Microdiscectomy - Month 10

Radiating pain: Absolute ZERO.

Able to do bending and squatting.
Able to do most of my missing actions.

Leftovers:

• Surgery weakness still persists that forbids stretching any of the doable activities.
• Numbness: still persists on right leg (foot, thigh and buttocks).
• toes on my right foot has very less sensation

MicroDiscectomy Week 10

Radiating pain: Absolute ZERO.

Still No Bending, Lifting and Twisting.

Able to do most of the missing actions - sitting for longer durations, going to office, driving...

Walking has improved to Elliptical cross trainers. Running is still a luxury.

 

Leftovers:

• Surgery weakness still persists that forbids stretching any of the doable activities.
• Numbness: still persists on right leg (foot, thigh and buttocks). But, I can feel some improvements here.
• Squatting is still a luxury (eliminating putting up shoes, socks or picking up objects from the floor)

MicroDiscectomy Week 6

Radiating pain: Absolute ZERO.

Still No Bending, Lifting and Twisting.

Fast walking is now possible. Car Driving is now possible.

Started to work from 6th week onwards.

 

Leftovers:

• Surgery weakness still persists.
• Numbness: still persists on right leg (foot, thigh and buttocks). But, I can feel some improvements here.
• Squatting is still a luxury (eliminating putting up shoes, socks or picking up objects from the floor)
• Urinary side effects: improving slowly.

MicroDiscectomy Week 4

Walking - 2 X 20 minutes per day with ease.
Straight Leg Raise: 60 degrees on each leg (it was earlier only 10 degrees on my right leg)

·         Right leg still has some weakness and foot drop as compared to left leg

Side leg raise: Perfect on left leg raise @ 60 degree. Not so perfect on right leg raise @40 degree.
Radiating pain: Absolute ZERO.
Stairs: Climbing up is possible. Climbing down is still cumbersome.
Numbness: still persists on right leg (foot, thigh and buttocks). But, I can feel some improvements here.
Urinary side effects: still persists

Can I walk on my own: YES
Can I sit for longer durations: I believe so, even though I have not tried for more than 30 mins at a stretch


Recovery has been exactly to the book apart from the urinary complication.

Black out - vasovagal attack - 06-Mar-2011

A funny thing happened today. I fainted today and my kids had written me off.

1700 hrs: Got up and went to toilet at approx 1715 hrs. Luckily left the door unlocked.

The moment I sat down in the toilet, i blanked out. The next thing i could remember was my wife calling me. I opened my eyes to see my wife and a whole lot of neighbours. Events as explained by them:

·I had taken a very long deep breadth with lots of noise.

·My wife heard it from outside and rushed in. I had fainted on the potty seat. Luckily I had fallen on the side and was lying on the wash basin. A fall in the front would have undone the whole surgery efforts.

·I did not respned for the next 30 minutes with people pouring water on me and banging on my chest…. My eyes and mouth were dead open. There was no sweatness and my body had turned ice cold.

·Finally, I woke up and was immediately able to get up and walk back to bed.

·No abnormal behaviour noted in ECG. Blood sugar was normal. BP was low at 100/80.

Not sure what had happened. But, looks like i had a miraculous escape.

Lessons learned: No self medication, leave the bathroom doors unlocked and have someone always nearby.

MicroDiscectomy - Lessons Learned

• The doctor is the GOD. Follow the instructions to the core. Do not bring in your intellectual brain into this phase.
• Have Patience during Rehabilitation. Avoid responding to any of the below 2 situations. Take recovery as per what doctor planned.
• There will be times when you will be at lows as you will not be able to do many things on day 1
• There will be times when you will feel you can do more and will want to do more.
• Have an assistant during surgery and always near you till full recovery. Do not believe that you can manage alone
• Avoid Coughing or Sneezing post surgery - take good care. Learn how to cough/sneeze properly - jist in case if you have to.
• Avoid Constipation at all costs
• Plan to have stool softeners atleast 2 days before surgery and continue for atleast 2 weeks post surgery till you are sure of normal stool discharge. Eat Lots of high fibre foods.
• Never stretch your back:
• You need to be able to sit and get up with stress on your legs and not with stress on your back. Learn how to lie down on the bed and how to get up from the bed.
• Get a "raised toilet seat", if your toilet seat is low.
• If you happen to originally sleep on the floor due to your back pain - buy a good bed before surgery. You will not be able to sit down or lie down post the surgery
• Get firm office chairs of decent height which also has a firm back support. You should be able to sit into and get up using your legs and not your back.

Microdiscectomy Week 2 - Discharge from Hospital - 19/Feb/2011

Finally, I am discharged from hospital on the 10th day.

• Able to walk slowly.
• Weakness exist in calf muscles
• Climbing steps is possible with extreme caution.
• Took an hour's flight to reach from Surgery centre (Coimbatore) to my hometown (Chennai). The travel included an hour of taxi travel to airport, an hour of waiting at airport lounge, an hour of flight and an hour of taxi travel from airport to home. I was able to manage it without any inconvinience.

At home:

• Fully on bed rest
• Three small Walks of atleast 0.5 km each
• No sitting, No Bending, No Twisting and No Lifting

Microdiscectomy Week1&2 - Hospitalization - Post Op

Day 1: Fully on bed. Impact of General Anaesthesia was horrible. I was fully on drips. No liquid or solid foods allowed due to fear of vomitting. Lips were dry and literally I was begging to get a few drops of water.
Day 2 and Day 3: Still on bed. Only liquid food - juices, soup and tender coconut. Still on drips.
Day 4: Was made to sit and walk.

• Started with solid foods
• Started with small walks of 10m and slowly reached 50m by end of the week
• Remember to weak back belt always - particularly when you get up/into bed and when you go for toilet.
• Use proper posture to get out of bed without twisting your back.

Complications: Urinary Bladder weakness and Constipation

Microdiscectomy Surgery - 09/Feb/2011

Spinal Decompression along L3-L4 and L4-L5
Microdiscectomy done at L4-L4 level

Operation Notes: Patient prone on OT. Midline skin incision over L2-L5. L3-L4 spinous process split using burr. Midline fenestration done at both levels. L4-L5 extruded disc removed.
Findings: End plate avulsion seen at L4-L5. End Plate attached to the extruded disc. Incidental dural tear sutured with 6.0 vicryl. Tisseal applied. Wound closed in layers. Suction drain.

MRI Scan - Dec 2010 - Detailed Report

Mr.Sivakumar (M/37years)
3T MRI – LUMBOSACRAL SPINE
Dec 11th 2010

Sequences
Sagittal - T2,T1
Axial -T2
Coronal -T2FS,T2Neurography
MR Mylogram


Observation:
• Scoliosis visualized with convexity to the right.
• Degenerative changes noted in the form of anterior and posterior osteophytes.
• Diffuse disc bulge with annular tear noted in L1-L2 with right posterocentral herniation causing ventral the cal sac indentation and mild spinal canal stenosis with bilateral neural foramina narrowing (right>left).
• Asymmetrical diffuse disc bulge along with disc extrusion and annular tear noted in L3-L4 with ventral thecal sac obliteration and sever spinal canal stenosis and neural foramina narrowing impinging on bilateral traversing nerve(left>right).
• Asymmetrical diffuse disc bulge with annular tear noted in L4-L5 causing ventral thecal sac obliteration and sever spinal canal stenosis and neural foramina narrowing – impinging on bilateral traversing nerve (left>right).
• Ligamentum flavum hypertrophy visualized in L3-L4 and L4-L5.
• Facet arthrosis with hypertrophy noted in L3-L4 and L4-L5 levels.
• Disc extrusion in L3-L4 andL4-L5 along with inferior migration in L4-L5.
• The vertebral bodies appear normal. No collapse/bone destruction. No spondylolisthesis.
• No evidences of primary canal stenosis.
• Neural arches of the lumbar vertebrae appear normal.
• Rest of the lumbar intervertebral discs appear normal. Disc height is maintained.
• Rest of the neureal foramina apperar normal
• The sagittal diameters of the llumbar spinal canal are as follows (in mm).
o L1-L2 : 11.5MM
o L2-L3 : 15MM
o L3-L4: 6.2MM
o L4-L5 : 7.4MM
o L5-S1 : 10MM
• Conus medullaris and cauda equine nerve roots appear normal.
• Sacroiliac joints appear grossly normal.
• The perivertebral soft tissues are unremarkable.

Impression:
• Scoliosis visualized with convexity to the right.
• Diffuse disc bulge with annular tear in L1-L2 with right posterocentral gerniation causing ventral thecal sac indentation and mild spinal canal stenosis with bilateral neural foramina narrowing(right>left).
• Asymmetrical diffuse disc bulge along with disc extrusion and annular tear in L3-L4 with ventral thecal sac obliteration and severe spinal canal stenosis and neural foramina narrowing – impinging on bilateral traversing nerve (left>right).
• Asymmetrical diffuse disc bulge with annular tear in L4-L5 causing ventral thecal sac obliteration and severe spinal canal stenosis and neural foramina narrowing – impinging on bilateral traversing nerve (left>right).
• Ligamentum flavum hypertrophy and facet arthrosis with hypertrophy visualized in L3-L4 and L4-L5. Disc extrusion inL3-L4 and L4-L5 along with inferior migration in L4-l5.

MRI Scan - Key Findings - Dec 2010

Severe Stenosis at L3-L4 and at L4-L5.
Disk Extrusion at L3-L4 and at L4-L5.

Symptoms - Dec 2010

• No bending at waist – just 10 degrees
• Leg lift in both lefts are about 30 degrees
• Numbness in right leg – back side of thigh, back side of calf, sole and toes
• Severe sciatic pain along right leg at slightest jerk
• No urinary or bladder related symptoms