I’ve decided to proceed with surgery to fix the isthmic spondylolisthesis. This post better explains what in the heck is wrong with me and will cover what the doc plans to do during surgery.
You’ll have to excuse my lack of medical knowledge; in high school, I decided to skip anatomy so I could take more chemistry and physics classes. It has served me well in life as far as work is concerned, but in situations like these I’m more lost than the average person. My lingo is guaranteed to be wrong, my explanations won’t be perfect, but hopefully I can get the point across!
A lot of what I will reference or quote in this blog post about the fusion process is pulled from the “Spine-Health” website. I’ve done other research, scouring papers published in medical journals, reading other scholarly articles, etc. I’m not linking those articles as I feel that the Spine-Health site is one of the easier ones to understand.
What’s Wrong With Me?
I have isthmic spondylolisthesis, which is when a vertebrae slips forward due to a fracture or break in one of the small stabilizing bones. It’s not clear when the break occurred, but it is this break that has allowed one vertebrae to slide forward over time and pinch nerves. My symptoms have been worsening for many years and are now bad enough that I can’t bike. Could I have slowed this down? Maybe. Do my genetics play a part? Yes, thanks dad! (My dad had the same section of his spine fused when he was only a year or two older than I am now … the apple doesn’t fall far from the tree!)
I had someone ask me how to avoid issues like this happening to them. First, don’t have bad genetics. Second, if something hurts or feels odd, like your leg going numb all the time, when you’re biking / running / skiing / etc., go see a doctor sooner vs. later. I’ll never know if I could have postponed or even prevented surgery by strengthening various muscles and getting my biomechanics in better working order.
What Will Surgery Be Like?
Surgery will involve incisions in both my abdomen and my back in order to get this done. My surgeon says that he knows I’ll abuse whatever he does for a fusion based on my hobbies, so he wants to do it the most secure way possible to try and avoid any issues in the future. I can get behind that approach — I like his goal of doing this once and then being done with it. Data says that fusions performed from the front and back are greater than 95% likely to hold. Nothing is a sure shot, but I’m hopeful.
From what I understand, a vascular surgeon will first go in through the front, reusing my c-section scar as an entry point. That person’s job is to make the spine accessible for the spine surgeon, safely moving aside organs and major arteries (eeeeeep). Once the area is ready, the spine surgeon will “decompress” or increase the space between my lowest lumbar vertebrae (L5) and the sacrum (S1). He’ll add some kind of mechanical spacer there to hold this open and restore the amount of spacing that’s supposed to be there to keep the nerves happy.
Next, this area will get stitched up and I’ll get flipped over. The surgeon will make incisions in my lower back to access the back of the spine. He will remove some bone as part of the process. (This is where my anatomy fails me, I’m not exactly sure which sections of bone need to go?!) He will set that bone aside to be used later. He’ll continue to remove damaged disc material and add any other necessary spacers. Long screws will be put into my vertebrae, and the screw heads will be attached with rods to immobilize this joint. The doc will use a combination of cadaver bone AND recycle some of my bone removed as part of the surgery, grind it up, and pack it around the screws (and maybe also in the spacing between the two vertebrae?). Over time, this bone graft along with the screws will fuse into place making a very strong connection.
My next blog post will talk about expected recovery times and whether the doc thinks I’ll return to cycling .. !