CURRENTSMy Back: the nuts and bolts of it
To help provide my life needs - food, water, medicine, taxes, bills, Internet, necessities. It's a very expensive time to be alive for me. Please visit this page for in-depth surgical history. It will be early-to-mid 2014 before I can begin to perform publicly again. Remember, to be fully alive one must take risks, or nothing much in life changes. Life is supposed to change. That's the only absolute. Please don't feel sympathy for me: I am gathering strength, learning skills, playing the piano again, and getting ready to continue along my Golden Path. I am so blessed to have such support. Click here for my latest personal report (Oct, 2013)
OR: Send personal checks, money orders payable to Jessica Williams:
The following is a physical and medical account of my quality of life (QOL) 7.5+ months after a Three Level Lumbar Peek cage fusion — S1 L5 L4 —including 6 pedicle screws, 4 peek cages, 2 radiolucent rods, autografts taken from inside the pelvic illiac structure and a heck of a lot of pain, moaning and groaning
- SWEDISH HOSPITAL, Seattle/Notes/Transcription
- Pre-op Diagnosis: L4-S1 stenosis and DDD, Post-op Diagnosis: L4-S1 stenosis and DDD
- Anesthesia: General endotracheal
- Operative Findings: Degenerative changes at L4-S1, Stenosis, Spondylolisthesis, Lordosis, Scoliosis, Kyphosis
- Indications: Pt had failed nonsurgical management and did not want to risk narcotic addiction to manage her symptoms.
- She has had a previous laminectomy at L5-S1 in the past and now has persistent radiculopathy from a recurrent or persistent disc herniation at L5-S1 on the right. She also has 2-inch-plus loss of height from collapse of the discs which contributes to her foraminal stenosis at both levels. She has lossof disc height which contributes to her hyperlordosis and postural kyphosis deformity.
- L5-S1 posterior interbody fusion and posterior fusion
- L4-5 lateral extracavitary arthrodesis
- L4-L5-S1 pedicle screws
- Posterior posterolateral fusion, L4-5
- Smith-Peterson osteotomy, L4-5 and L5-S1
- Neuroplasty, adhered nerve root, L5-S1
- lnterbody cage, L4-5 and L5-S1
- Bipedicled paraspinal trunk flap
- Laminectomy with foraminotomies and medial facetectomy L4-5
PT had failed nonsurgical management and did not want to risk narcotic addiction to manage her symptoms.
She has had previous laminectomy at L5-S1 in the past and now has persistent radiculopathy from a recurrent or persistent disc herniation at L5-S1 on the right. She also has loss of height from collapse of the disc which contributes to her foraminal stenosis at both levels
She has loss of disc height and postural height which contributes to her hyperlordosis and postural kyphosis deformity.
(I had shrunk almost 3 full inches — I was short.)
DESCRIPTION OF OPERATION
- After consent was obtained, the patient was taken to the OR, anesthetized, Foley was placed, intraoperative monitoring electrodes and SCDs were all placed.
- The patient was placed on a Jackson table in the prone position with all of her bony prominences padded.
- The patient was prepped and draped in typical sterile fashion.
- A standard posterior dissection was done at the lumbosacral interval from L4- to S1 from the tips of the transverse processes to the sacral ala. A C arm was used to confirm the correct level.
- At L5-S1, through a minimal laminotomy, a discectomy for fusion was performed on the right side and an interbody and posterior arthrodesis was performed.
- Hand instruments and a burr were used.
- The cartilage endplate was decorticated to establish bleeding subchondral bone.
- Morselized autograft and a PEEK cage was placed into the interbody space and the posterolateral gutter for the fusion substrate.
- The previous adhesions from the previous laminectomies at L5-S1 remained a problem.
- The arachnoid adhesions were then released by performing a neuroplasty out lateral to the confines of the bony portion of the spinal column to establish freely mobile lumbar nerve roots.
- Because this was lateral to the foramen and outside the bony canal, it was the lumbar plexus origin.
- The posterior elements of L5-S1 were then resected with osteotomes and a burr in a manner described as a Smith Peterson osteotomy so that physiologic lordosis could be induced into the fusion contruct.
- Tl1is was required because distraction of the disc space to put a cage in from the back induced kyphosis at the L5-S1 motion segment. The posterior elements did not allow compression and lordosis without the osteotomy.
- At L4-5, through a lateral extracavitary approach, an arthrodesis was performed on the right side.
- Hand instruments and a burr were used. The far lateral dissection required dissection into the retroperitoneal space and retraction of those tissues.
- This was more involved since it required dissecting the paraspinal muscles down to the lateral side of the vertebral body.
- This allowed us to access the disc space with no retraction on the thecal sac.
- The cartilage endplate was decorticated to establish bleeding subchondral bone.
- Morselized autograft and a PEEK cage was placed into the interbody space for the fusion substrate.
- Because the minimal laminotomy was inadequate to decompress the nerve roots, since it was so far lateral, a laminectomy with bilateral foraminotomies and facetectomies was then performed by removing the osseous confines of the of the lateral recess and foramen laterally.
- This was accomplished with a combination hand instruments and a burr and done bilaterally.
- The posterior elements of L4-5 were then resected with osteotomes and a burr in a manner described as a Smith Peterson osteotomy so that physiologic lordosis could be induced into the fusion contruct.
- Pedicle screws were then placed bilaterally at L4, L5, and S1 using standard technique.
- The implant position was then confirmed with the C arm and intraoperative monitoring was used to test the screws which were all within normal limits.
- The posterior elements were decorticated with a burr and the remaining autograft was used for the posterior and inter transverse fusion at L4-5.
- Due to the soft tissue contractures from the previous lumbar surgery, the typical manner of closing the wound by suturing the fascial layer and subcutaneous tissues was impossible.
- Therefore a bipedicled paraspinal muscle trunk flap was developed.
- This was done by releasing the contracted and fibrotic dorsal lumbar fascia off the midline which allowed it to be mobilized to the midline and closed without tension on the suture layer that was used to bring it to the midline and roll the muscle belly into the wound defect obliterating the dead space in the midline. #1 Vicryl suture was used for the flap.
- The rest of the wound was then closed in multiple layers over a deep fascial drain.
- 0 and 2-0 Vicryl suture was used for this portion and the skin was closed with a running nylon suture.
- The patient was placed in a sterile dressing and recovered uneventfully.
END OF REPORT
Printed on 8/13/2012 5:59 PM Swedish Medical 2B 8/13/2012 6:08:10 PM PAGE 20/0?2 Fax Server, FIRST HILL 747 Broadway Seattle, WA 98122 4307 WILLIAMS, JESSICA J - MRN: 1000327822 - DOB: 3/17/1948, Sex: F
- D/C Summaries signed by Morrow, Darin F, PA·C at 07/30i12 0704
- Autr1or: Morrow, Darin F, PA- Service: (none) ,1\uthor Type: Physician Assistant
- Filed: 07/30/12 0704 Note 07/30/12 0700 Note Type: D/C Summaries
- Time: Cosign Rooney, Richard C, er: MD at 07/30/12 0811
- DISCHARGE SUMMARY Darin F Morrow, PA-C
- This note must be assigned Note Type "D/C Summaries" to be searchable
- Jessica Jennifer Williams
- Age/Gender 64 y.o. female
- MRN 1000327822
- Attending Rooney, Richard C, MD, PCP Shalit, Peter
- Hospital Problem List Active Problems: • No active hospital problems. •
- Final Diagnosis: Lumbar spinal stenosis and DJD L4-S1
(sounds like it hurt - JW)
So where am I now, 7.5 months post op?
Emotionally I'm in fine shape. It's made me a better person, it's opened channels to new levels of awareness for me. I'm more able to love. And I have a piano again. The best one I have ever had. There was a lot of scar tissue there from a previous laminectomy done when I was in my early thirties. Dr Rooney removed all of that, thus opening up places of severe armoring (muscle spasms in catatonic lockdown). Chakras. Energy blockages. Simply by opening these areas of blockage by removing the masses of scar tissue and nerve root adhesions, I feel like a teenager again. Just wish I looked more like one.
I don't drive and never have... well, OK, I drove for a few years about 30 years ago, but I was not very adept. I always got stopped by peace officers for doing illegal things, but received no accolades for driving correctly. I drove about as well as Glenn Gould did. Horribly.
My friends take me everywhere I need to go. My one best friend has literally kept me going — from feeding me to giving me showers to keeping the house clean. I can't do a lot on my own yet. There may be a few things I'll never do again. Fortunately my playing is better than ever. It has changed. I sit up very straight. There is a new magic I carry now. I learn through illness. I must have needed to learn a LOT. But driving will never be on my to-do lists.
The roads here are in such terrible disrepair (yes, even I-5) that I can only ride for short trips. I am full off stainless steel and titanium. And those PEEK cages are cylinders that hold bone infusion, which takes forever to solidify. The bone was taken from the inside of my pelvis, the Illiac Crest. That is one darned painful operation all by itself! So — I am trying to avoid the shaking and quaking of the roads that might loosen screws or cause the infusions to somehow become displaced. You think weird thoughts when your body is suddenly not entirely organic.
Some folks might feel like a prisoner in my position, but I have a lot of love and protection around me, so I am quite happy inside. Actually, I find moments of pure ecstacy. I've forgiven people I thought I could never forgive. And some people I've just forgotten. But I understand now, and "fault" is a fiction in most cases. It's chemistry, and vibes, and subjectivity. Most people are good.
The issue of pain is always there. I was on a quite high dosage of 1) morphine, and then 2) a steady dosage of hydrocodone. 10 mg 4 or 5 times daily. I slept a lot, but also woke up a lot. I took valium also to relax the muscles around the wound site. My pain level 4 months ago was 6-9. Now it is 3-6. Sometimes I hit zero! When I play and I am completely in another Universe. My body STILL does my pre-conscious bidding when I am at my instrument.
I developed a sleep deficit which I now am making up for. I keep erratic hours as I lower the Norco dosages slowly (a very addictive narcotic). I have found natural ways to induce sleep, and am doing some very heavy-duty vacationing when I sleep. I go places, meet people, play my music, and am at peace when I awake. I am having REM sleep again and it is like rain, clearing away the dirt and pollution. Dr Hanscom (my new neurologist) believes that sleep may be the biggest single factor in correct healing. But true healing is multifactorial, and many entities play a role in spinal pain: anger, anxiety, and fear being but a few.
I am now down to 2 x 10 mg hydrocodone, one when I awake and one when I go to sleep. 3 on a bad day.
The scar is down my spine to my coccyx and is about 12 inches long. It has healed well. So far, no signs of "instrumentation rejection" or of latent infection.
My pain is not as much of a problem as other matters. I cannot shower myself, and I can't put on my socks or tennies. I can't pick something up from the floor, and I can't stand for long periods. I will never run. I joke that I'm from the East Coast. Nobody runs from anything where I come from. I walk slowly, but with NO cane. I am taller now (nearly 6' tall, and 150 pounds) but am unable to rotate much at the hips. No hula dancing. I am no longer able to hunch over the piano, and must sit up stock-straight like a proper student. Which I always was and always will be.
But I will focus now on what I CAN do. The past is dead. The future is bright.
My body is very well-proportioned now. I wish it had always looked like this. I look like a model! If only I wasn't 65. But 65 is very young and being happy and with a full-charge of future plans and dreams, I often feel very young.
My hair is usually mussed up and it's been forever since I used makeup. My skin and hair seems better for it.
A problem is that I have limited stamina. And most people that have back lordosis and stenosis also have arthritis in their back and elsewhere. I do too, but, miraculously, not in my hands or fingers.
It's only seven+ months. I have a year, maybe a year and a half of healing work ahead of me, including physical therapy and frequent meetings with me and myself. I have a full schedule. Time for only the important things: Loving. Feeling good. Laughing. Playing piano. Playing with the dog. Playing with friends. Making friends, keeping friends. Letting them know I love them. And that one special love that grows beyond anything I ever imagined. That's the diamond at the center of the Universe, the lodestone of my life.
I know I will be fine. Your donations take all the stress off of me. Money equals power to most. To me, it presently equals stress. And stress is a great danger to us all. When we help each other, stress recedes and we gain true power. Not the power over others, but shared power with others as our brothers and sisters. Sharing has to be the missing clue that hangs up most governments and countries and peoples. If we just share, there's enough here for everyone! 8 billion? Bring it on. We are humans. We are so strong and capable and purely beautiful. Especially when we work together.
All I can say is, whatever happens in the future, thank you from my heart for all your help. I would not be here without you.
FATE is for sheep. I choose WILL.