Correcting Degenerative Spondylosis

When I was unexpectedly let got my my employer of nearly 20 years back in 2017, I threw myself into a physical fitness regimen to occupy my time and work on chronic health issues that had been bugging me for several decades.  I was determined to lower my A1C, try and get ab definition, improve my aerobic capacity, and increase my yoga practice from 2 or 3 times a week to 5 or 6.  For about 9 months of 2017, I was successful in working towards my goals and making significant progress.  A1C lowered by a whole digit.  First time in 1/2 a century I went from Michelin Man torso to almost a semblance of abs and ribs and lats definition.  Practiced yoga so much that I began to name the pelicans who soared over the South Ponto cliffs where I practiced each day.  After 60 to 90 minutes of yoga and crunches and extended plank poses, I ran the 93 stairs from parking lot to top of cliffs, 10 or 12 or 15 times in a row, pushing myself to go as fast as possible, taking 2 to 3 stairs at a time, going both up and down.

This ledge no longer exists, since a fancy coastal hotel has destroyed the bluff over-look which is now apparently private property.

This is where I made a BIG mistake.

An aging guy in his 50s shouldn't be trying to do Parkour (as I had previously in Orange County at the beach on the massive rocks there), or extreme stair running.  All of that IMPACT did not do my hips, knees, or spine any favors, as I thudded down the stairs and sprinted up them at a running pace.  The whole time I was driving down my A1C and helping my muscle groups to develop, I was causing high cycle fatigue to damage my hip joints and spine (L4-l5-S1) with all the cumulative impacts.  In 2018, I found a new job here locally in Carlsbad, and cut my yoga back to twice a week, along with stair running just twice a week.  In 2019 some developers destroyed the South Ponto Beach cliffs with a high end boutique hotel construction project that blocked the top of the stairs and eliminated the pretty spot in all of Carlsbad where anyone could practice yoga, a hundred feet above the ocean with an on-shore breeze.

Also in 2019, I began to limp as my right hip started to show significant signs of wear.  My lower spine felt akin to "a stack of tea cups and saucers" that were ready to tip over and crash, if I did something as "extreme" as reaching 2 or 3 feet diagonally in front of me, my back popped, felt like it was going to collapse, and drove significant chronic sciatica on my right side all the way down my right leg.  In the 2nd 1/2 of 2019, I had a series of X-rays and MRIs that revealed Spondylosis, disc generation, leg nerve impingement, and 4 mm of misalignment on L4-L5-S1.  My orthopedist explained that the minor misalignment was not a huge issue, but the nerve impingement would only continue to get worse.  My right leg would sometimes "go out" for a step or two, as if it was no longer attached.  Then it would come back.  The ortho explained that the frequency and duration of the absentee-right leg would increase over time, as the nerve got further crushed.
The recommended solution, as to do an ALIF, Anterior Lumbar Inter-fusion, where they cut you from belly button down the middle, open up your abs, move over all your sacked intestines in-tact to the right side, scoot over your aorta and vena cava, and access the front of your spine to excavate (medical dremel tool) the front of your disks & vertebrae,  inserting titanium cages that have allograft adult stem cells inside of them to encourage your spine to accept them.  Then they turn you over on a sandwich bed in which you, the patient, are the meat of the sandwich.  Once on your stomach, two Large slits are cut on your left and right lumbar muscles along the muscle fibers, and screws and tie rods are installed on the back side to stabilize all the cage and allograft work that was just done on the front side.  After a 6 to 8 hour surgery, you stay in the hospital 3 to 5 days, and you DON'T BLT (Bend, Lift, Twist) for the next 3 months, minimum, wearing a little back brace that covers the 3 incisions, but which does not Prevent you from Bending, Lifting, or Twisting.  "How will I know if I've gone too far?" I asked the Doctor and his RN.  "The pain will tell you".   This freaked me out before surgery, as I tried on the back brace a week before the operation, having wrongly assumed it would be a confining corset that would not let me move.  I can move a great deal in the back brace. My body screams at me when I've moved too far.

So 16 days ago, on Monday morning at 530am, I had my ALIF surgery with the posterior back hardware reinforcements completed.  At the 6 hour mark (of the 8 hour estimate) the orthopedic surgeon came out to talk to Dr Desert Flower to tell her I was fine and everything went well, while his PA apparently closed up my sutures. An hour later in recovery, I kept complaining that "a giant is kneeling on my back's left side!" (the side that previously had not hurt at all).  The pain meds flowed freely Monday and early Tuesday, and I complained very little. On Wednesday I was weening myself off the pain meds, and feeling good enough to come home.  Thursday DDF brought me home, and I've been rather sedentary since October 25th, as my spine slowly builds bone around the titanium hardware and the 3 separate spinal bones become one longer, strong bone fused together.

I had sought out a 2nd opinion, which took 2 weeks before planning the surgery, since DDF's employer based health insurance has a 2nd opinion consulting service where they get experts from Cleveland Clinic and Mayo Clinic to review the case.  The 2nd opinion concurred with he ALIF.  The 2nd opinion also concurred that fixing the spine has to happen before repairing the damaged right hip joint, or a substantially increased risk of hip joint dislocation could happen if the spinal fusion was attempted after a hip replacement.  I spoke to the VP of Business Development at OrthoFix about the Phoenix NXG system that was going to be installed into my body.  He was a very helpful person who spoke confidently and intelligently about OrthoFix's products, regulatory body approvals, Quality System, FDA approvals and recalls, and fielded hardware installations that number in the 10s of thousands when Gen 2 and Gen 3 (current) are considered together, since Gen 3 is not much different that Gen 2.  As a life long engineer interested in quality aspects of premium products, this comforted me somewhat, and I thanked the VP for his openness and time.

The merciful NSAIDs I'd been taking for my hip were discontinued October 14th, a week before spine surgery, since NSAIDs inhibit new bone growth.  Now I'm just on the Tylenol, but sometimes the Tylenol has hydrocodone or Oxycodone in it, when the pain gets above a 5 on the 1-10 pain scale.  I'm actively trying to not become dependent on the narcotics, so I endure a 1-3 or 1-4 level until I feel it crescendoing towards a 5 or 7 or 8.   The first week at home was relatively pain free, with barely 1 out of a possible 8 pain killers being taken each day.  Then, on Saturday November 2nd, we had friends over, and I over-did it with activity, grilling, refilling hummingbird feeders, going in and out of the house, and Saturday night my left leg - the one that has a good hip and never hurt me previously - was in tremendous pain all night, resistive to any narcotics, and preventing sleeping more than 20 minutes at a time.  Sunday I rested, sedentary, but Sunday night was no better.  Monday I rested again, and finished a good book on the Tulsa 1921 Memorial Day massacre where state sanctioned mob violence destroyed the African American section of Tulsa burning down 1100 buildings and leaving 5000 people homeless (there will be a blog posting on this later, here).  My doctor's office has advised that I Carefully and Cautiously stretch while laying on my back, to bring my knees to my chest and straighten my legs without bending my spine.  I hope it works tonight... zobaczymy.
My cousin and one of my co-workers had this same spinal surgery on their necks, where the wind pipe and throat are moved over and hardware installed on the cervical vertebrae.  Both my cousin and my co-worker told me the importance of stretching after surgery, with reasonable limits... and once all the bones are fully fused in 9 to 12 months, that I'll need to stretch every day to avoid stiffening up and getting sore again.   So I have that to look forward to as well.

Next October (2020) I get to have my right hip joint replaced, since the protective cartilage is completely gone and I'm bone-spur-to-bone-spur grinding whenever I walk and load the right hip.  Getting old is So Much Fun!