Refresher: Last week, we remembered WHY I had spinal fusion surgery over two years ago... Here, we recall the phases of recovery in which I endured, including learning that I was NOT recovering as expected.
Recovery following Spinal Fusion Surgery
I was scheduled to be in the hospital for 6 days. The surgery went beautifully (as described by my doctor); what was supposed to take 8 hours took less than 5 due to lack of complications. The surgeon ordered 6 days of in-patient recovery.
By the morning of the day after my surgery, the hospital staff had me sitting up and walking. By day 3, I was (slowly and painfully) doing laps around the hospital floor. By day 4, I was climbing stairs. By day 5, I was so desperate to be home and in my own bed that I begged the fellowship doctor to release me, even though I had fainted that very morning. I wanted to go home with my new husband (we were married three weeks before the surgery).
It also takes longer to return to a normal active lifestyle after spinal fusion than many other types of surgery. This is because you must wait until your surgeon sees evidence of bone healing. The fusion process varies in each patient as the body heals and incorporates the bone graft to solidly fuse the vertebrae together. The healing process after fusion surgery is very similar to that after a bone graft.
In general, the earliest evidence of bone healing is not apparent on an x-ray until at least six weeks following surgery. During this time, the patient’s activity is generally restricted. Substantial bone healing does not usually take place until three or four months after surgery. At that time activities may be increased, although continued evidence of bone healing and remodeling may continue for up to a year after surgery.
The length of time required for a patient to take off of work to recover depends on both the type of surgery and the kind of job one has. It can vary anywhere from approximately 4-6 weeks for a single level fusion in a young, healthy patient with a sedentary job to as much as 4-6 months for more extensive surgery in an older patient with a more physically demanding occupation.
Prior to the surgery, The Surgeon anticipated that I would return to work at the beginning of the 2010-2011 school year, which would have been five weeks post-surgery. He explained that since I was a healthy, young patient, and because there were no complications during the surgery, I would have a fast, successful recovery. However, during my four-week check-up following the surgery, my pain was still so severe that I required the use of a walker, bed-rest and large doses of pain medication. The Surgeon altered his original work-release, allowing me to return to teaching by working only half-days for two weeks (opposed to full-time). The Surgeon still thought that I could return to work full-time at week seven. My body told me otherwise...
Following spinal fusion surgery, a postoperative rehabilitation program may be recommended by your surgeon. The rehabilitation program may include back strengthening exercises and possibly a cardiovascular (aerobic) conditioning program, and a comprehensive program custom designed for the patient’s work environment in order to safely get the patient back to work. The decision to proceed with a postoperative rehabilitation program depends upon many factors. These include factors related to the surgery (such as the type and extent of the surgery) as well as factors related to the patient (age, health and anticipated activity level.)
The Surgeon did not prescribe me any physical rehabilitation outside of the occupational therapy and physical therapy treatments that I experienced during those five days I stayed in the hospital. I returned to work without the skills to walk, sit, bend forward or climb stairs with my new body….
Failing to Recover: Four Months Post Surgery
At my 4-month check-up, I was in excruciating pain daily and I was still unable to return to work full-time. I required the use of the orthopedic walker, which “typical” patients abandoned after four weeks. I also continued to need prescription pain medication and muscle relaxers. Every day, life was unbearable. My pain was undoubtedly WORSE after the surgery than before. My mobility was brutally limited and my pain intolerable. However, the x-rays revealed that there was nothing “wrong” with the spinal fusion itself. The rods and screws were in their appropriate places. The bone graft was successfully taking. The Surgeon told me that I was "an outlier" and that he “did his part” when he successfully completed my surgery. As often happens to people who have Invisible Disabilities or Chronic Pain, The Surgeon then told me that “Maybe the pain is in my head.” He recommended that I contact a Biofeedback Specialist. The rest, according to The Surgeon, was up to me….
The Six Month Mark
On Christmas Eve of 2010, I reached my 6-month mark of recovery. I continued to only work three days a week, which daily caused me insufferable agony and stress (physical and emotional). I still required pain medication and muscle relaxers, prescribed by The Pain Management Specialist, as The Surgeon refused to acknowledge my pain. Through a Physical Therapy consult at The Surgeon’s office, I was told to walk three miles a day – WITH my WALKER – outside, in the snowy streets of Saint Louis in December, which I did daily. Despite all of my efforts, I was still restricted from "normal" life because the pain was so relentless...
Trying Anything to Get Better
To give The Surgeon the benefit of the doubt, as well as to prove him wrong, I began the process of Biofeedback Therapy with a wonderful specialist named Mr. Mark.
Biofeedback Therapy works primarily through machines that monitor your condition and report them back to you in real time, like your blood pressure, heart rate, skin temperature, your sweat and your muscle tension. The theory is that by being able to see what it is on a machine, you can train yourself to understand the feelings you receive. It is also a form of alternative medicine, in that people train themselves to know their individual responses to activities that tend to trigger pain. One result of being able to know your body's systems, through Biofeedback Therapy, is that you can end up controlling more muscles than were previously thought to be uncontrollable. You can see what happens and are able to gain control over such things as your own heart, temperature and even muscle tension.
After four months of weekly Biofeedback Therapy sessions, Mr. Mark was NOT convinced that my pain was psychological, as determined by The Surgeon; therefore, he did not see a need for Biofeedback Therapy. Rather, Mr. Mark suggested that my pain was, in fact, physical or mechanical. To be sure, Mr. Mark conducted a physical evaluation. The evaluation revealed that there were mechanical problems with my low back as well as my left hip. Mr. Mark recommended that I get another MRI and that I schedule an appointment with the leading Physical Therapist in his office. The MRI revealed that my left hip was sprained. The Physical Therapy evaluation revealed that I have Failed Back Syndrome-Post Spinal Fusion Surgery and Chronic Pain Syndrome.
According to Spine-Health, Failed Back Surgery Syndrome (also called FBSS or Failed Back Syndrome) is a generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery. Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to rather than after back surgery or spine surgery.
I immediately began physical therapy with multiple PTs at Mr. Mark’s office, where I have continued treatments 1-2 times weekly. The PTs determined that the Spinal Fusion actually restricted much more than just the bulging discs in my back; rather, it was the cause of severe immobility of multiple joints in my body. This immobility is the primary source of my pain. Additionally, due to the Spinal Fusion, my body will remain immobile indefinitely. Upon learning this information, I consulted with The Surgeon, who refused to comment on the findings of the Physical Therapists. I then saw a Second Surgeon who explained that my Spinal Fusion had “took” – which meant that the rods and screws were now a permanent part of my body – and that there were no more surgical options for me. He told me that I needed to “find ways to learn to live with the pain.”
Besides weekly physical therapy, I continued to see Mr. Mark for Chronic Pain Counseling. I also spent a year getting Acupuncture Treatments and added weekly Manual Therapy to my treatment regimen. Additionally, Mr. Mark was one of the many people who encouraged me to write this blog.
This is my story of getting diagnosed with a disability and learning how to live with my painful and invisible disease.
Information from:
WWW.SPINE.ORG
http://en.wikipedia.org/wiki/Spinal_fusion
http://www.biofeedbacktherapy.net/
http://www.spine-health.com/treatment/back-surgery/failed-back-surgery-syndrome-fbss-what-it-and-how-avoid-pain-after-surgery
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