Spondylolisthesis

[muddywaters]

Glad you're doing so much better Jack.

For some reason, my MRI's having indicated ~ 4-5 mm. of retrostilothesis.

I am seeing a spine surgeon tomorrow. I guess I can ask him what grade this is.

Good luck people; fusion's a big deal.

m

[Jack-of-all-trades]

Glad you're doing so much better Jack.

For some reason, my MRI's having indicated ~ 4-5 mm. of retrostilothesis.

I am seeing a spine surgeon tomorrow. I guess I can ask him what grade this is.

Good luck people; fusion's a big deal.

m

I was curious as to your progress.

[Mastermind75]

Hey Dodgegirl I was wondering if you had your surgery yet?

Jack how are you doing now in your recovery? And how far out are you now?

[Rob]

I had a grade 2 spondylolisthesis (~30% slip) between L5 & S1. I also had a torn L4/L5 disc. I had a L4/L5/S1 fusion on the 15th of this month and am now in recovery. My doctor / surgeon took an anterior / posterior approach. If I can answer any question or be of any help please feel free to ask away...

[Carmen]

I had a grade 2 spondylolisthesis (~30% slip) between L5 & S1. I also had a torn L4/L5 disc. I had a L4/L5/S1 fusion on the 15th of this month and am now in recovery. My doctor / surgeon took an anterior / posterior approach. If I can answer any question or be of any help please feel free to ask away...

HI Rob,
How long did the doctor say your recovery will be? Did he use the minimally invasive procedure? You must have had your surgery on the 15th of March. When did he say you could drive? walk down steps?...Was there any meds you liked over another? Did you have a myelagram? I have a grade 1 spondylolisthesis. One doctor told me that I would need to have a T12 to the sacrum incision. Whatever the answer is give it to me straight. Thanks, Carmen

[Rob]

Hi Carmen.

I did have my surgery on March 15th. My surgery lasted just over 5-hours and I was in the hospital for 3 nights. I had my surgery at Emory University Orthopedic & Spine Hospital just outside of Atlanta. If you’re in the Atlanta area I could provide you with my surgeon’s contact information. So far (need healed yet) I would strongly recommend the surgeon and the hospital. My surgeon is a professor of orthopedic surgery at Emory university and has preformed thousands of spinal fusions. The hospital ONLY does orthopedic surgeries, all rooms are private, no visiting hours (visitors any time), only 40 beds, and pull out couches so a family member can stay with you if you want.

1) In regards to how invasive the surgery was, I had a 360 degree fusion of L4/L5/S1. With this surgery the approach is both anterior (front) and posterior (back). They made a vertical 4" incision from the left of my belly button down. They only had to cut through the skin and fat as all the muscle and organs can then be moved to the left and right providing a straight shot to the front of the spine. My surgeon prefers the anterior approach because there's no need to cut through muscles and remove the lamina (back part of the vertebra) to access to the discs.

After removing the discs they placed an ‘infix’ device between the vertebra (Zimmer Spine - InFix Lumbar Interbody Spacer System). The ‘infix’ device is basically a metal (titanium) cage. There are other styles and types of cages, it’s really the surgeons preference on what they use.

The ‘infix’ cage is filled with BMP (bone morphogenetic protein) as opposed to actual bone. If they used bone it would have been necessary to harvest it from my hips or pelvic. This significantly reduces the pain and recovery process. If they had to harvest bone from my hips or pelvic there would have had to be additional incisions, etc. My doctor / surgeon explained that BMP has a 95%+ bone growth success rate versus 85%+ for actual bone.

If I would have only had a one lever fusion (i.e. L5/S1) this would have been the extent of it. However since I had a two lever fusion (L4/L5/S1) they had to turn me over during surgery and make two parallel 2" incisions, left & right of my spine, through the muscle on my lower back to insert metal rods and pedicle screws to minimize movement and support my spine to facilitate the fusion process.

Though the anterior / posterior approach may sound more invasive than only a posterior approach, it is probably less traumatic since they don't have to remove the muscle from the back of your spine and remove the lamina to access the discs.

In regards to your incision, I honestly have no idea.

2) In regards to recovery, the milestones are supposed to be:

6-weeks – Should be able to see bone growth
3-months – Fusion should be well under way
6-months – Fusion should be complete back to full activities

In regards to general activities –

2-4 days – up & walking
3-6 weeks – start desk work
6-12 weeks – can travel (i.e. air travel)

In regards to other stuff –

I’ve been driving as a passenger in the car periodically since coming home from the hospital. Of course you have to ride in a car to come home from the hospital.

They encourage walking to prevent blood clots, pump your blood to promote healing and build your muscles. I’ve been outside taking walks since the Friday following surgery (3/19). I’m now taking 20-25 minute walks 3 times a day.

I was told I could drive as soon as I’m comfortable enough to do so. They didn’t put any time frame on it. I haven’t driven yet, because I haven’t had too, but I’m quite sure I could.

3) In regards to stairs, I met with a therapist the day after surgery and she had me get out of bed and walk in the hall. On the second day after surgery she had me walk up & down a set of stairs in the therapy room. I live in a house with the bedroom on the second floor. I have been walking up & down the stairs in the house since returning to the house from the hospital on Thursday 3/18.

4) In regards to meds, as you may be able to appreciate, it’s REALLY an important part of post op to control the pain and find the right medication and level of medication to make you comfortable. While still in the hospital (3 nights) I was on a pain pump with Dolotin. This is the wonder drug for pain!

I had a self administering pain pump with a button (similar to Jeopardy contestants) that you push when ever you want more meds. The button is connected to a pump and automatically administers the meds through your IV. The pump is controlled / programmed and will only allow you to receive a prescribed amount of the meds no matter how many times you push the button. Dolotin is really strong and the only three negatives are:

i) you don't want to break away from it when it's time to wean yourself off of it.
ii) you don't remember most of what anyone says to you while you’re on it.
iii) you don't receive any meds while you’re asleep. I learned to push the button every time I would wake up!

The REALLY good thing is that it works!

The day before leaving the hospital the nurse weaned me off of the Dolotin:^ They switched me to oral (pill) Oxycodone '10-325', generic for 'Percocet' (10mg of Oxycodone with 325mg of acetaminophen). I stayed on this for about 5 days.

It was a bit difficult sleeping at night. The posterior (back) incision and stitches made it feel like I was lying on top of something making me uncomfortable. I asked for something to help me get to sleep and they prescribed Ambian, for which I've taken before due to back pain and not being able to sleep. This did the trick. One Percocet and one ambian just before going to bed. This would keep me a sleep for ~4-hours. Then one or two Percocet’s when I'd wake up in the middle of the night and that would help me sleep for another 2-3 hours.

I switched off of Percocet after ~six days to Hydrocodone (10/325), generic for Norco. This is quite a bit less intensive than Percocet and I've been taking it every 4 hours to date. I'm still taking one ambian every night to get to sleep, along with the Norco.

The pain isn't that bad and I would describe it as mostly discomfort with some pain from time to time during the day.

In general keep in mind everyone is unique and doctors have slightly different approaches and preferences in how they preform the surgery and what types of materials they use.

Let me know if you need or want any other details / info.

Regards,

Rob

[Jack-of-all-trades]

Rob,

I was curious about the pain med you were on in the hospital, Dolotin. Is it new? Is there a trade name/generic name?

[Rob]

Hi Jack (?),

It is new and not yet discovered as I apparently just invented it!:^) I don't know where I got the spelling but I was actually trying to say 'Dilaudid' (hydromorphone). Sorry everyone please excuse my error.

Thanks for picking up on it.

Regards,

Rob

[Rob]

Hi Carmen,

I hope you cought the thread from 'Jack of all trades' regarding 'Dolotin'. I'm not sure where I picked up that spelling (my pain meds, the internet, ...???) but I meant to say Dilaudid (hydromorphone).

Sorry about that...

Regards,

Rob

[Jack-of-all-trades]

Hey Dodgegirl I was wondering if you had your surgery yet?

Jack how are you doing now in your recovery? And how far out are you now?

Back pain is "0" about 60 % of the time. I tend to push it and it bites back. Frankly, I'm having a worse time getting off my remaining opioid. I've been on something or the other for 3 years. Last summer was 75 mcg fentanyl/hr patch with 30 oxycodone a day. I had weened off the fentanyl and was down to 4.5 to 5 10/325 Percocets before surgery as a result of spending a lot of time in bed and keeping activity pretty much zero. I had Dilaudid after surgery (worked like a charm in the hospital). I was on 12-10/325 for about 10 days after surgery. I'm now down to four 5/325 a day a stuck at this level for 3 weeks and still spending half the day in moderate withdrawal. I don't need the meds for back pain, at least regularly. I'm ready to be done with them.