Lessons I learned as a patient going through postoperative recovery from back surgery.
Many of my patients take some comfort in knowing that, as their surgeon, I have also undergone the very procedures I prescribe for them. From the patient’s point of view, it makes total sense. Having been a patient, and being a patient now, I have insights on procedures and processes that many other surgeons find are quite difficult to acquire. For example, my first-hand experience going through postoperative recovery.
As a consequence of a very competitive athletic past, my cervical discs eventually herniated and degenerated. After suffering for years with chronic pain and the accompanying nerve pain and numbness in my extremities, I underwent cervical fusion (C6-7) about 15 years ago.
Postoperative recovery was pretty typical. I experienced post-surgical discomfort that is expected from fusion. I managed the pain with medication. But the worst part of my post-op was the shock of the unnatural stiffness and loss of flexibility and movement I found in my neck. My pain was gone, and that was good, but so also was part of my life.
I also reflected that mine was just a single level fusion. I could only imagine what patients feel after three-level cervical fusions.
A few years later, the pressure from the fusion exacerbated degeneration in my adjoining discs in my neck. I knew that another surgery was inevitable, but this time I had a good reason to be optimistic about a better outcome.
I’m a spinal neurosurgeon with a private practice in Beverly Hills, CA. I’m also an attending surgeon at Cedar Sinai Medical Center in Los Angeles – a world-class hospital known for advancing innovative medical technology like artificial disc replacement. The same technology that I’ve spent most of my professional life researching. By the time the need for this second surgery emerged, the FDA had approved cervical artificial disc replacement surgery. I was, quite literally, among the first patients in the U.S. to opt for the procedure.
My postoperative recovery with single-level artificial disc replacement was better by far than the fusion. The surgical discomfort was the same, but I felt the difference: I had retained flexibility and movement in my neck.
Admittedly, I took a risk opting for artificial disc replacement so early in the clinical trials. But my experience with fusion forced me to look at other options more aggressively.
Spinal fusion has been around for nearly 100 years. For some contrast, fusion was developed at a time when physicians were still using iron lungs for polio patients. And very much like the “iron lung,” fusion is a brute force solution to solve a complex problem.
There are still some uses for fusion, but with my research on the success rate of artificial disc replacement, I believe that the application of fusion grows narrower with each passing year.
Consider the fact that both artificial disc replacement and fusion are major surgical procedures. Both can take up to seven hours, depending on the patient and the circumstances of the procedure. But this is where the similarities end.
When you fuse the bones of the spine, the direct result is reduced flexibility and loss of mobility. But hidden within that loss of flexibility and mobility is a structural problem that produces additional pressure on adjacent discs that are forced to compensate for loss flexibility from the fused section of the spine. The result is that many fusion patients require further surgery on the adjacent discs in as little as five years after the first surgery. That’s what happened to me. I was fortunate to have access to artificial disc replacement when it came time to “fix” what the fusion had broken.
Which brings me back to the issue of postoperative recovery. Based on my own experience, I believe that that fusion slows down recovery because it forces the patient focus on “taking it easy.” I convalesced the first week or so to give my body time to recover from the surgery and felt ready to get back to my active lifestyle. But I was always reminded about the surgery from the loss of mobility and my limited movement – often, unnecessarily.
When I had artificial disc replacement for the same location in my neck, I allowed only one day of recovery and I was quickly back to speed and got back into my full work routine. The reason for my quick recovery: I wasn’t limiting movement unnecessarily. I felt healthier sooner, and I was back to my old self faster.
Of course, this is a purely anecdotal observation of my recovery, but I have seen similar patterns of recovery from other patients. When surgery produces perceptible limits – either mechanical or from pain – the memory of surgery makes us cautious. When there are no discernible limits – we remember our former healthy self and begin to behave accordingly. Once the actual memory of the surgery fades away, we return to previous activities without hesitation.
Another example, again with myself as the patient.
Several years after my cervical artificial disc replacement surgery, my upper lumbar discs (L1-2-3-4) had completely collapsed. Bone was riding on bone, and the pain was often unbearable. The situation had gotten so bad that my spine was visibly misshapen. Again, I decided to take an aggressive approach and go for a three-level lumbar artificial disc replacement. A three-level procedure of this kind was pushing the limits of my clinical research, but again I took the risk and again I was rewarded with a fast postoperative recovery.
I gave myself one week of convalescing at home, but after that, I was back to light tasks at my office. As soon as the discomfort from the surgery was gone, I felt healthy! I felt normal! Had I undergone lumbar spinal fusion, the convalescing might have taken up to 3 weeks, but I would have to endure the psychological impact of so much loss of flexibility and movement.
The best option is no surgery at all. Often, with many of my patients, I’ll start them on a course of nutrition, exercise, wellness screening, and a bit of pain management when needed. Many of my patients who remain faithful to the program often stave-off the need for surgery for many years.
When chronic back and neck pain becomes so debilitating, that’s when we opt for a surgical solution that makes the most sense and has the best possible outcome. My personal experience has shown me that back and neck surgery does not have to be the end of your life. Surgery should be the start of a new life without pain. However, my personal experience has shown me that the best outcome is one that preserves your flexibility and movement.
After all, movement is life.
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