The TLIF Spinal Surgery
The choice when all else fails!
I am going to share my experience with the TLIF type of spinal fusion surgery but first a little background on my condition.
Beginning in 1992, at the young age of 27 I arrived home from my factory job with a moderate amount of back pain. I didn't think too much about it because I work on a concrete floor in boots all day in a chemical plant so it happened from time to time, but this time it felt a little different? Without warning I went to get up out of a chair and down I went in a severe back spasm unable to move. A back spasm is when all of your back muscles tighten so much that you can't move and barely breathe with tons of pain to boot. To make a long story short, this led to the ER, then a neurosurgeon, pills, rest, physical therapy, chiropractic sessions and ultimately my first of 3 spinal surgeries. I was suffering from a herniated disc, which is when "cushions" between the vertebrae ruptures & fluid runs out onto the nerves. The MRI showed my back was that of a 55 yr old man and that most of my lower spine was in bad shape. I was too young for a fusion so the surgeon just trimmed off the excess disc and bone and sewed me back up. After I recovered with therapy I was good for about 3 yrs before trouble came up again. This time I received steroid injections in my spine, 3 over the next 3 months which gave me relief for over 10 yrs. In 2005, after all else failed again I had my 2nd surgery and this time a fusion was needed because of severe deteriorations. I recovered quickly and made it another 3 yrs before a 3rd surgery and fusion were needed. Both surgeries in 2005 & 2008 were TLIF surgeries and the subject of my hub. These two surgeries addressed all of my weak areas so with continued stretching, strengthening and carefulness I should be done with surgeries, I hope.
Surgery or not?
Believe it or not I am not a big fan of surgery. I hate relying on medicines but being cut open is a lot more dangerous. After trying every imaginable remedy with no luck this was all that was left. My surgeon, Dr. Jonathan Borden in CIncinnati was a well known and very respected skilled neurosurgeon so I knew I was in good hands. He explained the TLIF, which stands for Transforaminal Lumbar Interbody Fusion. Basically he would cut about a 2" incision in the back and remove the disc, place a spacer in to keep the spine the same length and then inject bone marrow into the space that would eventually harden into one solid bone. He would then put in screws & a rod to secure the bones while the space hardened. The screws and rod would remain in place forever with no problems. Since your lower back is only a 1/3 of your total spine, movement wouldn't be that restricted, but I would have to learn the proper way to bend and refrain from unnecessary twisting and lifting more than 40 lbs. My main concern was to be pain free and stable.
Just like most surgeries you arrive at the hospital about an hour ahead of time to register etc. You are then rewarded the ole "tie in the back" hospital gown and slip free slipper socks and of course a bed. All the usual health questions and then the IV is placed in your arm for all of your medicines and fluids. During my pre surgical appt a few days earlier everything was explained to me in detail from the surgery, what to expect, how long I would stay, recover, what anesthesia etc. Plus you sign all the scary forms that release the hospital and doctor if you should become paralysed or die, if you aren't already worried by this point then this pretty much does you in.
After the IV is put in you get some much needed medicine to relax you and the surgical nurse & anesthesiologist talk to you one last time before you are wheeled off to your new adventure. You arrive in a cold room and moved from your warm bed to a cold table, but at least you do get some warm blankets again. You stare around the room at all of the equipment, lighting, monitors etc and at this moment I am so ready to be asleep. Usually you hear the words, " I'm going to put you to sleep now" and you wake up somewhere else entirely having missed the whole procedure and thankfully so. You hear horror stories about patients waking up during surgery but unable to move or speak, I couldn't even imagine that.
The worst is over..
Once in the recovery area and then to your room that will become your home for a few days you are feeling pretty good. You are drugged up a lot and hopefully not ill from the anesthesia. In 2005 my surgery was "smooth sailing" from start to going home. In 2008, I had a rough time with reactions, inability to urinate etc but these are not common occurances as evidenced in my earlier surgery. The day and night of surgery you do very little and unfortunately sleep is one of them. You can't move very smoothly because of the painful incision and it takes two nurses to move you from side to side, neither one is comfortable for long. Then you finally get that split second of peace and fall asleep then in comes a nurse to give you pills, check vitals or something and then its back to the drawing board again. One thing I didn't mind though was the food. I thought it was pretty good, I know I must be strange?
After a mostly sleepless night you are ready to go home and will just about do anything to do it and lucky for you the nurses will give you your chance. Lying down time is over and it is time to stand up and walk for short distances. I am not going to lie but this hurt but at the same time it felt good to get out of that bed. I would sit up in bed, put on my required backbrace, pull the velcro straps tight and I was ready to be mobile. Once on my feet, with my wife at my side for balance we would take a slow but steady walk out my room and into the hallway. We would then walk as far as I could stand, turn around and come back. The more I did this the easier it got and the less painful. I hate taking medicine but was encouraged so I could do more without being sidetracked with pain. I'm speaking now from events from my 2005 surgery because that is more the norm. I was allowed to rotate between standing, sitting and laying but I had to call a nurse before I attempted any of the above, in case I would fall.
Later that day I was sent down to therapy where they would watch me walk and teach me new ways to manage myself. I was taught to swing my whole body around when ever I would turn or get up from a downed position to avoid twisting my spine. I was shown how to get on and off of a toilet, shower stall, pick things up, with and without a trusty handheld "grabber" and finally to walk a small flight of stairs. I passed everything with flying colors and as long as nothing else went wrong I would be going home in the morning. I just had to "suck up" one more night away and then I would be home. That last night wasn't near as bad as the first. I still didn't sleep much because comfort was still hard to come by but I did manage to squeeze in a few hours instead of a few minutes like before.
Headed home & Beyond
The next morning on day 3 I was given my release and going home. The nurse made sure I had my prescriptions and my discharge instructions with all of my "dos and don'ts" and I was wheeled down to my wife & car that was waiting for me at the hospital entrance. The car ride home wasn't too bad but I did feel every little bump in the road. My wife made sure she avoided as much as she could. Once home the sight of my bed was like a huge chocolate fudge sundae I was so happy to see. I had the back brace that I would need to wear whenever I was on my feet and this helped a lot, it made me feel less like jello- ha ha!! I put it near the edge of the bed where I could reach it whenever I got up. All of my family and friends would come and visit me for the next several days because I was restricted to the house. The doctor still wanted me walking but inside for the most part, at least for the first week. After that I made it to the driveway and then a few houses at a time, it felt so good to be outside. This was in September so not too bad yet weather wise for Ohio.
I went back to the surgeon for my follow up after a month, got an xray and my therapy prescription. I was feeling and doing very well so he had no problem getting me started with exercising. The xray was pretty amazing. You could see the screws and rod and spacer, it just didn't look real to me, is this really in my back? The picture I have on this hub is after my 2008 surgery so all 6 screws are in and 3 rods. There are two pairs on one level and one pair on the other.
Therapy went well and I was back to work after 8 weeks off and feeling good. I would have exercises that I would have to do forever to keep me as strong and as flexible as possible and I would also have to re train my body to use less back and more hips and legs, which everyone should do anyway. Except for lifting heavy objects and doing a lot of repetitions of bending, stooping & twisting, I can pretty much live the same life. Sadly my restrictions cost me my beloved meter reading job and I am now on permanent disability as a house husband which after 4 yrs I still don't enjoy and can't adjust to, but at least I'm not confined to a wheelchair, which is where I was headed without the TLIF surgeries.
Just for reference, my surgeries were:
1992- lameniectomy(trimming of bone & disc)at L2-3
2005- TLIF at L4-5
2008- TLIF at L2-3
L= lumbar(lower back) and the numbers represent the vertebra involved.