Revision Surgery Case: Dorcas W.
58+2-year-old female had classic flatback syndrome from previous Harrington rod instrumentation and fusion for idiopathic scoliosis. At nearly 20 years postoperative, she had progression of her unfused lumbar spine below the rod, spinal stenosis, and both coronal and especially sagittal spinal imbalance. She underwent a complex two stage spinal reconstruction with a midlumbar PSO to reshape her scoliosis and her lumbar kyphosis into a more normal alignment allowing her coronal and sagittal balance to be perfect at nearly 10 years postoperative.
Revision Surgery Patient Experience: In Her Own Words
My Rods and My Screws, They Comfort Me or My Tinker Toy Spine
My experience with Dr. Lenke started in early 2000. For 2 years prior, my mobility had steadily decreased as my pain increased. I had experienced spinal surgery once before and I wasn’t really interested in doing that again. So we tried physical therapy, massage, daily exercises, swimming, and lots of Ibuprofen! Then one day, I saw a reflection of a bent over old woman in a store window. To my shock and horror, it was me!
This was the second time in my life when pain had insidiously started to control my daily activities. The first time was nearly 20 years prior when I had spine surgery to correct my scoliosis. That procedure involved the insertion of a Harrington rod in my lumbar spine. As far as decreasing the severity of the scoliosis, this surgery was only able to improve it by 5 degrees. After a full year of wearing a cast/torso brace 24 hours a day, the relief of pain was good and life returned to being productive. During the last two weeks in the brace, I was allowed to take it off and swim to strengthen the atrophied muscles. This was the prescribed therapy at that time. Having not been a swimmer, I found a book on “How to Swim” in our son’s elementary school library and learned the breaststroke. I maintained a good regimen of exercise and swimming over the following years.
Life went on. But eventually pain started to seep into my life again. The next time I visited my primary care physician, she readily referred me to Dr. Lenke. Within a short period of time, we were in the office getting x-rays and the first consultation. To be honest, I don’t remember much of what he said, except for a few phrases like “Harrington rod failure with degeneration of the 4th and 5th lumbar spine…total spine reconstruction…right hip degeneration from poor body alignment…58 years is a good age to do it”.
The phrase “total spine reconstruction” really woke me up. Clearly I could no longer deny what was happening to my body. I took a few weeks to think it over. During that time I really looked at how I was living with pain, adapting my life around my pain, and how it was limiting me. I started to monitor how much pain medication I was taking (not good!). I tried putting pillows under the right leg for comfort (not successful!) and I actually looked at my body, which I had spent years ‘hiding’ (HA!). Who was I fooling? Me!
My next step was to collect information. The next time I went to Dr. Lenke’s office, I had notebook an inch thick of materials downloaded from the Internet and copies of pages from medical texts. “Sagittal imbalance” became a familiar phrase. Cages, rods, screws, bone graft all had new definitions. Diagrams and photographs and x-rays helped me to ask questions and better understand the answers.
I was finally ready to accept what Dr. Lenke had said. I turned 58 with the realization that the longer I waited, the longer the rehab period would be (age increases the number of days to regain strength).
The preoperative testing and blood storage started. One of the tests showed that not only was I experiencing spinal degeneration, but spinal stenosis as well.
The surgery went beautifully. Afterwards, as I was lying in the hospital bed, the thought entered my head, “Am I really pain free, or am I in denial again!” I truly was pain free for the first time in I don’t know how long, because the pain had been so insidious in its growth and I was so good at denying it.
Now the question is how has back surgery affected my life? I am no longer a bent over old woman! People I have not seen for a long time, say, “Not only do you look taller, but you don’t have the look of pain in your face”. (I thought I was hiding it!)
Other things in my life have changed as well. Living pain-free gave me the courage to walk away from a 40-year career as a Registered Nurse! Now, my passion and energy go into a non-profit community mediation center designed to help neighborhoods become safe and sustainable. This is another way to meet people in crisis, which seems to be my preferred way to serve humanity.
Life is much improved now that pain no longer controls what I do or where I go. I can lift my grandchildren and go hiking with them. On my 60th birthday, we even climbed to a summit point on the Appalachian Trail! Walking long distances is not a problem. Going up and down multiple stairs is not impossible.
There are some limitations. I seem slower when I walk or go upstairs. I can’t bend! On the other hand, before I couldn’t stand up straight! Back seats of automobiles are not climbed into, especially in smaller 2-door cars! BUT I can get down on my knees without pain! I can drive and ride long distances without pain! I can’t sit cross-legged on the floor. My lung capacity is limited because of the rigidity of the spine and singing is more of a chore as I need to take more frequent breaths. I have poor abdominal muscle control (of course, they weren’t in such good shape before the surgery!). I don’t clean the gutters on our two-story house, but I didn’t do that before!
Get the picture? Life has improved. Granted, total reconstructive back surgery is not to be entered lightly. I needed to collect and understand a lot of information. Finding friends and family to help and talking to others who had the surgery were important steps for me.
Paramount to the healing process, however, is trust in the physician and the team you have caring for you in the hospital, during rehabilitation, and at home. Dr. Lenke made this all possible for me, and for that I am deeply grateful.