BACK

At 58 the MRI detected a smaller spinal canal in my neck. pretty much the same in the lower back. My hip replacement fixed the issue of a cyst pressing on my sciatic nerve. Over the last year, new symptoms appeared and old symptoms stayed the same. My outcomes have been outstanding. It takes work to find the right surgeons, explore alternate methods, and least invasive options.

April 2022. The 2 shots to L4/5 had a 100% result and the outcome lasted 60 days. I was able to ski for 17 days and had no issues of pain or symptoms until the last day of skiing. Another shot will be addressed and I have decided on surgery as the best option.

I had the 3rd shot and only gets the symptom relief to 85%. The issue is the long head of the left leg hamstring and left diagonal across the butt. I do get numb but not like before shots. i guess it takes 2 to do the job.

The option for surgery comes down to specific items. 1-specific symptoms. (I have them and diagnostics to prove) 2- Mental Health outlook 3- Age and Strength 4- No RA and will fuse. My neck is fusing at 8 months. I meet the items and can expect a 90% success.

GOALS > ACTION = Results 100% Feeling great.

After Hip, Neck surgery the leftover symptoms were: Numb left foot on the sole, numb left calf, some numb right foot sole, a knot mid hamstring, and some lower back pain in the glute.

MRI Show the area of L4/L5/S1 as a possible issue with the least space at 6mm vs 22mm normal.

MRI is the golden standard.
Close up. A buckle in that nerve. After L1 the spinal cord becomes like a horsetail as the nerves branch out. called
XRAY 2015 Shows a grade 1 slip between L4/5

Since Chiro, PT has not addressed the root cause, time to seek options.

I consulted with two Specialists: Dr. Marc Coleman who performed Medial Branch Blocks, Radio Frequency Ablation, and an epidural on my cervical spine with good success.

Dr. P J Tortalini performed the surgery on my neck in July 2021 and a specialist in the lower spine as well.

The decision was made to try 2 sets of shots to the lower back L4/L5/S1. The results are that 100% of the symptoms are now gone. (This may not be an option for life but least invasive vs surgery).

Now I am skiing and working on becoming stronger. The plan- Wait and see. I can have 3 shots a year. Insurance only pays for 3 you could have 6 in a year.

Guided by fluoroscopy and injected dye, a nerve is coming out of the spine to form the sciatic nerve.

Results outstanding 100% symptom relief Jan and Feb 2022. able to ski for 17 days. Symptoms came back over time in March. the third shot in April gave the 85% symptom relief but need 2 shots for 100% relief.

My knowledge of cervical fusion helps me understand the risks with the lumbar. The laminectomy will open up the vertebra and allow surgical access to clean up the L3L4L5 area. Full recovery to active skiing is 6 months. Desk Job return to work is 4 to 6 weeks. Cannot bend over at back for a while and no heavy lifting. It will be a long slow recovery.

L3-5 Decompression with Posterolateral Fusion
May consider an isolated 4, 5 Fusion at the time of surgery

I have a smaller canal space from birth and my paralysis comes back after 3 months with shots. DO to want to narcotic medicate and cannot take NSAIDS for cervical fusion.

WHY The cage shape? angle and height adjustment allow hand fit by the surgeon. The angle is larger in the front anterior of the spine.

WHY ROD and Screws? A normal spine has 3 contact points. The Disk, and 2 points on the pedicle the posterior or backside. This forms the 3 points/triangle to support while waiting the 2 years for full bone fusion

CAN Anything help fusion? A lot.

Yourself: No nicotine, no NSAIDS, Check Vitamin B12 and vitamin D. Up your protein. prehab and rehab.

Surgeon: Stem cells, Bone fragments, and biologics. Technique and Implant type.

PLIF Animated

Getting ready to have surgery takes a bit of work but will help in the long-term outcome.

PART 1 is working with a Physical Therapist. An assessment was completed and overall history. Then on to some instruction on bridges and pushing the back flat (pelvic tilt) and lifting each foot, then same with 1 arm then 2 arms. This was then transferred to standing against a wall. Heel 6 inches from the wall. Pelvic tilt to achieve a flat back. Heels will want to lift and have to resist. then lift a foot up. I could not do that.

I went in thinking I am in decent shape and came out with I need to get to work. 10 mins a day every day for these.

Sheet 1

It works wonders took about 3 weeks to be able to pelvic tilt and compress the core while standing not even using a wall.

each side has 2 screws and a rod connecting. The Center is the Cage.
Side view only fusing L4/5.

Laxative mgmt – Senna-s (results in 3 days) if NOT Mirilax (Results in hours ) If not magnesium citrate (30 mins to a few hours)

Pain Management – Narcotics are restricted by Govt — order early if you are running out. Best to get your after-surgery medication at the hospital/surge center before you leave. Have on hand NARCAN, if you forget and take too many opioids Narcan will save your life. Accidents happen.

Take pain meds for pain not getting high. Take the meds before the pain comes back at the prescribed timeframe if not you may be in pain for an hr or more before the meds take effect. called onset.

BLT – NO BEND TWIST OR LIFT – First few weeks 5 lbs lift is restricted. Bend no bend more than 90 degrees from Hip to leg. Twist as in reach with one arm across the other side or twisting at the waist. 3 Min Vid is better at explaining.

I have an In-home Nurse who completed a baseline assessment and a PT tech (Joseph) who does the same baseline.

Baseline 1- sit in a chair and get up (The CDC tests for fall risk) I could not do even one up and own sit.

Chair Sit Stand = CDC and daily walking total.

4 Week POST OP 100% Perfect.

Increase weight lift restriction to 20 lbs from 8 lbs

More stretch bands and seated 5 and 10 lb dumbells. No Overhead Movements.

Seated Indoor Bike

Swimming.

Will have 2x a week for 4 to 6 weeks in office PT.

AUGUST Weight restriction 20 lbs, Sept 30, Oct, 40, Nov 50. No more heavy lifting without help.