[mmglobal]

Many of you know that on Saturday I returned from Germany, having been there with a series of clients. One of them had a 4-level procedure that was truly incredible. He's given me permission to write about it.

Of all my travel clients, he has the highest pain tolerance I've ever seen. At first I thought he wasn't in that much pain as we could always calmly discuss where he was. After the discogram, I came to appreciate how he could remain calm and not appear to be in distress in spite of really intense pain. After the 4-level surgery, I discovered that he's no ordinary human. However, just because he's not showing it, doesn't mean that he's not really hurting.

His surgery was planned to be ProDisc at L2-3, L4-5 and L5-S1, with an anterior cage with screws at L3-4. L3-4 was very severely collapsed and had substantial scoliosis at several levels that was dramatically compounded by a trapezoid shaped L3. It put a huge kink in his spine and turned out to be much more serious than anticipated. It was not possible for Bertagnoli to correct the scoliosis without reshaping L3. He cut a wedge out of the inferior part of the body to make the endplates parallel, but leaving a very trapezoid shape between the bodies. Because of the compromise of the endplate, he needed to maximize coverage with the fusion cages, so he used 2 cages turned 90 degrees, achieving almost 100 coverage. After placing the first cage on the small side, he went in from the opposite side (without another incision) and put a screw in the vertebrae on either side of the wedge shaped space. Using a threaded rod like a jack screw with nuts on either side of each screw head, he was able to pull the disc space into a normal alignment. Before he did this, all three ProDiscs were already in place and looked way crooked. I was very concerned about how things looked. But, when he pulled the L3-4 space down on the high side so the (new) endplates were parallel... everything was pulled into a normal alignment. It was absolutely one of the most incredible surgeries I've seen.

The patient had a difficult recovery with 3 days in ICU, but for someone so severely disabled for such a long time pre-op and for such a large surgery, this is not unexpected. He got out of the hospital on day 8. I spoke to him yesterday at the hotel and he said, "At this point, I'm actually having moments when my mind isn't occupied by pain." Upon further questioning he said it's been years since he's experienced this. Of course the post-op pain is still substantial and the med-levels are still higher than pre-op... but I can tell you from experience, these are wonderful signs. We don't know how good he'll get, but at least he has a chance.

I hope that he'll come along and write more later,

Mark