mmglobal L4-S1 2-level Charite Sept 2002

[mmglobal]

Originally Posted by original post by mmglobal August 10, 2003

SURGERY DATE: 9/20/02 AGE: 46

SURGEON: Zeegers

SURGERY LOCATION/CLINIC: AlphaKlinik, Munich, Germany

DEVICE(s), LEVEL(s): SB Charite' III, L4-5 and L5-S1

ONSET OF LUMBAR PROBLEMS, DATE OF INJURY, CAUSE, ETC...:
On 8/19/97, I was rear-ended at high speed on the San Diego Freeway. At the time, I was in excellent shape with no limitations.

PRIOR SPINE SURGERIES AND PROCEDURES (IDET, ESI, etc...):
2/2000 microdiscectomy/laminotomy 15mm protrusion L4-5.
9/2001 microdiscectomy/laminotomy 14mm protrusion L5-S1.
(Both surgeries successful in dealing with disc protrusions, but unsuccessful in dealing with debilitating low back pain.)
In the years leading up to my first discectomy, I had 8 lumbar Epidural Steroid Injections and many courses of Physical Therapy.

PRE-OP MEDICATIONS:
OxyContin, 80mg/day
Neurontin, 1200mg/day
WellButrin, 300mg/day
Bextra, 20mg/day

PRE-OP DIAGNOSTICS (discogram, nerve root blocks, etc...):
4 discograms all showed positive at L4-5, moderate positive L5-S1. MANY MRI's over the years showed increasing DDD. By the time I got to the surgery, both discs were turning black and the surrounding endplates were predictably sclerotic.

PRE-OP NEUROPATHIES:
I had substantial left foot pain and numbness. About 1/3 of the time, I'd say it was severe. I had lost the axial reflex in my left ankle. My gait was altered and I frequently dragged my foot or stumbled over it.

PRE-OP CONDITION: I'd been on disability since the first surgery in 2/2000 (2 1/2 years) I'd been taking opiates, Neurontin, andi-inflammatories, and anti-depressants for over 2 years. (Actually, the a-d's were only for 1.5 years). I was in a constant fog of pain and meds. I still had substantial L5-S1 radicular symptoms that I thought were permanent. In addition to the low back pain (60%), I suffered from left leg/foot pain and numbness (40%). I had lost the reflex in my left ankle and often dragged my foot and would frequently stumble over it. For the last year of so before my surgery, I was mostly a shut-in. Although I could go out and do things it was rarely worth it and I shut myself away much of the time.

TIME POST-OP AT ORIGINAL POST HERE: 10 1/2 months

DESCRIBE YOUR SURGICAL EXPERIENCE:
The AlphaKlinik was great. Their staff, equipment and facilities are all first-rate. I was not prepared for the amount of post-op pain I'd be experiencing. I think that there is a difference between the way they deal with post-op pain in Germany vs. the US. After a couple of days I got the OK to take my own pain meds and ratcheted up the Oxycontin. By a couple of days later, I was taking twice the Oxy that I'd come to Germany on. I struggled with spasms throughout my back for months prior to the surgery and it got worse after the surgery. For the first week, when I should have been getting better, I was getting worse. 1 week post-op I started PT and that really seemed to help. A few days later, I was taking outings around Munich. By 2 weeks post-op, I knew I was going to be a success, but was still in significant pain from the surgery, so it was hard to tell what my life would be like... when all the surgical pain would be gone, what would be left?

At 2 weeks post-op I returned home and immediately started cutting back on the meds. I had taken the last Neurontin the day before the surgery and never took another. I was taking 120 mg/day of Oxy and had a long way to go.

Regarding surgery induced symptoms: For the first couple of weeks post op, in addition to the abdominal pain from the surgery, I had substantial groin pain that was, at times, severe. When sitting from a standing position, I'd have a shot of pain that would go into my left testicle. It was pretty severe. I later found that this is also common in fusion patients (at least in the ones with testicles). This symptom faded within a couple of weeks. I'd view it as surgical pain rather than surgery induced symptoms. Except for this, I had no surgery induced symptoms.

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 improvment, limitations are still serious.
5. Good, substantial improvement, some limitations.
6. Excellent: no limitations.

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.

FUNCTIONALITY: _4_ SATISFACTION: _6_ [6 WEEKS POST-OP]

FUNCTIONALITY: _5_ SATISFACTION: _6_ [3 MONTHS POST-OP]

FUNCTIONALITY: _6_ SATISFACTION: _6_ [6 MONTHS POST-OP]

FUNCTIONALITY: _5_ SATISFACTION: _6_ [1 YEAR POST-OP]
Explanation of decreased functionality below.

FUNCTIONALITY: _6_ SATISFACTION: _6_ [2 YEARS POST-OP] Although I have some limitations, I cannot bring myself to rate functionality as good instead of excellent.

MEDICATIONS / DESCRIBE CONDITION 1 MONTH POST-OP:
My left leg/foot pain is substantially reduced. (I thought it was permanent and wasn't expecting relief from it.) My low back pain is so much better I can't believe it. When out on a walk with my wife, I slipped on some dirt and my foot slid and caught. In the past, that would have brought me to my knees, but now I don't even stop walking. I am amazed. I remember the first time I smiled a natural smile without forcing it out through a grimace of pain... it felt wonderful. I knew I was a success and was looking forward to getting my life back.

At 6 weeks post op, 4 weeks after starting my taper, I was off opiates entirely. That was after 2 1/2 straight years!!!! It took another week for the withdrawals to go away.

MEDICATIONS / DESCRIBE CONDITION 3 MONTHS POST-OP:
I stopped the opiates at 6-weeks. I immediately started tapering off the anti-depressants and was done 3 weeks later. That left only the anti-inflammatories. At 2 months I was riding my bike all over the place and rollerblading with the dogs every day. At 3 months, I was playing tennis. I still have some pain on and off. I've had a couple of episodes that scared me, but they were relatively short lived and not too severe.

MEDICATIONS / DESCRIBE CONDITION 6 MONTHS POST-OP:
I'm still taking anti-inflammatories, but no more opiates or Neurontin or anti-depressants. My life was restored!!!! At 4 months I was SCUBA diving, and rock climbing. At 5 months, I was playing some soccer... very lightly with friends, no competitive sports. Unfortunately, my knee went south and at 6 months I had knee surgery... completely unrelated to my back. It will probably end my athletics. Certainly no more soccer or volleyball or basketball, but hopefully I'll get to play tennis again and play other sports that I can do somewhat gently. (I don't think my doc saw me play tennis when he said something about that... if you are doing it right, it's really tough on your knees. Maybe I can acquire a 'medium switch'. I'm not sure I can play a sport and not go all-out.)

Again, I still have some pain and occasionally have a scare, but again, it's short lived and not too severe. My knee problems and some cervical problems are keeping me from any athletics, but my lumbar spine is in pretty good shape.

MEDICATIONS / DESCRIBE CONDITION 1 YEAR POST-OP:
Medications: Bextra, 10mg 2x

In a week, I'll have my 1-year anniversary. A few days ago, I went to my local OS for my 1-year x-rays. Everything looks great. I am still living life again. I don't take any opiates, Nerontin, or anti-depressants for my back problem (since shortly after my surgery). I am no longer a chronic painer. I do still take Bextra (anti-inflammatory). I have experimented many times with leaving it. Most of these experiments have been short lived, but in August, I went about 3 weeks without it. I can function, but I start having LBP and my most evenings I'm quite uncomfortable, with a pain level of 4 to 6. Going back on the Bextra, I have an occasional pain level of 2 or 3, with a rare trip into 5 or 6. These are always short lived and do not keep me from any activity or require more than a couple of ibuprophen or asprin. I still sleep well, which is something I could never do for years before my surgery. I'm pretty normal. My knee and c-spine have kept me out of athletics. But, I'm still flying a lot and have taken several long trips in the airplane. I can fly all day and still go to see a play that night. I'm taking sailing classes at the local junior college, which are much more strenuous than I expected, but perfectly OK with my back. I'm helping to coach a soccer team and am looking forward to being more and more active at each practice. Life is great again! (edit to add: soccer practice was too much for my knee, so I've stopped coaching.)

However, I still have some radiculopathy in my left leg. It increases slightly with activity. It's still just annoying, not painful. As always, I must remind everyone that I had severe radiculopathy prior to my surgery and did not expect it to get better. I do not regard this as a failure of ADR. The 90 to 95% relief I experienced was an unbelievable surprise. I do notice some minor changes which make me wonder... but not worry. I'll discuss this with Zeegers and let everyone know what he has to say.

MEDICATIONS / DESCRIBE CONDITION 2 YEARS POST-OP:

2-year update thread.
I'm taking Bextra 10mg/day. No other prescription meds. I still have a small numb spot on the bottom of my left foot. With too much activity, it gets bigger and I get some minor foot pain. (Remember that I had severe radiculitis that I did not expect to get better.) I'm 10,000 percent better than I ever thought I'd be.

More updates coming soon.