I’ve shared a lot about my experience with spondylolisthesis and spinal fusion, but I’ve never really talked about how my back pain started in the first place. This is my “backstory.”
Who Moved My Cheese?
It all started with a piece of cheese.
It was the late 1990’s, and I was spending spring break with my grandparents. This was an annual tradition for my sister, my cousins, and me. I have some great memories of those weeks together, many that I will cherish forever.
But one memory I won’t cherish was the sofa bed in my grandparents’ den. To date, it is THE WORST sofa bed I’ve ever slept on (and one that would continue to host guests for another 15+ years, believe it or not). During that visit, I remember waking up after a particularly uncomfortable night with an aching lower back. I didn’t think much of it at the time.
At some point that day, I went to the refrigerator to get a piece of cheese. I bent down and…POP. Now, this was a long time ago, so I don’t know for sure if there was a literal popping noise or sensation. But there was definitely a before & after moment. I bent down and I was fine; I stood up and I wasn’t. I suddenly had terrible pain in my lower back, and I couldn’t stand up straight.
I somehow survived the rest of the week and the plane ride home to Georgia while bent at about a 60 degree angle. When I got back home, I went to see my family doctor, who vaguely diagnosed my pain as being caused by “a disc.” He didn’t say which disc or what was wrong with it. No x-rays or follow-up either. He did send me home with a prescription for Tylenol with Codeine and instructions to rest until I felt better. I spent the next two weeks lying flat on my back in my parents’ living room, until I was well enough to make the two hour drive back to my university and finish out the semester.
In hindsight, I wish I’d had better back care from the start. But I was a healthy, active 23 year old, and I guess there was really no indication that something potentially serious was going on.
My Initial Diagnosis, Maybe
I graduated that May with my Master’s in Social Work, and I got my first “real” job at a community behavioral health center in Athens, Georgia. At some point I must have had a flare up, because I took myself to the doctor again – only this time I ended up seeing a specialist (an orthopedist, I think) who sent me for an MRI. When we met to discuss my images, he identified some kind of issue with my back – something out of the ordinary. I have no idea what it was. The only thing I do recall is his prognosis – that in time my condition (whatever it was) would “either get better, get worse, or stay the same.” (I remember this clear as day because NO SH*T, SHERLOCK.)
I suspect this was when my spondylolisthesis was initially diagnosed. I wish I had copies of the images, or my medical records, or even the doctor’s name, but no such luck.
In the Meantime: Kids, Running, and Life
I spent the next 15 or so years with manageable lower back pain. I stayed active and had two healthy pregnancies with no major back issues. Occasionally I’d have a period of increased pain, which I could usually manage with Ibuprofen and a heating pad. Once or twice I went to physical therapy, which I don’t recall being particularly helpful or unhelpful.
In 2012 I started running, and I very quickly made the leap from “casual running” to “marathon training.” While I don’t believe that running caused my spondylolisthesis (it was definitely the cheese!), I’m sure the repeated stress on my discs was not helpful to an already underlying condition. I don’t know whether my high mileage contributed to or sped up the slippage of my vertebrae, but as my doctor so astutely predicted in 1998, there was at least a 33% chance that it would get worse in time.
During the 3 years I spent long distance running, I had my fair share of aches and pains, particularly in my hips and IT bands (but oddly enough, almost never in my back). In retrospect, I suspect that some of my “running related injuries” were actually symptoms of my worsening spinal condition.
In the spring of 2015, shortly after my second full marathon, I began having inexplicable pain during my regular runs. In a blog post from April of that year, I described the pain like this:
It was a very typical run…which is why I was so surprised by the terrible pain in my legs. I don’t remember exactly when it started, but I do know that by the time we finished our third mile, I was barely able to run at all. We actually had to walk the last couple of blocks.
The worst pain was in my calves, but I pretty much hurt everywhere from the waist down. Calves, quads, ankles, even my lower back.
I blamed it on my running shoes. I bought a shiny new pair, and waited for the pain to resolve. But it didn’t – not really.
I questioned whether my training method was to blame, both for my ongoing “injuries” and my lack of improvement as a runner. I’d used Jeff Galloway’s Run-Walk-Run method since day one, but I began to experiment with other types of training, including a halfhearted attempt the Maffetone Method.
Actually, “halfhearted” is a good word to describe my running in general at that point. My heart just wasn’t all the way in it. My training was inconsistent for a number of reasons. It’s hard to explain – running kind of just stopped feeling good to me at that point. The physical benefits of running were becoming outweighed by my increasing ailments, and this was depleting my enthusiasm for the sport.
But I kept pushing – I was determined to get back that runner’s high. I signed up for the Rock’n’Roll Savannah half marathon with my best friend, Ami. And I ran it, despite being severely undertrained, derailed by my asthma, and still not fully recovered from my spring/summer injuries.
That was November 2015, and it was my last half marathon (to date).
A (Real) Diagnosis
I guess that half marathon was my body’s last straw. In the weeks that followed, the pain in my right hip became intense and constant. By then I was also experiencing numbness in my right foot, which was quite scary. I was still convinced that I had a running injury, and I diagnosed myself with piriformis syndrome. I even switched to a new primary care doctor with a specialty in sports medicine.
Luckily (unlike me), my doctor actually went to medical school and almost immediately recognized the symptoms of a damaged disc. I was genuinely surprised that the pain/numbness in my hip, leg, and foot were related to a back injury. She prescribed an anti-inflammatory and sent me for an MRI for further diagnosis.
I was also referred for physical therapy, which I began right away. During my one of my first sessions, the physical therapist noticed a prominent bump on my lower back. It had been there for as long as I could remember, and I’d never given it a second thought. But it alerted her immediately to an issue that went beyond a herniated disc – spondylolisthesis, or “a spondy,” as she called it. She referred me back to the doctor and halted physical therapy while I waited for my MRI results to be interpreted.
Sure enough, in addition to a herniated disc, I had a grade 2 spondylolisthesis, which meant that my vertebra had slipped forward by about 25-50%. (I later found out that a second vertebra had slipped backwards as well.) Both spondylolisthesis and a herniated lumbar disc can cause significant back pain, hip & leg pain, and numbness and tingling in the leg & foot. Both issues can compress the sciatic nerve and/or irritate the piriformis. So while I wasn’t too far off with my self-diagnosis, it turned out to be something much more serious.
Anyone who’s been through a similar medical situation will be familiar with what followed. Essentially, I had to go through a checklist of conservative treatment methods before a surgeon would even agree to see me.
First, medication. This included muscle relaxers, a course of oral steroids, and an intramuscular steroid injection. The only thing that gave me any significant relief was 800 mg of ibuprofen 2-3 times a day.
As I mentioned above, I also tried physical therapy. After just 3 sessions, my PT determined that she was unable to treat my spinal condition and my pain, which seemed to be worsening by the day.
Next, I was referred to a pain management specialist. I had to wait several weeks for the appointment, and during that time my condition continued to deteriorate. The pain in my hip was intense. The pain management doctor 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 condition non-surgically. I felt hopeful.
I received my first epidural pain injection on January 21, 2016. Four days later, I had such a severe headache that I drove myself to the ER, where I learned that a dural puncture had occurred during the procedure. This means that 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. This complication occurs pretty infrequently (about 0.5-1%) during epidural steroid injections. I was treated with something called 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.
After this terrible experience, I wasn’t too keen on returning for my second epidural steroid injection, and luckily my primary care doctor didn’t push the issue. Instead, she suggested 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 requested another physical therapy appointment. I saw a different PT, who reaffirmed after one session that I was not a good candidate for physical therapy.
Time to See a Surgeon
People warned me that a surgeon would almost certainly recommend a surgical treatment plan (versus more conservative interventions). But a spinal fusion is 1) major surgery, 2) a complicated procedure, and 3) somewhat controversial. It’s absolutely not the answer for everyone with chronic back pain, but there are certain conditions for which it’s considered medically indicated – including spondylolisthesis.
My surgeon explained that the procedure (called a Transforaminal Lumbar Interbody Fusion, or a TLIF) would stabilize my spine. It would not be a solution for my back pain; rather, it would relieve the compression of my sciatic nerve and prevent further slippage. My slip was “unstable,” meaning that it was shifting. Further movement could have caused serious and/or permanent nerve damage.
Spinal fusion obviously isn’t the answer for everyone, but I felt like non-surgical options would be a band aid and that I would need surgery sooner or later. I opted for sooner.
My L4-S1 spinal fusion was on May 26, 2016. I’ve documented my recovery pretty thoroughly here. If you’re considering a spinal fusion or recovering from one, I hope my experience will be helpful to you and give you hope.