• Michelle Crawford

My Back Pain Journey - Part 2 of 3

As the name implies, this post is a continuation of a three-part series on my back issues and back health. If you have not already done so, please go here to read the first part of the story.

 

Before I begin, it is important to issue this caveat:

I am not a medical doctor, and even if I were, there would be no way for me to know your particular medical history and current condition. Since I do not know who may come across this blog post or to what end they may use it, I want to be very clear:

This is my experience only.

If you are suffering with back pain, particularly if it is as severe as I describe, it is important to consult a medical professional to discuss the particulars of your condition. While yoga is an important tool for health and wellness, there remains a place for modern medicine.


We should use all available knowledge and wisdom, adding emerging research to proven ancient practices, factoring in our individual condition and circumstances, to obtain the best possible outcomes.

Proceed at your own risk - disclaimer complete!

 

My Diagnosis and Conservative Treatments


As I mentioned in my previous post, it took several months to get a definitive diagnosis of spondylolisthesis and degenerative disc disease; my insurance required six months of physical therapy prior to approving certain diagnostic imaging.

Were they also nice to look at...? I mean, it didn't hurt.

To satisfy this requirement, I participated in a number of physical therapy sessions that included various massage techniques, exercises, and water therapy. Now, I have to say, I thoroughly enjoyed my therapy sessions and my outstanding therapists - who wouldn't like to be rubbed down and personally trained by someone who is caring and enthusiastic about helping people?!


Unfortunately, despite my enjoyment, I found little relief from the physical therapy sessions. Maybe my inability to improve through PT alone was owed to the severity of my condition…or perhaps the sessions were not effective because of my unwillingness to accept the body’s natural healing power (but more on that later).


During these months, I refrained from exercise partly to avoid exacerbating my condition and partly because physical activity was just really painful. I avoided extensive standing or sitting in one position, and I could not walk for any considerable distance - forget running.

I was effectively crippled.

In early 2015, upon completion of my therapy, I finally received insurance approval to get the MRI imaging requested by me and my doctor. That is when I received my diagnosis of spondylolisthesis. I was not surprised by the severity of my condition: I felt it on a daily basis.


I immediately began to research the treatment options for spondylolisthesis. I came across research that suggested a spinal fusion, but I went on to read several accounts of negative outcomes.

Naturally, that scared me.

The adverse outcomes described included various levels of disability and chronic pain. Since I was already experiencing both of those things, I was not enticed to undergo such a drastic procedure that may leave me experiencing more of the same.


Thus my neurologist referred me to a pain management specialist who offered less invasive options to explore prior to considering surgery. These options included injections performed under general anesthesia, and therefore not without risks, but none as potentially severe as those associated with a full spinal fusion. These injections were considered the conservative option.

Details about the injections - click to enlarge.

In late spring and early summer of 2015, I received a series of these injections performed at my local hospital.


I received great care by the medical professionals, but the procedure (or rather, waking from anesthesia and receiving the flush of fluids in my spine) was sure painful! Unfortunately these injections provided only a little relief that was relatively short-lived.


I found myself growing anxious as the months passed by and, with them, what I took to be my youth, my best years (ha!).

In my growing desire to be pain-free and return to active participation in life, I returned to my neurologist seeking a more permanent solution: surgery.

(Side note: It was summer 2015, in the months between the injections and the surgery, that I met the man who would later become my husband. I told him about my condition right away and explained that I was considering surgery to correct the problem. He was supportive, but I’m not sure he knew exactly what he was getting into...with the procedure and with me!)


At a concert for my husband's birthday just a few weeks after my surgery. Suffering for love - is there any greater honor?!
 

The Surgical Option


Before we get into the surgery itself, I want to make an important statement here about being your own medical advocate.


As I was exploring options with my neurosurgeon, he suggested an artificial disc replacement. This was a newer technique of removing the disc and inserting replacement hardware, and it wasn’t news to me: I had already come across disc replacement as a possible option during my research.

In this model of the spine, the blue parts represent the intervertebral discs. They can actually replace these when they are damaged!

Based on his recommendation of disc replacement, of which he happened to be a specialist, I continued to further research the surgery. I liked that this option was more likely to preserve range of motion and less likely to contribute to degeneration at other levels in the spine (compared to spinal fusion).


Unfortunately I discovered that disc replacement is contraindicated (not recommended) for patients with spondylolisthesis.* This is likely due to the shifting of the vertebra – simply replacing the disc does nothing to hold the vertebra in place, particularly in the presence of a pars defect, which I had.

Had I taken my surgeon’s initial advice and proceeded blindly with the disc replacement, I may have been back in his office requesting a fusion within a year so.

I will always advise my readers (and anyone else who'll listen) to be your own medical advocate. Listen to the experts, do your own research, weigh all options carefully. As the master of your own health, wellness, and ultimate destiny, please be informed.


Okay, rant over!


When I returned to my surgeon, I shared my discovery that disc replacement should not be utilized in my particular case/condition. I showed him the research and, thankfully, he agreed – crisis averted! We further discussed the risks and decided to proceed with the lumbar spinal fusion (L5-S1). The surgery was scheduled for September 15, 2015.

 

My Spinal Fusion


I went into the surgery feeling both nervous and hopeful. The procedure itself lasted much longer than anticipated and, upon waking, I was told that they had nicked my dural (thecal) sac early in the operation.

This is a dramatization, not my actual CSF leak.

The dural sac surrounds the spinal cord and contains cerebrospinal fluid (CSF), which serves as a cushion for the brain and spinal cord. My surgeon said that very little of my fluid had leaked and that I should not experience any adverse symptoms. I would stay a couple of nights in the hospital, prove I was up to eating, walking, and using the bathroom on my own, and then be released to continue my recovery at home for two weeks.


Alas, the best laid plans: I did, in fact, experience dreadful symptoms of this cerebrospinal fluid leak.



The First Few Days of Recovery


(Warning: if you’re particularly squeamish about bodily fluids, you may want to skip the following paragraph. In other words: too gross, didn’t read; I was in terrible shape.)


My low CSF headache was so severe upon sitting up that doing so caused episodes of violent vomiting (you’re welcome for that image). While it’s never ideal to puke uncontrollably, it’s particularly awful when your back is held together solely by dissolvable stitches and surgical tape.

The pain I experienced was indescribable.

I’ve broken three bones (femur, clavicle, and pinky) and birthed my son after a 14-hour labor, but all previous physical discomfort pales in comparison to the first 3-4 days following my spinal fusion.

I distinctly remember begging my family to go ahead and pull the plug, only to be devastated to learn there was no plug to pull.

I’m convinced that my recovery would have been relatively uneventful had my dural sac not been nicked…but I guess this adds to the drama of my story, no? #blessed


I remember being visited by a cheerful physical therapist who was there to get me up, moving, and on the road to recovery. Apparently the PT department was not aware of my CSF leak condition, which demanded I lie completely flat or suffer the immediate consequences.

My chipper therapist cajoled me into attempting to stand, and, well, suffice it to say that I was impressively unsuccessful. I informed her that in no way would I be leaving the bed, thank you very much.


I’m certain she took me to be just another stubborn patient who preferred comfort over recovery. Some calls were made and I was finally relieved of my physical therapy duties for the time being.

Being a hero does not mean being perfect. Healthcare pros are people too!

Again, I want to stress here, be your own advocate! People who work in healthcare are just that – people. They often have hearts of pure gold, but they are not perfect, nor do they work within a perfect system, so we must accept that accidents and miscommunications can and do happen! Speak up for yourself and your loved ones!


My mom discovered online that caffeine was often used as a treatment for these type of headaches, recommended it to my medical team, and got me some soda (thanks mom and reminder again to advocate for yourself and your peeps!). I was feeling better around day 4 or 5, and was soon up and walking around my unit in the custom pastel gowns I ordered for this particular occasion (I’m so ridiculously extra, y’all).

Throughout my stay at the hospital (a full week!), I was treated with such care by my medical team that I was moved to write personal thank-you notes. I spent half a day writing to everyone from the unit manager who checked on me regularly to the PCA who gave me my sponge bath to the food service member who took all my food orders (and I was a difficult budding #vegan at the time, guys!).

I say this not to brag about how wonderful a person I am, but rather to encourage each of you to take time out of your day to thank each other, to love on each other. It’s something we can all focus a little more on and can never do too much of.
Young love and beer. Sigh.

In case you're still interested in the romantic element of this story: my now-husband Jarrett, whom I had only been seeing for about 2 months at the time, stayed with me in the hospital every single night (I’ve been making it up to his cat ever since). He was working about an hour away from the facility, so you can imagine the inconvenience it was to sleep in a hospital cot (or on the hospital floor or with me in my hospital bed), then get up and drive an hour to work, rush home to shower, grab work clothes, feed the cat, then drive another hour to see me. And I was no picnic at the time (see unmentionable paragraph above) - I had to be helped with the most basic of tasks including eating, drinking, and the downstream effects (ahem) of those two activities. It was obvious to me then that I would marry this man and the rest, as they say, is history!


Anyway, back to my recovery.


The Weeks and Months That Followed


I was released from the hospital after seven days and set about my real recovery. The drive home with my dad was torturous, each bump sending pain radiating from my low back. I felt incredibly weak in my midsection, like a strong wind might snap me at the waist. I took my painkillers as prescribed and knew enough about addiction (much knowledge hard-won through personal experience) to know to stop taking them as soon as possible.


My generous boss (who I still work for today!) donated a week of additional paid leave so I could continue my recovery as planned. It was a blessing because, as single mother, I definitely couldn’t afford to miss a week of pay and I wouldn’t even be able to drive before a couple more weeks.


When I returned to work, I was still very sore and weak. Sitting and standing for long remained painful, but I expected this. When commuting to various meetings, I had to drag my laptop around in a roller bag (which, come to think of it, I believe I borrowed from another lovely coworker!). Going up the stairs to my 2nd floor apartment was no slice of pie either.

Actual Facebook posts by yours truly.

Luckily, Jarrett moved in with me to help me recover and be at my beck and call, where he remains to this day. Well, the conversation went more like, “If you’re going to be here every night, shouldn’t you bring your cat over?”

Early in my recovery, getting aid from Loki.

About 6 weeks out, I was feeling much better, and by December I was well enough to go hiking in North Carolina for our first "family" trip with Hawken and our newly adopted dog, Millie.


By January, I was anxious to get moving again and hotly anticipating the all-clear from my doctor to return to CrossFit.


In March, six months recovered, my surgeon told me it was safe to “resume all activities as normal” – music to my ears!


I was out the door and signed up at CrossFit OCI before the end of the week. There, over the next 4 years, I gained more strength in my back (and legs and arms and otherwise) than I ever had before - but more on that in my next post!


In the final post of this series, I’ll talk about things we can all try at home, for free or with minimal investment, to build healthier backsides from the inside out. Many of these techniques have hastened and stabilized my recovery and are helping me combat continued disc degeneration.

Please stay tuned!

 

I know I have at least a couple of readers who currently have spondylolisthesis, and many more who are suffering with degenerative disc disease in general, so allow me to speak directly to you all:


Although I have described some unpleasant side effects and a long and, at times, difficult recovery, I do not regret my spinal fusion and I’d do it again in a heartbeat.


When I was conducting my research, I found very few articles/blogs/etc. on positive outcomes of a spinal fusion, so I want to be perfectly clear that my surgery was and is a success. But please know that every case is different and what worked for me may not work for you. I cannot say it enough (obviously) – DO YOUR OWN RESEARCH!


If you’re not sure where to start on research of this type, please don’t hesitate to ask me. I’ll probably blog about my investigative processes eventually, but if time is of the essence, you should reach out to me now. I'm happy to chat with anyone who asks.

 

*I found a more recent (4/10/2020) product approval on the FDA’s website that says disc replacement can be utilized for spondylolisthesis of grade I or less. I’ve done no research on the outcomes of this procedure in spondy patients, so please look that up for yourself if you’re considering surgery!

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