[Katie]

SURGERY DATE: March 17, 2010

AGE AT SURGERY DATE: 55

SURGEON: Dr. Luiz Pimenta

SURGERY LOCATION/CLINIC: Sao Paulo, Brazil

DEVICE(s), LEVEL(s): C5/6-Nuvasive NeoDisc w. carbon fiber screws; L4/5 - Nuvasive XLIF with PEEK cage, no other hardware; L5/S1 - Nuvasive ALIF w. PEEK cage as above (I have severe metal allergies and could not have any metal implanted)

COST = $35,000 US
AMOUNT BILLED: same
INSURANCE ALLOWED: None
OUT OF POCKET: All
TRAVEL: $1500 round trip airfare per person, ~ $100/night hotel
EXPLANATIONS? We stayed for three weeks, but nine days were in hospital. It originally was only planned for three days, but constipation made it necessary to stay until everything started working. No extra charge.


ONSET OF LUMBAR PROBLEMS, DATE OF INJURY, CAUSE, ETC...: Back pain started in late 1990s when I tried to pick up something off the floor on my rt side while sitting. Conventional therapy kept sciatic pain in control until early 2006. Pain then became constant and crept up to 8-9/10 without medication. When I finally was able to get pain management in 2008, pain levels went to a 3 to 6 out of 10 depending on the day.

PRIOR SPINE SURGERIES AND PROCEDURES (IDET, ESI, etc...): No surgeries until Brazil. But had discogram and procedure done in June 2009 in Quebec that surgeon had heard about at a recent conference. He injected Methylene Blue dye into three bottom lumbar discs to try and eliminate pain. It failed.

PRE-OP MEDICATIONS: 300-360 mg of morphine/day. Allergic to many other medications like Fentanyl.

PRE-OP DIAGNOSTICS (discogram, nerve root blocks, etc...): As above, had discogram which showed L3/4 to L5/S1 positive for pain, eight steroid spinal injections, nerve testing. Positive Hoffmann's sign for myleopathy (compression of spinal cord) Spondylosis was missed by almost a dozen surgeons in three MRIs, two CT scans and numerous x-rays.

PRE-OP NEUROPATHIES (what, where, & degree of pain, numbness, tingling, sexual/bladder/bowel symptoms, etc.): C5/6-compression of spinal cord caused numbness of hands and arms while typing, painting. Continuously dropping things. Could not walk on my heels or toes, poor balance, bladder hesitancy, no libido, problem with swallowing. Bowel problems, but could have been caused by high levels of narcotic. Little pain though.

Severe pain in lower lumbar that necessitated high levels of morphine...made work impossible with slurring of speech, memory loss, lack of coordination etc.


PRE-OP CONDITION (Please include %leg pain/% back pain, pain levels, type of pain, ability to work and function, disability status, etc.... be direct, but be as verbose as you need to): On permanent disability... Ontario surgeons stated that surgery for my cervical was too dangerous. Also would not operate 'just for pain'. (I still have problems with memory/brain function now from too long on narcotics.)

Only had occasional leg/sciatic pain which my chiropractor usually eliminated...it was more from muscle pinching the sciatic nerve.

Pain level in lower back was 8-9/10 without meds, 3-6/10 w. meds It was a burning/throbbing pain with occasional sharp stabs if I moved wrong. Sitting or walking for any length of time was impossible. Could not bend over to put on socks without help, etc. Had to use wheelchair when I went out to shop.

TIME POST-OP AT ORIGINAL POST HERE: Four months, one week post-op.

DESCRIBE YOUR SURGICAL EXPERIENCE: Extremely easy, compared to what I was expecting! I fell asleep in the hospital room in my husband's arms after an injection for 'relaxation' and woke up back in my same room eleven hours later. Surgery was just over eight hours long. Much of that time was spent postioning me for each procedure.

I had three different incisions, one for each level. It was discovered half an hour into surgery that I had grade 2 spondylosis at L5/S1, that was missed by every other surgeon who saw my images in the past three years.

The XLIF surgery at L4/5 was done very skillfully, with almost no pain at that site post-op and only a two inch horizontal incision on my left side. The ALIF incision was a bit larger, and to the right of my navel. Dr. Pimenta had to go around the hip bone to reach that level and straighten out the vertebrae.

The NeoDisc horizontal incision at C5/6 was just two inches long as well, and hidden in the fold of my neck. All of my neurological problems disappeared within a day or two of surgery, despite all other out-of-country surgeons telling me that they would be permanent, that they could only stop the progression of deterioration, not bring back function.

I requested and had an epidural catheter during and for the day after surgery for pain. I have problems with pain control and having been on such high levels of narcotics pre-op, I was afraid that the pain would be out of control post-op. As it turned out, the only pain I felt was from the incisions and a bit if I moved suddenly. It was far less than the pain I had from a hysterectomy in 2003.

At two days post-op, I felt like running up and down the hospital corridor, but restrained myself I walked several hours a day though. There was some distraction pain in my legs after the catheter was removed, but it was more of a big annoyance than painful.

I had a huge problem with constipation, having gone in with an impacted bowel from the excessive narcotics, and traveling. In hindsight, I should have emptied my system before I left home. Because of this, I stayed in the hospital for an extra five days until all systems were 'go'.

We were able to travel around Brazil for a week to a few resorts on the ocean, to rest up before going back for final x-rays and check-up with the surgeon. While I took it very easy, I was able to be in a car for up to four hours and walk slowly on the beaches, and go out for dinners.

When we got home though, I crashed and slept for up to eighteen hours a day, for almost a week. The pain was still very slight, but the adrenalin was gone

RATE FUNCTIONALITY / SATISFACTION AT INTERVALS BELOW:

FUNCTIONALITY:
1. Very poor: much worse... disabled after surgery.
2. Poor: worse after surgery.
3. Neutral: No improvement, or improvements offset by new problems.
4. Fair, some improvement, limitations are still serious.
5. Good, substantial improvement, some limitations.
6. Excellent: no limitations.

Somewhere between the two. Since I had two fusions with no reinforcements, I am being very careful not to overdo things. Sitting too long or standing on hard surfaces for extended periods still hurt, but only 1/10th of the pain of before. Sudden moves still give me a sharp pain, but it disappears quickly.

I am limiting what I lift, etc. until I know that everything is fused as it should be.

My neck is terrific...almost no limitations with range of movement.

SATISFACTION:
1. Very sorry I had the surgery.
2. Somewhat sorry I had the surgery.
3. Too soon to tell, or I'm ambivalent about the surgery.
4. I'm somewhat glad I did my surgery.
5. I'm very glad I did my surgery.