Monday, October 18, 2010

3 months, Already?

Yes, 3 months! The big milestone for spinal fusion!

I am now back at work, and would you believe it back to almost a fully normal existence. I can bend and lift, but do sparingly until cleared with an x-ray (in a week or so).

Why is this possible so soon? It is because of the surgical approach and age, but also largely due to allograft use.

Sometime about a month ago, all of a sudden I noticed a change. When taking a misstep (i.e. stepping in a pothole during my walk) I no longer felt the twinge of pain. When getting in and out of a car, bed, chair; I felt like I could actually move my lower back without that familiar feeling of things being pulled and moved. It felt like it was solid again. Now it wasn't completely perfect, but it was a drastic change for the better. I gave it a couple of weeks to make sure it was going to stay that way, and then filed to go back to work.

I am going to guess that that is when it fused, but I will hold off that judgment until I have radiographic proof. Otherwise I feel great. I did one of my usual shifts last week--46 hours upright in two days with 6 hours of sleep in between--and I was much better than before surgery. There was still some back pain as the days wore on, maybe a 2/10, however I think most people would have some by hour 20 surgery or not. Before surgery I was at a 6-7 and hardly able to think by then. Legs feel great, no weakness or tingling, but definitely fatigued. Hamstrings still are playing a role in the limited endurance, but I am almost back to a pre-op level of flexibility there, about 45 degrees. Since those stretches can be done without a solid fusion I have been doing them regularly and that is the result.

One thing I want to highlight here is the allograft. What is allograft? It is a piece of donated tissue (in this case, bone) from a deceased donor. Doctors will refer to this as bone from a bone bank, DBM (deminirelized bone matrix), and many other terms that fail to convey exactly what it is, but it is essentially a small 3/4" thick section of someone's femur, processed and sterilized with a hole in the middle to put the BMP sponge in. It is serrated at the top and bottom so it stays in, and once your own bone grows down the middle it will eventually be absorbed and replaced by your own bone.

Typical bone graft for spinal fusion
In the old days the way to go was to use a piece of your crushed up pelvis with other substances to fill that void the disk used to take up, and while great for fusion, it made it take significantly longer to become solid since the mush has no structural value. You can try to get around that with various metal implants, but they never last long and tend to work loose or cause other issues. Using the allograft gives structural support (the femur crush strength is significantly stronger than your own vertebrae), helps the long term outcome since there is nothing to work loose, and reduced the 6 months of instability and significant pain, to just three weeks of pain and two months of being limited. Combined with using BMP it is the reason I am back at work and having this high of a quality of life so soon. To the family who agreed to donate, and all families that do so--thanks.

I will update this again once I have the x-ray results, but I continue to stay optimistic.

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