Three levels w. Dr. Pimenta in Brazil

[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.

[Maria]

Congrats Katie! It all sounds so incredible and like a fairy tale outcome! I actually had to go back and look at your age again as it's hard to believe you're only a year younger than me! You sound so fit now!!

Are you currently on any pain meds at all? Sounds like you don't need them from what I read altho I may not have seen where you mentioned this if you did.

Thanks for the update~ it's really uplifting to hear how well you're doing and you must be absolutely ecstatic to have your life back

[Katie]

Yes, I'm still on a few morphine a day, anywhere from 20mg to 80mg, depending on how busy I am. If it never gets better than this, I will be thrilled From what other fusion patients have posted, their pain levels have usually disappeared anywhere from six months to a year post-op. It is a far cry from 360mg/day.

So if I behave myself and don't spend time in my garden, etc. then I am basically pain free. (And I am very careful about bending, twisting etc. while doing my favourite things ) I don't think it can be much more strenuous than physio for building my core strength. I've started exercises in the pool and it really feels good, again as long as I don't over do it.

Thanks for asking, and the nice words. It feels awesome to finally go out and have a shot at real life and not be totally looped on pain meds or pain

If anyone has any more stories about their recovery from fusion or cervical ADR, I'd love to hear them, especially if they have experience with Nuvasive.

[Crystal33]

That was a great story to read. I have somewhere read positive review about this doctor before. He must be fairly exceptional and an example of what all spine surgeons should be like.

[dshobbies]

Katie,

Sounds great. You hold your breath for so long, hoping you're making a good decision and then, you're there. For you, this is a dream come true. I hope you continue to improve and ultimately get your whole life back.

Taking it slow is the key but looks like you already know that. Please keep us posted,

Dale

[Gil Denis]

HI Katie

Keep Moving Forward

Gil

[Katie]

You too Gil! If I can ever help, you know where to find me

[Katie]

Thanks dshobbies It sure isn't easy being good And when I'm not, it is so hard to break down and take something for the extra pain. I have to admit that those three months without being able to drive were probably the most frustrating I've had in a long time. I hate being a passenger

I'd love to get some feedback from others with similar surgeries (fusion without any reinforcing rods or screws, etc. and see how limited their activities are. My body tells me when I've gone a bit too far, but I'm not sure if it is doing any real damage, or just irritating tissue. I know a lot of it is muscle pain, as the relaxants I take do the trick. But there still is a throbbing in the spine itself at times. No sharp pains tho, so no damage so far at least as far as the x-rays show

Thanks for all the encouragement and advice.

[Katie]

Crystal, Dr. Pimenta is indeed exceptional and I would highly recommend him to anyone. It was actually easier flying to Brazil than to Germany, as there was no jetlag. They are almost on the same time zone as we are, give or take an hour. And the beaches we went to post-op were worth it too

He is a very kind and compassionate man and surgeon and very easy to talk to...something very rare in the medical world I've found.

[dridobits]

So glad you are doing well. I haven't been on the site for so long. When one starts to get some life back, well you grab it. Let's keep in touch. Many many hugs. I'm proud of us and the courage it took for us to do our surgeries. Hugs, Liz