Back To Basics

So, I’m recovering from massively invasive spinal surgery . . . Wait, wait, wait, OK, let’s back up!

2020-11 In November of last year, I woke up one morning with debilitating back pain. The pain level itself wasn’t incredibly high, but it was so uncomfortable that I basically couldn’t sleep for a week until I finally discovered Aleve PM and melatonin. I had had unexplained pain in this particular spot before but never this significant or this persistent.

Over the next few weeks the pain migrated from my upper back to my left shoulder down my arm, eventually to settle as numbness in my fingers and weakness in my left triceps and pec. Indeed I had had some numbness in my left fingers off and on over the years but it had always resolved itself. Because this wasn’t going away, I asked my doctor for some help; he referred me to an orthopedist and a physiatrist. The ortho took x-rays and couldn’t find anything wrong so it seemed most likely that this was a nerve issue.

2020-12 I met with the physiatrist shortly after Christmas and demonstrated how this fit athlete could barely do a pushup due to the left arm weakness. She ordered her own x-rays and an MRI, hypothesizing that we would see some nerve impingement in the lower cervical spine.

When the MRI came back it did indeed show a slight herniation (bulge) in one of the cervical discs on the left side that was likely causing my symptoms. However, much more worrying was a diagnosis of “critical spinal stenosis” around my C5-C7 vertebrae. That means that my spinal column was being massively compressed there, which my physiatrist found very worrying.

In addition to the compression potentially causing nerve damage itself, it put me at much greater risk of much more catastrophic damage, like paralysis, if I experienced jarring movement, like an auto accident. I assumed this compression must be the result of my football playing days but the doctors told me it was likely congenital. Given that 20 years ago my mom experienced sudden and unexpected paralysis, maybe it is even hereditary.

2021-02 My physiatrist agreed that I could pursue conservative treatment for a little while to see if conditions would improve. I did physical therapy on my neck and spine twice a week for the better part of two months but unfortunately didn’t see much improvement.

2021-03 At this point my physiatrist became more insistent that I should pursue surgery with due haste. The longer my spinal cord remained compressed, the higher the likelihood of permanent nerve damage.

I met with neuro and orthopedic surgeons. They reviewed my imaging and mostly gave me two options: 1. fusion, 2. disc replacement. In both cases they would go in through the front of the neck and reduce pressure on my nerve root. These were pretty routine procedures with rapid recovery and low likelihood of complications. Everyone seemed to agree that these were my only options.

My last visit was with Dr. Patrick Curry of Boulder Centre for Orthopedics. Although he thought it likely that surgery would be the ultimate answer, he engaged with me much more openly rather than the “You must have surgery right now and here are your options” approach I had received from others – which I appreciated.

He noted the disparity between the worrisome spinal cord compression evident in my MRI and my symptoms which were much more related to pressure on the nerve root. He presented the same fusion and disc replacement options that I had been presented previously – but he was concerned that they wouldn’t adequately solve my issue since not just the discs but the c6 vertebra as well were providing pressure on the spinal canal. As such, he presented two additional surgical options:
1. c6 corpectomy – which he didn’t recommend for someone my age (One of the unexpected benefits about spinal surgery in your 40s is being constantly told how young you are – I guess it’s all relative!) – 2. posterior laminoplasty.

In posterior laminoplasty, he would go in the through the back and peel back tissue to create more space/room in the spinal canal. While he was in there, he would go around the spinal cord to clean up the anterior disc herniation as well. This would have a longer recovery than other options (having to cut through my muscular back and neck) but he believed it would more comprehensively address my issue(s) – with a lower likelihood of leading to more and more surgeries in future.

In the spirit of informing a decision with more data, we agreed to do a CT scan immediately and another MRI at higher resolution before finalizing a decision of which surgical option to pursue. After reviewing the new imaging together, we decided on the posterior laminoplasty.

2021-05 Unfortunately it took months for insurance to approve all of the imaging and the procedure – not very comforting when I had been told that the longer I waited the higher the likelihood of permanent nerve damage would be!

Finally we set a surgery date – May 20 – and then I began to get scared. I had never had surgery before and this would be really invasive, risky stuff – cutting open my neck and back and messing with my spinal cord! What if something went wrong and I turned into a vegetable? What if I went under anesthesia and never woke up? What if these were the last beautiful moments I would ever spend with my darling 3yo or amazing partner? What if I hadn’t prepared my work team to keep going in my absence?

The closer we got to May 20, the faster time seemed to go, such that all my ability to prepare for what was to come – practically and psychologically – seemed to fly out the window. Multiple pre-op appointments came and went but I always seemed to leave with more questions than answers. Suddenly, the morning of the procedure arrived and there was no looking back.

2021-05-20 Katie and I woke up very early the morning of May 20 and drove to Porter Adventist Hospital just south of Denver. The surgery prep team was amazing! Everyone introduced themself and told me exactly what they were doing before or during the operation. They all gave Katie (who was in constant communication with my brother, Nick) an opportunity to ask questions too.

They asked me 100 times who I was and what I was there for so I was pretty confident they wouldn’t get me mixed up with another patient. The anesthesiologist even turned out to be a close colleague of one of my friends from college! All this to say, as I was wheeled to the operating room, while I was still scared, my anxiety was much reduced. In the operating room, as the drugs kicked in, I remember making jokes about the funny looking x-ray protective gear and then . . . that’s it.

2021-05-20 I came to propped up in a hospital bed with a neck brace on and Katie right beside me. The surgery had lasted ~4 hours and everything had gone as expected.

Now I was hopped up on drugs for pain management, had a drain inserted into my trapezius, a foley catheter inserted into my bladder, and a big incision stitched up on the back of my neck!

I would need to remain at the hospital until I could meet a few pre-defined milestones. For the time being, though, it was time to rest. Katie returned home and video called me with our 3yo, which made everything feel much better.

It wasn’t a restful night per se as nurses were coming in and out of the room all the time, taking vital signs, giving me medication, and asking lots of questions. Between my inability to move, the catheter, and a numb finger (where the oxygen sensor was on tightly), it wasn’t terribly comfortable, but I managed to piece together some sleep in preparation for the following day’s work.

2021-05-21 By the time Katie rejoined me next morning, I was already checking off milestones. The catheter was out (Hallelujah!). The physical therapist came and helped me sit up, then stand up, then go for a short walk. The occupational therapist came and helped me go to the bathroom, brush teeth, and take a shower. It was funny how jubilantly the nurses would celebrate each of these milestones – it felt a lot like us at home celebrating the same milestones with our 3yo!

This all seemed relatively straight forward until I had a chance to sit down and catch my breath. Only then did I realize how exhausted I was; I had to take an hour-long nap immediately! And that’s how the rest of my day went: getting up to push the boundaries of longer and longer walks, eating a little bit, and then napping to recover.

After Katie left for the evening, Mom came to visit me and we had some good walks and talks along the hospital floor. The night came and went and suddenly it was Saturday, the first day I was eligible for discharge!

2021-05-22 Saturday proceeded like the day before, with routine functions like walking becoming more, well, routine. Finally the nurse checked my drain and declared that the small amount of discharge being produced meant that I had met my final discharge milestone. They pulled the drain out (which felt like someone was flossing my insides) and I was free to go!

Katie drove me home and I was elated to be rejoined with my pack. I made it home in time for our bath and bedtime routine then turned in very early myself.

Now I’ve been home for a week and every day keeps getting better and better. I’m blessed to have an amazing support team around me: my mom, my sister-in-law (who flew in for the week), and especially my partner. Katie has suddenly found herself a single parent with one wild 3yo and one wild puppy – and now a spinal recovery patient as well! She’s phenomenal, though, and is always making sure I’m nourished, comfortable, and have the right medication at the right time.

I’m still in a neck brace (which makes many things uncomfortable – including sleeping!), still on medication (a little less every day), and still on supplemental oxygen at night (meant to counteract the effects of some of the medication). I’m regaining physical capacity daily, though. Walking is the only form of exercise I’m currently allowed (which makes sense as my HRV is still incredibly low) and up to 11,000 steps / day.

Candidly, this is all very hard for me. As someone who is used to feeling invincible, suddenly I feel very vulnerable. And it will be a long road to full recovery . . . but so far the slope of the curve seems to be positive and pretty steep. With this great team around me, I’m very optimistic and looking forward to this as my next great adventure!