Sometimes good, sometimes bad, always inevitable. And lucky (or not lucky) for most of us, we have good old Facebook to remind us how things used to be. You know that “On This Day” feature on Facebook? Here’s what it had for me last week.
March 9, 2012: I was about to run my first ever race, the Gate River Run 15K here in Jacksonville. As a former non-runner, this was a huge deal for me. I was so nervous. And afterwards, I was bursting with pride at my 1:43 finish.
March 9, 2015: I was on an airplane – my very first international flight – on my way to Jerusalem, where I’d run in the Jerusalem Marathon. It would be my 3rd half marathon in 3 months and my 10th or 11th (something like that) in 3 years.
March 9, 2016: I learned that I will most likely need back surgery.
Let me back up here quickly, just in case you haven’t been following along. After months of back pain, hip pain, and numbness in my right foot, I finally saw a doctor in December 2015. I learned via MRI that I have two things wrong with my back: 1) a herniated disc, and 2) a spondylolisthesis (a slipped or displaced vertabra). My sciatic nerve is being compressed, which is what’s causing the hip pain and the numbness & tingling in my foot.
We started with a conservative treatment plan – physical therapy and oral steroids.
After just 3 sessions, my physical therapist determined that she was unable to help me, and she referred me back to my physician. Medication wasn’t helping much either. After the round of oral steroids, we also tried an intramuscular steroid injection and muscle relaxers. The only thing that really gave me any relief was 800mg of ibuprofen 2-3 x day.
In January, I consulted with a pain management doctor, who recommended a course of epidural steroid injections. He felt that once we relieved some of the pain and inflammation, I could return to physical therapy and begin correcting my spinal conditions non-surgically.
Unfortunately, things didn’t go as planned. On January 21, I received my first epidural pain injection. The procedure seemed to go smoothly. I had a slight headache afterwards, but I didn’t think it was related to the injection, since I’d had a touch of a headache that morning before the procedure too.
But my headache didn’t go away. I took Tylenol, had caffeine, drank water, took sinus medication – nothing helped. It just got worse. The pain spread down to my neck, which started to feel scarily stiff. The only thing that helped was lying down and sleeping.
I remembered learning about “spinal headaches” in my childbirth classes, and I began to think that maybe I had one. Still, the risk of getting a spinal headache (a headache resulting from a dural puncture) was quite low for epidural pain injections. What were the odds that this had happened to me?
By Monday, January 25, I was in so much pain that I cried while driving my kids to school. I dropped them off and drove myself straight to the ER.
Turns out I did, in fact, have a spinal headache (or a post-dural puncture headache). When I was given the epidural pain injection, the needle accidentally punctured the sac surrounding my spinal cord. My cerebrospinal fluid was leaking, and this was causing the pressure in my brain and spinal cord to fluctuate – hence, the headache.
I spent all day at the hospital on IV fluids and pain meds, and I was given a blood patch – a surgical procedure where my own blood was injected into my back in order to close the hole created by the puncture. It was not pleasant, but it relieved the headache almost immediately.
So – needless to say, I wasn’t too keen on returning for my second epidural steroid injection. The incidence rate for a dural puncture in this type of procedure is 0.5%, so chances are I’d be fine a second time around – but I didn’t even want to attempt it. Besides, I’m fairly convinced that it’s just a temporary fix anyway.
So instead, I returned to my primary physician, who told me that it was time to consult with a surgeon. She referred me to a neurosurgeon, whose first available appointment was 5 weeks away. In the meantime, I would just have to manage the pain with ibuprofen, heat/ice, and rest.
I also requested another physical therapy appointment. I saw a different PT, but after just one session, he reaffirmed what his colleague had told me – that I was not a good candidate for physical therapy.
So I waited. I tried to take daily walks, and I was able to do a little bit of yoga & stretching, but for the most part I wasn’t able to do much physical activity. I continued taking 800mg 2-3 x day, but about 3 weeks in, I started getting severe stomach pains. I haven’t taken any NSAIDs since then.
So that brings us to March 9, 2016 – the day I met with the neurosurgeon.
I’ll do my best to explain what he had to say. First – here’s a picture of my back from the MRI of my back.
It doesn’t take a medical license to see the part of my back where’s something’s not right. The doctor said that this weighs heavily in my favor – because the rest of my back is so healthy, it’s easy to identify the problem and to apply the correct treatment to it. This makes me a good surgical candidate with a high outcome of success.
As you can see, the disc between L4-L5 is kind of smushed. But check out the disc between L5-S1 – that one is all messed up. This is also where my vertabrae are out of place. See how L5 is pushed forward? That’s the spondylolisthesis (or “spondy”).
The doctor said that my spondy is most like congenital (I was born with it). This means that part of my vertebra (called the facet) probably didn’t form correctly, which caused it to slip forward over time. So for everyone who’s asked, my back problems were not caused by an injury, an accident, or by running. This was something that was bound to happen over time.
The most common surgical procedure to correct a herniated disc is a lumbar decompression back surgery, which can often be done as an outpatient procedure. Because of my spondylolisthesis, I will require a more complex surgery, called a Transforaminal Lumbar Interbody Fusion (TLIF). In plain English – a spinal fusion. Here’s my basic understanding: the doctor will use screws, rods, and a spacer to stabilize L5-S1. He’ll then perform a bone graft, and he’ll place it in the space where the vertabrae will eventually fuse together.
This is all pretty new info to me, and I haven’t done much research yet. According to the neurosurgeon, the procedure will take about 2 hours, and I’ll probably spend about 2 nights in the hospital. Recovery should take about 6 weeks, with a pretty rough first week or two. And I could be able to start running (a little) about 3 months post-surgery.
So what’s next? First, I’m going to get a second opinion. And then I’m going to meet with the surgeon again, this time with my husband. At the earliest (barring a rapid deterioration in my condition) my surgery would be scheduled for late April/early May. My kids get out of school in late May, so this will require lots of coordination and pre-planning.
So. There you have it. I’m still in a holding pattern, but at least I’m finally getting closer to reaching a solution. I’ll keep you posted on what I decide and what’s up next. For more real-time updates, keep an eye on my Instagram page, as I generally post there at least once a day.
And if anyone reading this has experience with a spondylolisthesis and/or TLIF back surgery, I’d love to hear your thoughts. Just try not to freak me out too much.