on either side. The doctor said it would look like I'd been clawed by a bear. 🙂 |
They used staples instead of surgical thread, purportedly because they had to cut through a bunch of scar tissue from the first surgery to inspect the hardware. Apparently staples hold and heal better under those circumstaances. It feels like a zipper! Next week I get them taken out. One at a time. With pliers. Yay.
So that is the state of my back. Even just sitting in a chair or laying down in bed was very painful, despite the fact that we have a completely adjustable Tempur-Pedic bed with a memory foam mattress. (In the hospital they had intravenous pain drugs in addition to the Oxycodone, but they didn't let me bring any of those home, lol).
Teresa had very thoughtfully bought me a mattress pad made of open-cell foam, thinking that it would help me to be more comfortable sitting on the couch. It turned out to be a bit awkward to try to use it that way, but it made excellent raw material for some additional padding. The first thing I did with it was to try to find a way to keep pressure off of the incision (or at least minimize it) by putting some sort of pad on either side. I tried a couple different approaches, which finally evolved into this:
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| I cut out a sort of "collar" of open-cell foam and taped it to the inside of a t-shirt using "100 mile an hour tape". |
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| Turned right-side-out and worn over another t-shirt, this provided enough stand-off distance to reduce pressure on my incision and allow me to sleep and sit in a chair with less discomfort. Later on, it also turned out to be excellent at holding an ice pack in place. |
Once I was getting up and out of bed for more than a few minutes at a time, I tried the back brace. I knew immediately that it would not work for me as-designed. It puts *all* the pressure directly on the incision, which produced burning, searing pain (I have a pretty high pain threshhold, but this was extraordinary). Although the padded t-shirt works well at helping to keep pressure from a flat surface off the incision, I also had to put some additional padding on the back brace, since it fits right into that gap:
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| Back brace padding, version 1.0 |
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| Back view |
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| Side view showing additional padding where it presses on the incision. |
This worked well, and I wore it constantly during the first couple of days that I spent out of bed. But by the third day, the pressure on my rib cage from the side panels really started to hurt, and I had to add even more padding:
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| The additional padding across the bottom helps to relieve the pressure on my ribs from the side panels. I also made one other modification - like many backpacks, this brace has a sternum strap to pull the shoulder straps tight across your chest. But also like many backpacks, these straps are poorly-designed and do not stay in place - they migrate upwards to the point where they are choking you right across the throat. So I added a loop of 100 mile an hour tape to each side to hold them in place. |
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| Back view showing how the pad is secured to the straps. |
I sent these photos and description to the person who fitted the brace initially, and I plan to talk about it with the surgeon's people next week at my post-op appointment. There are much more advanced materials available, and it seems as though they could have had some kind of temporary additional auxiliary padding to alleviate the pressure on these areas. I should not have had to struggle with this, especially during my first few days home when I was in the worst pain, had the least range of motion, and was loopy from 24-hour-a-day maximum doses of my pain medicine.
My other important accessories are several reacher-grabber tools placed strategically around the house, my dad's walking stick (it is not a "cane" - it had to be a "walking stick" for me to get him to agree to use it, lol), and a memory foam pillow recommended by a friend that relieves the pressure on my sacrum when sitting. It just came yesterday and I love it, so I plan to order more of them so that I don't have to carry it around from room to room. They have different configurations and materials for different kinds of chairs, including car seats.
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| My dad's antler-handled walking stick and my new Everlasting Comfort cushion. |
So that's the story - I am now at home recovering, going through the same kind of process as last time. I am able to get around pretty well and am staying up out of bed all day, but am only able to focus and concentrate for a few hours from late morning to mid-afternoon. The rest of the time I sit and watch TV, read some light fiction, play a game, or just sort of zone out. I have started going for walks outside, as the streets are dry and clear despite the cold (I wouldn't dare do it if there were ice or snow on the pavement). The poor dog is confused because I can't take her along, since I cannot bend over to clean up after her.
I am looking forward to being done with this recovery. If all goes well I should be able to drive again in a few weeks, and perhaps even do some Jeep camping by mid-summer. But I probably won't be able to carry any kind of a backpack (even a light day pack) until the full year's recovery is complete. I intend to follow the doctor's instructions to the letter, and hope to have similarly successful results and years of pain-free activity thereafter.
Mood: Optimistic
Music: Rammstein: Rammlied ("Wer wartet mit Besonnenheit, der wird belohnt zur rechten Zeit...")
posted by Brad @ 12:45:00 PM
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