As some of you may or may not know, I am two months away from back surgery. Every time I mention this, it seems that less people than I thought really know what’s going on—so, I thought I’d put everything into a blog.
Sometime right after last Christmas, I started to experience back pain. Around that time I also quit smoking cold turkey and started playing indoor soccer for the first time in 14 years. So, for a little while, I just ignored the back pain and wrote it off as some kind of side effect. By the end of March, not only was I still hurting, but it was getting worse. I could barely get out of bed in the morning, let alone easily complete simple tasks like putting on my pants or getting up off the couch.
Since I had experienced similar back pain before in my life, my first stop was at a chiropractor—one who came very highly recommended. He did everything my previous chiros had tried: manual adjustments, electro-stimulation, ice/heat packs, and even some acupuncture and pressure point techniques. At a certain point, he had me go get x-rays. We found a few things: my hips were misaligned (most likely from two months of hobbling around after I got a cactus burr stuck in the ball of my foot, then, like an idiot, didn’t have it taken care of right away); I had degenerative disc disease in my L5/S1 (for those of you who don’t know vertebrae, the easiest way to describe that area of your back is it’s where you do all of your sitting, pushing and carrying weight); and, he found a small fracture. After a few more adjustments, a total of five weeks of treatment, and my pain increasing rather than decreasing, the chiro admitted he couldn’t help me anymore.
At this point, I went to my GP, who is a DO, and we started to talk big picture. We discussed my options, she prescribed me a very mild anti-inflammatory/muscle relaxer/pain killer and wrote me a prescription for physical therapy. I embarked on twelve sessions over six weeks of 20-minute manual adjustments from a physical therapist, followed by an hour of stretching and exercises with PTAs, and ending with 20-minute ice and electro-stim sessions. Again, as with the chiro, most of the time, I only felt average, but never better. I loved everyone I worked with at PT – it just wasn’t what I needed. This was the second time someone told me they couldn’t help me anymore.
Back to the GP, who recommended that I try a pain management clinic. I started to freak out at this point, as I was about to embark on 22 days of work travel over five weeks. I imagined intense, unending back pain that I knew would only be aggravated by long east coast flights on packed airplanes, walking with heavy bags, sleeping in hotel beds, and sitting for hours on end at boring conferences on uncomfortable plastic seats. I ended up picking, at random, one of the most thorough and understanding doctors I’ve ever known. I later came to know that the pain clinic also does all the work for the Arizona Cardinals, and is one of the very best in the valley. And, let me also say, his nurses were so kind and comforting during injections that I might as well have had my mom in there with me.
Anyhow, this doctor agreed I had solved the misaligned hips problem, but that the degenerative disc issue was more serious than we originally thought and the fracture could be worse too. Next, on my menu of potential solutions was lumbar epidural steroid injections. I had three shots over three months (May, June and July); however, after only a few days of respite each time I received the shot, it wore off and I was back to square one. For those of you counting, this was “I can’t help you” #3. My pain management doctor referred me to an orthopedist.
All I wanted was this new doctor to point at me and say, “Ah ha! I know what’s wrong, and here’s how I’m going to fix it…” And, short the rest of the appointment, that’s exactly what he said. True, I might have had luck simply managing my pain for a while, but there is definitely something wrong with me that can and should be remedied. He sent me for an MRI, which revealed a clearer picture of the original x-ray.
First, while the discs in the rest of my back are big, beautiful, milky white, cushy, perfect discs, my L5/S1 is so totally depleted, it just looks like a tiny black squiggly line on the MRI (Wow, I thought, I’m not crazy - two vertebrae grinding together all day, every day really does hurt that bad.). Second, the pars fracture of my spine is absolutely a contributing issue. The technical term here is: spondylolysis (I’ll summarize below, but you can check out the full resource here: http://www.hss.edu/conditions_spondylolysis-pars-fracture-spine.asp)
Spondylolysis occurs when there is a crack in the rear portion of the spinal column. The human spine is made up of 24 vertebrae that are stacked on top of one another in the spinal column. The spinal cord is protected by a ring of bone that makes up the middle and back portions of the spinal column. The area of injury in the spinal column is between the pedicle and lamina. This is usually caused from excessive or repeated strain to the area of the spinal column called the pars interarticularis, and it is sometimes referred to as a pars defect when fractured through this portion of the spinal column. The lower portion of the spinal column is called the lumbar spine. Spondylolysis most commonly occurs in the lower back at lumbar vertebra L5 (BINGO!).
In athletes, this type of injury can be seen when the back is bent backwards repeatedly, in activities such as gymnastics, karate, and football. Specifically, this is common in offensive and defensive linemen. (For those of you who ever watched me play soccer, I was as aggressive as any defensive back.) But exactly why did all this happen? I was born frank breech; I took a really bad fall on ice and landed on the metal strip on our porch stairs; I had my kidney fractured by taking a direct kick during a soccer game, not to mention I threw myself around as a goalie for many years; but, who really knows. Everything added up to a pretty messy set of vertebrae and a fractured spine.
WARNING: GORY SURGERY DETAILS!
So, what’s the answer? A posterior lumbar fusion. With the help of a vascular surgeon, my ortho doc will make a 3-inch incision just below my belly button. In his words, he’ll “move aside the chitlins” to get back to the spine. Why not through the back? Because going through spinal nerves requires everything to be smaller, which means less room for what he thinks I need to be fixed. In any case, he will cram a cage made of a very light, virtually invisible plastic into the almost nonexistent disc space. Inside the cage, goes a cadaver bone graft, which has been stripped in a lab of any of the qualities of the donor. Even though the bone is dead, my body will say, “Hey, look, it’s bone. And there’s bone above. And there’s bone below it. Why don’t I make one nice, solid piece of good bone.” My doc will then make two ¾” incisions in my back, through which he will arthroscopically insert two titanium screws and a rod to hold everything in place. The whole procedure will keep me knocked out for 4-5 hours.
Then, it’s 2-3 days in the hospital. My mom is coming down for surgery and recovery, so, between her and Matt, I should be well taken care of. I will be wearing a brace for anywhere from six weeks to three months. After that, I can resume life as usual, and should expect no limitations on activities, and a less than 20% chance that I’ll ever experience any additional back or spine issues for the rest of my life.
I will say that, for the first time in my life, I was lucky enough to find a succession of the best doctors I’ve ever known. I wish I’d never started hurting in the first place, but at least I had some good people looking out for me. And, Matt deserves huge kudos for helping off the floor, off the couch, out of the car, out of the tent, and for lifting, carrying, packing and unpacking, unloading groceries, and generally doing everything for me. I don’t know how I’d live without him – physically, literally and metaphorically.
Well, that was lengthy, but needed. I hope you’ll all think of me on November 30. If you’re lucky, I’ll post some gross post-op photos and maybe, just maybe, a dorky picture of me in a back brace. I just want to be a normal, healthy, fun, capable, flexible, agile, recreating, walking, sitting, pain-free 30-year-old woman.
XOXO
Chelsea
