My L5-S1 Spinal Fusion Surgery
2011-05-23

Back pain sucks! Let me repeat, back pain sucks!!! You don't realize how important your back is to your daily activities until it hurts... and when it hurts it mentally takes you out of the game. Your limitations and frustrations affect not only you but those around you as well. This was me until I had surgery. Here is my story.

Background

Ok, let me give you a bit of background about myself in case you want to compare to yourself or someone you know with back pain. I'm an athlete and have always been in great shape. Played soccer year-round from 1st grade through high school. In high school I played football, soccer, and volleyball and was on varsity in each sport from my sophomore year on. In college I played volleyball at UC Irvine. Thereafter I graduated, got a desk job, and then... the pain came!

My pain was centered and slightly to the right in my lower back. At first I thought it was just muscle pain but it never went away. When I exercised the pain would disappear and I would feel great. The day after I didn't want to move, and the more I didn't move the more it would hurt! Sleeping was tolerable but mornings were the worst. I'd have to sit on the edge of the bed for five minutes or so before I could walk. I'd stand in the shower for a long time so my back would warm up. Then there was the painful scenario of putting on pants/shorts, socks, and shoes. Almost impossible. I can go on and on about how my life was affected. It really made me sad when I couldn't either pick up my kids for a hug or kneel down to their level for one.

After about four years of pain I finally went to the doctor. Yeah I know, I'm stubborn.

Early Doctor Visits

First stop was a chiropractor. Now I've always been skeptical of chiropractors and really don't want to go into whether or not they are beneficial or not. I can say that the first chiropractor I saw was a tool and the second one was incredible. Doesn't matter though as neither helped or could have helped me in the long run. The first chiropractor never took X-Rays and this I learned is a big NO-NO. He should have but instead he just blindly went to work on my lower back. Looking back I think I'm lucky as I never felt better or worse after being treated by that guy.

The second chiropractor I saw was the polar opposite of the first and the first thing he did was take a TON of X-Rays. This is when I found out what was really wrong with my back... a condition called Spondylolisthesis. This chiropractor was great. He got out a protractor and measured all the various angles of my slip on the X-Rays and determined a treatment plan that should improve my condition thereby giving me a better and more consistent lifestyle. Well, needless to say, it didn't work but I definitely appreciated his effort. Again, I didn't feel any better or worse after that round of treatment.

Condition

So I had good old Spondylolisthesis or for the lazy, Spondy. I never had a direct injury to my back but the facet joint between L5-S1 was broken and my disc was completely shot resulting in my spine slipping forward. After much speculation almost all doctors agreed that it was most likely the result of increased degeneration from a childhood injury. I'm sure with all the sports I played, especially playing volleyball at such a high level, really took its toll. You can see from my X-Rays below just how bad the slip was. I don't recall what stage it was identified as but I'll tell you it was the "hurts like hell" stage whatever that is. Note that I do consider myself lucky as I had zero leg pain. The sciatic nerve travels out between L4-L5 and that level has remained in tact for me. I can only imagine how much more horrible that pain would be on top of an already excruciating situation.

spondy spondy

Later Doctor Visits

After a year of chiropractor-myopia it was time to move on to the neurosurgeons. In 2005, I saw three different surgeons and pretty much got the same answer from each. I'm SOL. Two said they would never operate on me and one of those even proceeded to essentially say "suck it up". Btw, to that doc, screw you! I was demoralized. The third doctor, Dr. Jeffrey Deckey at the Orthopaedic Specialty Institute in Southern California, said he'd operate but the success rate was low. If I recall it was somewhere between 50-75%. The surgery involved a giant six inch incision down the middle of your back where they proceed to spread apart the muscles and all other stuff in order to fuse the vertebrae with some screws and rods. Inserted in place of the disc was some cage like device which contained a special enzyme that promoted bone growth/fusion. I don't recall all the details but it was an obvious NO WAY so I proceeded to manage the pain and gimp through life.

Four years had passed (now 2009, age 36) and I don't really know whether my pain had gotten worse. Mentally I had accepted my condition so everything was a bit easier. One day I decided to go see Dr. Deckey again. I wanted to know if my condition had gotten worse and whether or not there were new surgical techniques. Oh my! Immediately upon seeing a new X-Ray Dr. Deckey's first words were "We'll fix you right up!" I thought I was dreaming and I remember that office visit so clearly. For the first time I literally saw the light at the end of the tunnel.

The Surgery

The surgical procedures had advanced to the point where spinal fusion had become "minimally invasive" so to speak. It turns out that a lot of the guessing work has been eliminated and they now do the surgery with the help of computers using realtime X-Rays and 3D modelling to ensure the screws are properly placed without any nerve damage. In addition you're hooked up to electrodes at various places in your torso/legs that flag when a nerve is hit during the procedure. I was given a success rate in the ninety percentile range. Sign me up!

The surgery was performed with a total of five incisions. Four in my back and one in my stomach. The four in my back are each less than an inch long. If you look closely at the X-Rays below you'll see the staples that were used to close the incisions. There are two on each side of my spine right at the L5-S1 area. These two holes were used to screw in the four screws, two into L5 and two into S1. The other two incisions are way up high above the L1 vertebrae were the muscles are thinner. This is the CRAZY part. Those high incisions were used for inserting the rods. They are entered into the body and slid down along the spine under the muscles where they are then fastened to the screws to complete the bracing for the fusion. Say what?!?! Yeap, they slide the rods down along your spine under your muscles which results in very little muscle damage and faster recovery.

The incision in my stomach is the one that hurt most simply because my abdominal muscles were cut. It's about three inches long and was the entry point used to suck out my previously deteriorated disc between L5-S1 and insert a cadaver bone in its place. Yes a cadaver bone! It is easiest to access the disc from the front of the spine. If you look closely at the X-Rays below you'll see the cadaver bone (i.e. white block) between the vertebrae. Note the dime sized washer in the middle of the vertebrae. In the front of my spine there is a screw holding this washer in place which in turn was used to hold the cadaver bone in place during the beginnings of the fusion process. I've had no bad dreams yet so don't believe the crap that comes out of Hollywood. To whomever the bone came from, thank you for being a donor!

back_surgery back_surgery

Recovery

I was in the hospital for five days following the surgery and I have to say that was the worst experience ever. First the hospital, St. Joseph, and staff were spectacular(!) but the pain I went through was the worst. I really felt that the surgery was borked and I had made a bad decision. Dr. Deckey kept reaffirming to me the surgery was perfect and I'd be feeling really good within TWO weeks. No way I thought. No F'in way! Of course the stomach and back pain from the surgery was bad. To alleviate the pain you take tons of meds. I was on Morphine for two days and OxyContin for one (btw, oh wow does that OxyContin stuff mess you up!). Thereafter the pain meds were slowly reduced but the most important point to note is the major side effect of those meds... constipation. Now after a major surgery like that a hospital won't let you leave until you have a bowel movement. Just imagine how it felt trying to poop a couple days after having four rods and two screws jammed into your lower back coupled with a long incision just below your belly button.

While that all sucked it got worse because of the Occupational Therapists! Oh how I hated those women who came once every day. They had the responsibility of making sure you can do day-to-day tasks before being let go. For example being able roll in/out of bed, going to the bathroom, putting on clothes/socks/shoes, walking up/down stairs, etc. As time goes on I'll forget more and more about my hospital stay but I will never ever forget those evil therapist women!

Take note that once you get home you'll absolutely need someone to help you in your day-to-day activities during the initial healing period. For me this was my incredibly supportive rock star wife Kathie. Thanks hun!

Dr. Deckey was right. A week after the surgery I was feeling quite good. Within two weeks I was getting around easily without much issue. Within three weeks I was driving. Within a month I was doing light exercise. Within two months I was doing moderate exercise. Within three months I felt close to 100% and was doing more than I could ever have dreamed of. At six months I was cleared to do whatever I wanted. Although, wink-wink, I was already doing whatever I wanted at the four to five month mark. Note that I got to this point without doing any physical therapy whatsoever. My youth and persistence to push my body during the healing process attributed to my success.

Now

It has now been two years since my surgery and I honestly feel 1000% (three zeros there!). Looking back the hardest part after being cleared at the six month mark was mostly mental. I was so used to knowing (pre-surgery) that I couldn't do most things and for a long time (post-surgery) it was hard to mentally get over the fact that my back is now stronger than it has ever been. My old back pain was such a daily part of my life that I stopped realizing how it was affecting my life. Now I'm able to do things I barely remember doing in the past and it's astonishing. Smile after pain-free smile after pain-free smile.

Thank you Dr. Deckey!

Cost

The final bill from St. Joseph Hospital was itemized as follows:

Room and Care$8,949.48
Pharmacy$7,661.90
Central Services/Supplies$14,256.76
Implantable Devices$62,188.06
Laboratory$4,832.04
Pathology$218.90
Radiology/Diagnostic$1,047.25
Operating Room Services$27,505.08
Anesthesia$1,793.36
Respiratory Services$0.01
Physical Therapy$1,401.68
Occupational Therapy$1,091.46
Recovery Room$1,584.14
Other Diagnostic Services$12.00
Surgical Device Hold/Release$0.01
Total Charges$132,542.13

Seems a bit crazy huh. Note that I never saw a claim mailed to me or filed with Aetna from Dr. Deckey's practice. Somehow he got paid so the total cost was higher than what I listed. The most absurd thing is my insurance company (Aetna HMO) eventually paid out a grand total of $54,782.24. The healthcare industry is wacked. But this brings up a good point... if you have access to an HMO and the doctor you want to perform your surgery is a member of your HMO then change! That's what I did knowing this surgery was coming. I also had two wrist surgeries in that time frame. I think after all was said and done I paid out around $200 in copays.

Yourself

I can only assume if you've read this far you're trying to make the hard decision of whether or not to get surgery yourself or for a loved one. No doubt there are people out there who have not had the same experience with spinal fusion as I did. I feel for them. All I can say is keep on researching. I hope my story here will help guide you along your way. Good luck!