My Back Surgery Journey: The Myths & Truths, The Helpful, & the Not So Much

(How the Cleveland Clinic & NovaCare Rehabilitation Rescued Me)

An obvious question: why I have written this? The short answer is that it may help somebody out here who is suffering right now. After 4 back surgeries over the course of nearly 20 years, I have learned quite a bit about this topic from a patient’s point of view. With somewhere around a half million lumbar spine surgeries annually in the US alone, I figured sharing my experience certainly wouldn’t hurt. If I help one person, that’s a win in my view. So, I will start with a history of my lumbar spine issues and procedures (promise not to get too long-winded), then address what the title of this piece suggests.

My back problem journey started in my mid-late 30’s, (1980’s). I did not know the cause of my pain and spasms; chances are they were related to genetics, football, and a 2-story fall (long story) that occurred in my early 20’s. However, I was able to manage with occasional rest and ibuprofen until shortly after I turned 50 in 2002, when it got far worse. Excruciating lower lumbar and shooting pain down the legs; the whole nine yards. I was diagnosed with severe stenosis and a 1-degree spondylolisthesis at the base of my spine. This basically means that my nerve had no room to maneuver; my lowest lumbar vertebra, L5, and S1 (tailbone) were misaligned, crushing the nerve. My L5 vertebrae was cracked for good measure (possibly because of the aforementioned fall) which likely contributed to the problem. The situation was getting worse almost daily so it seemed.

I wound up seeing a leading spine surgeon (will call him Dr. B) in Central Ohio where I live. He recommended we try injections first (Selective Nerve Route injections to be precise). They worked for about 18 months then stopped, so in 2005 I wound up getting surgery to fix my spondylolisthesis, get the disc decompressed and create more space for the nerve. It worked splendidly – for about 5 years.

As so often happens especially with active types like me, the vertebrae above the fusion eventually go bad from the extra wear and tear they get, since the lower vertebrae are fused. I wound up getting 2 more fusion procedures to fix these issues, the last of which was in 2012. I was fine after that until the summer of ’21. ?Then the real fun started.

I had been experiencing a slight increase in pain over that summer which got a little worse when I took up yoga. Then on Labor Day morning, I experienced something that many a back pain sufferer knows all too well – a serious and debilitating pain flair. I could not even get out of bed for an hour. Major lumbar, buttock and hip pain. Difficulty sitting and walking.

My previous surgeon (Dr. B) retired, so I reached out to my orthopod who referred me to a spine doc in his practice (call her Dr. A). She asked me about my pain, performed a few physical tests, took a quick x-ray, and prescribed what seemed like a cookie cutter approach of physical therapy, followed by shots if PT did not work, then maybe surgery if shots did not work. No MRI and not much thought either it seemed. Dr. A was emphatic that surgery should be avoided and tried to dissuade me from even thinking about that path. I thought to myself “she does not even really know what’s wrong and she is prescribing a treatment regimen that seems pre-baked.” I decided to go elsewhere.

One of my friends (call him George) sold insurance to Dr. B and he knew a few other spine docs who associated with Dr. B. George referred me to one of them, a spine/neurosurgeon with one of the 3 leading healthcare operations in Central Ohio (call him Dr. C). Dr. C graciously agreed to see me, asked me about my pain, conducted the usual physical tests, then ordered an MRI. I felt relieved that he at least ordered imaging. Dr. C called me 48 hours after the MRI, did not really explain what it showed (blabbed something about scar tissue). He strongly encouraged shots and said surgery was a perilous path that would involve a long painful recovery with an uncertain outcome.

I was a bit skeptical since I knew from experience that shots are a 50-50 proposition at best when you’ve already undergone surgery, especially as much as I had. Nevertheless, I proceeded with the shots but continued searching for what I felt would be a more informed set of answers. The shots did nothing, but lucky for me another buddy of mine got me connected to the Cleveland Clinic Center for Spine Health (CC), and then the wheels of progress started to turn.

Unlike Drs. A & C, the CC spine team analyzed the MRI in depth and ordered a CT scan to confirm its diagnosis. Turns out that the one of my latter fusions did not heal completely. As a result, the screws that were holding the hardware in place became loose from the wear and tear = nerve pressure = pain. So, in contrast the Drs. A & C who completely blew the diagnosis and associated prescribed treatments, the CC Physician’s Assistants and spine surgeon assigned to me walked me through exactly what was wrong, how it could be addressed surgically, and why they felt it would be successful. Of course, I asked about success probability and the CC spine surgeon told me that in my individual case (a key point) I could expect 80% relief. He was also careful to emphasize the importance of physical therapy (PT) in the recovery process. I said, “I’m in.”

So, the procedure took place in early May 2022. I will spare you all the gory, technical details, but it was a minimally invasive approach going in through my side. A small cage was used to address the unstable area and reduce pressure on the nerve. The old hardware was left in place.

I am not going to lie about the recovery; the first 30-60 days were hell. There were times when I wondered whether I was ever going to get better. Anxiety reigned. Lucky for me, I have a loving wife of 30 years who always walked me off the ledge. My next-door neighbor’s dad, who is a retired physician, also helped. He stressed that males often get impatient and assured me I would be fine in time. So, after 60 days post-op, the PT effects began to take hold and things started to turn north. Fast forward to today – about 8 months in. My pain is far less, and I can tolerate much more exercise than before the surgery. I can also sit much longer and walk much farther. It can take a year or more for nerve tissue to heal, so I have been told. Therefore, I still have a way to go. However, the surgeon's prediction of 80% relief seems well within reach.

So, now for the Myths and Truths.

Myth # 1: Let Statistics be Your Guide

Truth #1: Broad Stats are largely useless as a predictor of success. Each case is different and success rates depend on a host of factors.

I can’t count the number of times people have mentioned to me that they heard or read that over half of all lumbar spine surgeries result in same or more pain. If you Google these types of stats, you’ll see ranges all over the map. While the stats may be technically true depending on the study cited, they have no bearing on one’s individual success probability. I am living proof. I have had 4 procedures. Three have worked for me so far and one failed – but that one after 10 years. However, I had skilled surgeons, am generally healthy, and perform PT religiously. So, if someone feeds you a line about spine surgery stats or says that back surgery is for the birds, I suggest you disregard. In my case, I do it colorfully if you get my drift.

Myth #2: The Doctor knows best

Truth #2: Not all doctors know best; some do & some don’t

The history I provided above is a great example. If you are seeking treatment and something a physician is telling you does not seem right or the degree of effort seems lacking, or you are not comfortable for whatever reason, don’t be afraid to seek expertise elsewhere.

Myth #3: Surgery will fix everything

Truth #3: Surgery is only part of the equation. PT, diet and generally sound health practice is also key.

In my case, the physical therapists at NovaCare kick my butt every week, pushing me hard. I also exercise at least 40 minutes daily, so my fitness level is good. You get the idea. The doc you choose is important, but he or she cannot do it all.

Now, on to “The Helpful and Not So Much.”

My only purpose with this piece of article is to point out what is helpful communication in support of back pain sufferers who are thinking about or waiting on surgery and – more importantly – what is not. The best thing you can say is along the lines of:

·?????Sending positive thoughts your way

·?????If anybody can be successful with this procedure, you can.

·?????Seems like you covered all the bases, etc.

What you don’t want to do:

·?????Note the type of statistics mentioned above

·?????Relay some dumb horror story.

I mention the last point only because it happened to me frequently. I can’t count the number of times acquaintances of mine wanted to tell me about their brother or cousin or friend whose back problems were awful, or who had a failed surgery, or who is worse off now for whatever reason. You get the idea. Finally, one day I was in church, and another member of the congregation walked up, asked me how I was doing and then proceeded to tell me about an individual who … you know the rest. Another typical negative story. I just looked him straight in the eye and said “(Name), those types of stories are not helpful.” He got it, thankfully. When you are in pain and are waiting on or searching for a solution, the last thing you want to hear is a story about someone who is in agony after surgery. Not helpful.

So, I hope sharing my thoughts helps someone out here that may be suffering today. The main takeaways:

1.????Don’t pay too much attention to broad stats about success rates for your surgery. Each patient and case are different.

2.????In my opinion, the chances of a successful outcome are impacted most by these factors:

·?????An accurate, compete diagnosis

·?????Your general health and attitude

·?????Skill level of the surgical team and its experience with the procedure

·?????Your commitment to the recovery process – PT and all the rest.

·?????A supportive spouse and friends.

3.????Don’t be afraid to listen to your inner voice. If something does not seem right about what a physician is telling you, don’t be afraid to challenge and/or go elsewhere. In my case, it may have changed the course of my remaining years on this earth in a big way.

4.????Beware of naysayers who likely know squat about spine problems. What happened to other people has nothing to do with you.

Finally, I hope you never need back surgery. It is not for the faint of heart. However, surgery can make a major, favorable difference in your life if PT, shots, and other treatments do not help. So don't hold up a crucifix if someone mentions lumbar spine surgery.

Best wishes for a happy and pain free 2023, and if you think I can be of any help to you or someone you know, please message me here or send me a tweet @sapienza3.

Michael Sapienza