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Tuesday, January 26, 2010

The spinal story

Because some of you have expressed interest in the details of what's going on with my back, I thought that I'd briefly explain. I planned to post this on the day that the wonderful Kathleen Coy bobcat painting arrived. I scrapped those plans in a big hurry!

The reason why I had my most recent surgery and my earlier ones is that I have rapidly degenerating discs that began causing pain when I was a teenager. This surgery was my third spinal surgery. The first has a discectomy in my lower back - and turned out to be no help whatsoever. By four years later, that disc level plus an adjacent one had to be fused because my body had digested the remnants of the discs, and the vertebrae sat 'bone-on-bone' with no remaining discs between them.

The surgery that I had two weeks ago was a similar surgery but in my neck region. I've known for years that this surgery would eventually become unavoidable because my discs (the red layer between the vertebrae below) are disintegrating. Indeed, at the three disc levels where I had surgery, the discs were almost completely gone, leaving my vertebral bodies scraping against each other.

As a response to the instability of having almost no discs, my body started building bony spurs to try to hold the vertebrae stationary relative to each other. Those bony spurs pressed on the spinal cord (the thick yellow cord in the top middle of the picture) and on the nerves leaving the spinal cord.

This pressure was damaging the nerves and causing myriad symptoms, including pain in my neck and arms, muscle atrophy, and lack of sensation in my right hand.
So, two weeks ago, the surgeon went into my neck from the front (anterior). He first drilled out the remaining disc material at each of three levels and suctioned it out. He shaved off the bone spurs, including ones that were pressing on my throat and making it hard to swallow.

After cleaning up all the errant disc material and bone spurs, the surgeon carefully levered open the space between the vertebrae and placed bone grafts in the spaces. The goal is that my body will build more bone around the grafts, fusing the vertebrae to each other. Thus, four vertebrae will become one long bone.

The problem is that, during healing, the spine must remain stable, with little bending or twisting. To aid with this part, the surgeon placed metal plates on the front of my vertebrae to hold them in place relative to each other. In the picture below, only two discs have been removed so the plates are not as extensive as in my case.
The plates play an important role only during healing. After my body builds enough bone to fuse the vertebrae together, the plates are superfluous because the bone fusion is much stronger than the metal plates. However, unless I have more neck surgery in the future, the plates will remain in place. It's not worth a whole surgery just to remove them.

In my case, we had a very tough decision to make. In fact, four neck discs are disintegrated, including one (C3-4) that we ultimately decided to leave alone. The reason is that C3-4 can still move, so it protects the discs above it from degenerating even faster than they would if C3-4 were fused. As soon as a joint is fused, the discs just above and below it begin self-destructing at a faster rate because the joints undergo much more motion to make up for the fused section of the spine.

So, my surgeon and I know that C3-4 is causing me pain and will continue to do so. In all likelihood, it'll need to be fused in the next couple of years. But, for the sake of my long term prognosis, we decided to leave it alone for now, to protect the other discs. Our fear is that, in the next 40 years of my life expectancy, I'm heading toward a completely fused neck. That would be very bad - I'd have no head twisting or chin lifting ability. I'd lose my driver's license. I'd have a lot of trouble riding a bike, although I just might figure out a way to ride one!

Yesterday was my first checkup. I had several xrays as I moved my neck through its range of motion to see how the fusion is going. The goal is to see no motion at the fused joints. It's unlikely that will happen yet for me but I'm still awaiting the results.

Everyday for three months, I apply a plate-like apparatus to my neck so that it can bombard my joints with a magnetic field. Bone responds to magnetic fields by growing so this should help my body form stronger fusions. Another thing that causes bone to grow is stress so I'm required to walk miles every day. Each time my heel hits the ground, a shock wave travels up my spine and stimulates the bony fusions to grow stronger.

I still have substantial surgery-related pain. My head gets heavier as the day goes on, and the muscles holding it upright rebel. Moreover, it feels like one particular spot in my spine starts to hurt as the day goes on - I'm not sure what that means. On the good news side, the long-term right arm pain has only visited once since surgery. And, to my utter surprise, the pain in my leg is much less frequent than before surgery. I suspect that the pressure on my spinal cord in my neck was transmitting pain all the way down to my toes. Only time will tell if the improvement in leg pain is permanent.

In terms of the recovery, I've been given a huge range of possible time tables. I suspect that I'll be back on my bike outdoors, riding gingerly, sometime this spring but the exact time depends on how quickly my body heals.


  1. Thanks for the great explanation. That was very clear. I know how fortunate I am that my discs are deteriorating at such a slow rate. Proper care and I may never have to have a second surgery.

    I do understand about the radiating pain in arms and legs. In my case, because it was lower back, I was losing control of my right leg. The week before the surgery, I had 0% reflex ability in my right ankle. None. Immediately coming out of the surgery, the reflex was back.

    The body is amazing, but the spinal cord is most fascinating to me in its control of the body.

  2. I am amazed at your explanation, KB - it seems even more unlikely to me that you are up, about, and outside so quickly after your fusion. I only hope the improvements you have experienced so far are permanent.

  3. Wow...that's crazy. Great explanation but oh how I wish you weren't going through all of this.

    Hoping you get a great report from your surgeon from the Xrays!

    And very excited that your arm and leg pain may have been somewhat diminished as a result of the surgery.

    Looking forward to the next update!

  4. Okay, I'm at home today because I hurt my back at work yesterday and I really wish I hadn't read this! Yeeouch! I would have had sympathy for your situation regardless, but I have a lot more today! I hope that you continue to recover and that soon there will be alternatives better than the ones you have at the current time.

  5. What an incredible explanation!

    Thanks for taking the time -

    I've forwarded it on to my brother Paul so he can see what you experienced -

    He often asks about you and wants you to know he includes you in his prayers -

  6. great explaination. my only question: what in the world causes rapid degenerating disks?

    and have you read my dog blog friend sugar sweet's blog? her crazy lady is facing some serious spinal issues:

    Sugar's Crazy Lady is a gifted writer/author with a fabulous Formosan Dog (like Loki) who's now her medical alert and service dog. sigh.
    when all else is crud in the world...dogs make it so much better.
    wild dingo

  7. You are a very courageous person, KB! And a wonderwoman as well, to get out and about so quickly, especially with the pain you are experiencing. You attitude is about as perfect as I can believe -just getting back OUT into your beloved places and doing what you love HOW you can, no matter what - love that spirit you show - keep it up, for it will get you through this beautifully. Thinking of you so much!
    Hugs xo
    Sammie's mom

  8. Hi KB-- Wow, was a fabulous, informative post! Wild Dingo (btw, isn't she amazing?) sent me over here. She thought we could commiserate since I have some cervical spinal cord angst (C4-5-6-7 need to be replaced with a titanium cage). The surgery is frightening, but your focus on healing and rehab is heartwarming, straightforward and uplifting.

    Seriously, though-- you need to get your dog trained in service care. My docs call Sugar my "purse" since she carries everything for me, relieving my spine of pressure. She is better (and more reliable) than my medication!

    I'll send some good vibes your way, wishing for a speedy and uneventful recovery.

    Take care,
    "Crazy lady" Karen
    (and Sugar, of course)

  9. Sometimes I get discouraged because my own healing process is taking so long, but then I read about experiences such as yours, and I realize there are others who are in more need of prayers and good wishes. I'm not facing the possibility of more surgery, and I am back on my bike.

    I do hope your healing progresses well and that you are able to get back on your bike as soon as you hope.

  10. Thanks for the explanation and the graphics. I haven't wanted to admit it, but I wasn't sure what or where disks were in relation to your vertebrae. Now I know. Glad to hear some of the radiating pain is better and hope you can put off that other surgery for many more years.


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