This is a personal reflection of how I dealt with lower back pain, physiotherapy, laminectomy and recovery. Naturally, there is nothing scientific or medically authoritative about my story. I was in the dark when I was told that my back had gone in a spasm, and surgery would be necessary. I hope this website can help you to see some light in the dark, should this ever happen to you.
Lower back pain
It all started with a stiff, uncomfortable feeling in my lower back. Moving from a bent position to a straight up position would be painful - especially getting in and out of a car was sending pain through my lower back. Almost like a cramp, as if the mussels in my back told me that they preferred to stay in the position they were. It would cause me to walk uncomfortably for at least a few minutes after I got out of the car, until my lower back mussels would start to relax.
Exercise : sport
My first reaction to lower back pain was: I need to exercise. If my lower back mussels feel stiff and cramped up, they need to be loosened up, I thought. So I took up golf and tennis. Golf because it allowed me to relax, spending half a day per week away from the office, and tennis because it is intense exercise. Turned out that doing this for a number of months made things worse.
My first encounter with an orthopedic surgeon
As my lower back pain worsened (and started to radiate to my groin and knee) I decided to pay my GP a visit. Frankly, I was worried that something was wrong in the groin area. So the doctor had a look, felt around and had another look, and decided there was nothing wrong in the groin area. Relief. But he advised me to get X-rays, and referred me to the nearest orthopedic surgeon, because he had a suspicion that the sensation I felt in my knee and groin had something to do with my lower back pain.
After I got my X-rays at my local clinic, I made a appointment with the orthopedic surgeon. After a short introduction, I was asked to stand up straight and make a few moves. After that, I had to lay on a table, and again was asked to move my legs etc. All in all took about 3 minutes. Surgeon sat back at his desk, and said "We need a MRI scan, the X-rays are not detailed enough for us to decide what's wrong with your back. You will probably need surgery." And I was told to go and get that scan, and come back.
After I got my X-rays at my local clinic, I made a appointment with the orthopedic surgeon. After a short introduction, I was asked to stand up straight and make a few moves. After that, I had to lay on a table, and again was asked to move my legs etc. All in all took about 3 minutes. Surgeon sat back at his desk, and said "We need a MRI scan, the X-rays are not detailed enough for us to decide what's wrong with your back. You will probably need surgery." And I was told to go and get that scan, and come back.
Physiotherapy - part 1
I wanted a second opinion. So I consulted with a physiotherapist. The first thing she said was: "Surgery is the very, very last option. If all else fails, you may have to consider surgery. Before you get to that point, you can do a whole lot to relieve, and possibly take away your lower back pain."
A number of sessions with the physiotherapist followed, which included massages, acupuncture and an exercise program to flex and loosen up my lower back. She also taught me exercises to do daily at home (which I did, but not every day). And it helped. In the physiotherapist's words: "You respond very well to the treatment."
A number of sessions with the physiotherapist followed, which included massages, acupuncture and an exercise program to flex and loosen up my lower back. She also taught me exercises to do daily at home (which I did, but not every day). And it helped. In the physiotherapist's words: "You respond very well to the treatment."
Physiotherapy - part 2
At a party, I decided to dance with my 3 year old daughter on my shoulders. It was great fun, until the next day. The lower back pain was back, only this time worse than ever. There was also a light strange sensation in my buttock - as if something was cramped there, a mussel that felt overworked. I went back to the physiotherapist, who prescribed more massages, acupuncture and specific exercises. She also advised me to take "Cataflam" for 5 days - a medicine that reduces inflammation in your body. My lower back felt slightly better straight after a session with the physiotherapist, but my back started to hurt more and more. And now, getting out of bed became a real pain: this "cramp" in my buttock would tighten up whenever I changed positions in bed, and whenever I got out or into bed. It was a different kind of pain that the stiffness of my lower back - it was a sensation that began to radiate from my buttock into my leg.
The diagnosis
So what was wrong? The pieces that make up my spine ("vertebra") are separated from one another by soft disks, which contain gel. The disks are necessary to absorb shocks, and to make the spine flexible. Because of the way my body is built (surgeons have diagnosed me with a "very straight back") or because of an injury caused by playing tennis and golf, or because of my age, or because of all of the above, one of these disks was "torn". The gel from that torn disk had been seeping out, then got in touch with the nerves that run from my spine to my toes, and irritated these nerves - hence the sensation I felt from my buttock through my calve to my toes.
The turning point
And then, one day, I was not able to get out of bed. Something was so painful, pushing or pulling at the very bottom of my spine. Trying to stand up was excruciating. I tried to phone the physiotherapist, but she had office hours to stick to. It was 7am in the morning. I could not move, and didn't know what to do. Finally then, I got hold of my GP, who was so kind to come to my house for an injection (in my buttock). That helped slightly. But the pain remained, deep inside my spine. That night, in bed, I was unable to lie on one side of my body. Sitting up straight was less painful, so I tried to sleep in the couch, sitting up straight. It was torture. None of the standard painkillers we have in the house helped. I Googled my questions, and started to read stuff about lower back pain, how it can be prevented, managed and treated. So I put ice packs on my back ... to no avail. I walked short distances ... useless. Every time I would read about surgery, I would cringe. There was no way I would allow anyone to cut open my back.
For 4 days I sat in that couch (visited once by my GP, who gave me another injection in the buttock). Cramped up, thinking about whether I wanted to go and see that surgeon again. Hoping that it would all go away, really. I just needed to relax, I thought. But the pain did not go away. I got completely exhausted. So I did make an appointment with the orthopedic surgeon. Funnily, I was constantly on the edge of sobbing ... sobbing for the slightest emotions. The surgeon explained to me that I was completely exhausted, and cramped up (my back had gone in a spasm). I was admitted to hospital, and was given morphine and a really great hospital bed.
For 4 days I sat in that couch (visited once by my GP, who gave me another injection in the buttock). Cramped up, thinking about whether I wanted to go and see that surgeon again. Hoping that it would all go away, really. I just needed to relax, I thought. But the pain did not go away. I got completely exhausted. So I did make an appointment with the orthopedic surgeon. Funnily, I was constantly on the edge of sobbing ... sobbing for the slightest emotions. The surgeon explained to me that I was completely exhausted, and cramped up (my back had gone in a spasm). I was admitted to hospital, and was given morphine and a really great hospital bed.
MRI scan
It had to be done, but I was really nervous about this one. Patients I shared my hospital room with, told me that the MRI scanner is REALLY small - you don't even get a fist between your face and the inside of the scanner. Brrr. And then I got lucky. When I told the driver that was taking me to the scanner how nervous I was, he told me about a REALLY big MRI scanner (I think especially made for obese people), and he was willing to take me there. Apart from lying in positions that were very painful, the scanner itself did not make me nervous at all.
Decisions, decisions
The MRI scan results showed a disk heavily out of place, and pressing into my nerves. Something had to be done. But what? The orthopedic surgeon suggested "building a new spine". My back will give me trouble for the rest of my life, so I need a drastic solution, involving screws and titanium and what else? Doctors call it a "fusion". I went in total shock - while the morphine wasn't exactly helping to keep my feet on the ground. I felt I was too young for this sort of drastic, irreversible medical procedure. Also, I started talking to friends in the medical profession ... I needed second and third etc. opinions. I got them, and all were sounding like this: "You have to do this step by step. 'Fusion' - whereby two or more vertebrae are fused with one another - is at the very end, when nothing else helps. Right now, you need an acute solution for an acute problem: treat the disk that is out of place. Once that is done, maintain a lifestyle in which you work (exercise) towards a stronger back. So I decided to get out of there, and make an appointment with another surgeon. A neuro surgeon.
I was told that two kinds of surgeons operate on backs. Orthopedic surgeons, and neuro surgeons. Orthopedic surgeon are trained to operate on "skeletal" conditions, involving bone structure. Neuro surgeons are trained to heal nerve conditions (neuro surgeons are often also brain surgeons). When you look at my problem, it makes sense that two kinds of surgeons would be qualified: the spine is a network of bone and nerves. So in a best case scenario, you should get an orthopedic and a neuro surgeon in the theatre. But I decided to pick the brain of a neuro/brain surgeon.
The neuro surgeon took the time to explain everything to me, with drawings, jokes and books. This was necessary, because I needed this information to be able to make an informed decision (while the orthopedic surgeon never discussed this with me - he probably felt he could make this decision on my behalf). I had several options, he said:
1. Do nothing, and give it time
2. An epidural injection
3. Laminectomy
4. Fusion
The surgeon advised, for my particular case, that "laminectomy" was the way to go. Time I had been given (6 months of lower back pain, to be exact), with physiotherapy and exercise, but that hadn't helped. Since my leg was showing paralytic symptoms - I was not able to lift myself on my toes, and the back of my calf was feeling like dead meat - he advised that an epidural may take away the pain, but not the cause of the pain. If the cause of the pain (the displaced, raptured disk) wasn't treated, it may make things worse, with possible implications on my bladder function.
I was told that two kinds of surgeons operate on backs. Orthopedic surgeons, and neuro surgeons. Orthopedic surgeon are trained to operate on "skeletal" conditions, involving bone structure. Neuro surgeons are trained to heal nerve conditions (neuro surgeons are often also brain surgeons). When you look at my problem, it makes sense that two kinds of surgeons would be qualified: the spine is a network of bone and nerves. So in a best case scenario, you should get an orthopedic and a neuro surgeon in the theatre. But I decided to pick the brain of a neuro/brain surgeon.
The neuro surgeon took the time to explain everything to me, with drawings, jokes and books. This was necessary, because I needed this information to be able to make an informed decision (while the orthopedic surgeon never discussed this with me - he probably felt he could make this decision on my behalf). I had several options, he said:
1. Do nothing, and give it time
2. An epidural injection
3. Laminectomy
4. Fusion
The surgeon advised, for my particular case, that "laminectomy" was the way to go. Time I had been given (6 months of lower back pain, to be exact), with physiotherapy and exercise, but that hadn't helped. Since my leg was showing paralytic symptoms - I was not able to lift myself on my toes, and the back of my calf was feeling like dead meat - he advised that an epidural may take away the pain, but not the cause of the pain. If the cause of the pain (the displaced, raptured disk) wasn't treated, it may make things worse, with possible implications on my bladder function.
Laminectomy
Laminectomy, the surgeon explained to me, is a surgical procedure in which the affected disk (causing the lower back pain) is "fixed": the surgeon cuts away the part that protrudes and presses on the nerve(s). It involves a so called "key hole operation", which means that the surgeon makes a small vertical incision (about 5 cm) and carries out the operation via a telescope that is inserted via the incision. It means no cutting of mussels (so shorter recovery time) and an operation time of two to three hours, under full narcosis.
Under the knife
So I decided to go for it - laminectomy. I wished I didn't need to, but my lower back was still all cramped up, I was walking with a heavy limp (part of it felt like dead meat), and I wanted this whole experience over and done with. Arriving at the hospital early morning, I was first asked to wait and undress, and put on ridiculous looking, plastic ... errr, underwear. Then the anesthetist walked in, introduced himself and asked a few questions (about allergies etc.). I was then rolled into a room next to the theatre, where the anesthetist's assistant introduced herself, and again had a few questions for me, and stuff I had to sign. Shortly after arriving, they rolled me in the theatre, and I remember asking the anesthetist why their was like white smoke coming out of tubes above me (something to do with sterilising I think I remember). I said "hi" to the surgeon as he walked in, and then the anesthetist put a needle in my arm, and shortly after that put a mask on my face, and the lights went out.
I woke up in a room where a lady said something like "Ah, he's awake" and they rolled me out of there, off to Intensive Care - where I was to spend 24 hours for observation. A bad 24 hours, with very caring and attentive nurses - but I was not allowed to move, I had to stay on my back for 24 hours, and tat started to piss me off after, ... well, after I wasn't able to sleep on my back. Nurses came and went, gave me sleeping pills, washed me from top to toe, but I was wide awake, and terribly hungry.
Finally then, the next day, after the surgeon came for a check-up and declared that I was doing OK, I was given breakfast (lying down on my side). The catheder was removed (aarrrghhh) and I was introduced to the physiotherapist, who told me to get up and walk to my hospital bed in another room. Yes, walk ... after I wasn;t even allowed to move about an hour ago. There was a filthy thing with blood dangling from my back (residue from the operation) and a really annoying needle coming out of the side of my throat - which the nurses only removed the next day.
I woke up in a room where a lady said something like "Ah, he's awake" and they rolled me out of there, off to Intensive Care - where I was to spend 24 hours for observation. A bad 24 hours, with very caring and attentive nurses - but I was not allowed to move, I had to stay on my back for 24 hours, and tat started to piss me off after, ... well, after I wasn't able to sleep on my back. Nurses came and went, gave me sleeping pills, washed me from top to toe, but I was wide awake, and terribly hungry.
Finally then, the next day, after the surgeon came for a check-up and declared that I was doing OK, I was given breakfast (lying down on my side). The catheder was removed (aarrrghhh) and I was introduced to the physiotherapist, who told me to get up and walk to my hospital bed in another room. Yes, walk ... after I wasn;t even allowed to move about an hour ago. There was a filthy thing with blood dangling from my back (residue from the operation) and a really annoying needle coming out of the side of my throat - which the nurses only removed the next day.
Recovery
So here I was. The surgeon had cut away part of my disk. This probably meant that at this treated disk, as well as right above and below that disk, my spine was very fragile. So he first days after the operation were about keeping very still. I spent a lot of time on my back, in my hospital bed (I was hospitalised for 4 days), scanning the internet for advice and tips on lower back pain and recovery after operation. One thing kept on coming back: WALK !! So in hospital, I started walking rounds around the nurses admin desk, three to five times a day. And the physiotherapist gave me an exercise programme, which I took very serious.
Then, back home, I spent a month in bed, mainly. Still walking (in the garden this time, and longer distances every day), and doing the physio's exercises. I stopped taking painkillers as soon as I left hospital.
Then, back home, I spent a month in bed, mainly. Still walking (in the garden this time, and longer distances every day), and doing the physio's exercises. I stopped taking painkillers as soon as I left hospital.
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