Spinal Fusion Surgery - Part III

Third time's the charm?   I sure hope so...

After many, many years of controlling my back pain through chiropractic care, exercise, stretching, etc. (including through three combat zone deployments to OIF/OEF), in January 2019 I finally retired to the mountains of Idaho, anticipating a renewal of my beloved muscle-powered outdoor activities including bicycling, hiking and wilderness backpacking.

Within mere months, it became evident that I needed a replacement hip joint and so I had surgery on my right hip in Sept 2019.  This solved that problem, but highlighted the back issues.  Years and years of chiropractic, exercise, stretching, etc.  just weren't cutting it anymore so I finally went ahead and had back surgery.  After several miserable months of waiting through the very inconvenient timing of the COVID pandemic, I finally had lumbar fusion surgery in June 2020, fusing the vertebrae from to L2 through S1. I wrote about that surgery here:

Spinal Fusion Surgery

In a nutshell, it was extremely successful and life-changing.  After a one-year recovery period, I enthusiastically resumed my outdoor activities.  To be fair to the surgeon, he explicitly warned me that every decision I made for the rest of my life regarding physical activities would be a decision about "how to invest my remaining cartilage."   I took that advice to heart, and I invested it.  Aggressively.  Starting in June 2021, I enjoyed several good years of wilderness backpacking and hikes up to alpine lakes, several of which I also wrote about here in my blog.   This photo is from my first trip in June 2021, through the Lemhi Range in south eastern Idaho:

And this photo is from my next trip, to the Selway-Bitteroot Wilderness.  I scattered a portion of my dad's ashes at the fire lookout in this photo (the tiny little bump at the very top):

I enjoyed several more years of exploring Idaho on foot and by Jeep, but eventually began to run up against physical limitations again.  Medical imaging showed that I was now bone-on-bone between vertebrae L1 and L2, exactly the cartilage I'd been warned about "investing".  So it was time for spinal fusion #2.

They called this a "revision", as they extended it upwards. To do that,  they had to open up the entire previous incision to inspect the hardware, ensure that it would provide a good foundation for the revision, and replace the original rods with longer ones.  I wrote about that surgery here:

Spinal Fusion Surgery - Part II

This surgery, while technically successful, never had quite the same restorative results as the first one had done.   I continued to experience pain, and nothing the doctors could do would stop it reliably.  The most confounding aspect was that the pain was seemingly random, migrating around from place to place.  Some days it was in my back and ribs making it hard to move and breathe, other days it was in my feet, so that I couldn't put any weight on them- literally couldn't walk.  Sometimes it actually felt like someone was driving a nail into my ankle.  Physical therapy, various pain meds, TENS machine,  stretching - I did everything they told me to do, and it just wouldn't stop the pain reliably.  I'd have good days and bad days, and I could still do things, but I mostly could not hike anymore, and backpacking was out of the question.  I became a Jeep camper, driving around exploring the Idaho, Montana, and Washington backcountry in my Jeep, and "stealth camping" wherever I could find interesting places to stay.

Normally the one-year followup is the last one, but they scheduled an 18-month followup visit this time since my progress was sub-optimal.  When things still hadn't changed after 18 months, they ordered additional imaging to get a better look.  (I didn't want to waste any more time, so I had three MRIs - cervical spine, thoracic spine, and lumbar spine) plus two CT scans, all in a row in the same morning.  Trust me on this one - don't do that.  😂 

When I visited the surgeon to discuss the images, he pointed out that the top two screws (in T10) were loose - they had never successfully fused into bone like they were supposed to,  He said they were "aggressively loose", and "wobbling around every time I moved".   So there was a possible (likely?) cause of my persistent, transient, random pain.  In any case, the solution was another revision surgery.  I asked why they couldn't just do the medical equivalent of sticking in a few flat toothpicks and some Elmer's glue to get the screws to bite again, but I guess they don't reach that technique in medical school.  😉

I got onto the waiting list and did all the pre-surgical labs, etc.   I wasn't expecting to be able to get it done any sooner than late October at the earliest, but an opening came up on 22 September, so I jumped on it.

This was kind of a difficult decision, because my 50th High School reunion has been scheduled for 2-5 October, and I was planning to go.  I had been a little ambivalent about traveling, but decided it would be worth it and made the arrangements. But when the earlier surgery date became available, my main thought was "stop the pain, please".

So I sent my regrets to the organizers as well as my friends and teammates who are attending, and went ahead with the surgery. This  blog entry is dated on the date I started it, but today is actually Saturday Oct 3, so they are all there right now.   I am really super-bummed that I cannot be there, but I really hope that this will be worth it.

This third surgery (2nd revision)  involved going up two more vertebrae, so now I have screws in T8 and T9.   They weren't sure about T7 until they got in there, but he said they just put some bone material in between T7 and T8 to provide a "soft landing".  They did not replace the screws in T10 - they just took them out and filled in the holes.  They were also surprised to find that one of the screws in T11 was actually broken!  He said this was very unusual.  I asked if this would qualify it as a warranty claim, but I guess surgery doesn't work that way, lol. 

They then used what he called his "erector set" to connect some shorter rods to the existing ones and get the other vertebrae into line.  I hope it works - Teresa says I am alread walking straighter than I was, which is a good start!

Here are photos of my new hardware:

Lateral view

Anterior view

Now it's another year of recovery, starting out with extremeley limited activities and gradually progressing.  I know the drill by now.

So far I'm 100% on the bone growth stimulator, and  intend to keep it that way:

This is the app that tracks the Orthofix PEMF generator.  According to the doctor, it's purpose is to "fool my body into thinking I'm 15" nso my bones will grow back together.

Mood:  Painful but optimistic

Music: Garmsen - "Wo Bin Ich?"    ("Where am I?)