Give Ground Grudgingly: A Story of Fortitude in the Face of Revision Decompression Surgery of the Spine (AKA Redo Surgery)

Revision Decompression of the Spine (aka redo surgery)

Mr. Tom Duncan, a healthy and active 75 year old male presented to me with a complicated clinical scenario. I met him while in practice at the Hospital for Special Surgery in Manhattan, NY. He had been suffering from terrible right leg sciatica (pain that shoots down the leg in the distribution of the sciatic nerve) and had undergone a L4-5 decompression at an outside hospital 6 weeks previously. After this surgery he developed worsening pain, and frighteningly, a foot drop—a condition where you can no longer elevate your ankle and your foot hangs limp. As an active athlete he was mortified at his condition. I connected easily with Mr. Duncan, both being runners, and that he had spent time running around Muir Woods, the Dipsea Trail and Stinson Beach before he moved back to New York. I remember him being so frustrated and scared—and I was able to empathize. In my retirement, I want to be able to run and jump just like Mr. Duncan did.

On his MRI I noticed that while the previous surgeon had done a good job, there was still compression of the L5 nerve root. We talked it over and considering the paralysis of his foot decided to move forward with a revision surgery (a redo surgery). While this sounds simple, revision decompressions have an increased risk of destabilizing the spine and causing dural tears. Dural tears occur when the membranous lining of the spinal canal gets punctured allowing the cerebral spinal fluid to leak out. The risk of this is increased in revision procedures because there is scarring of the dura, making it more prone to injury, and less identifiable in surgery.

The case was risky, and I wasn’t sure I would be able to restore function to his leg. But Mr. Duncan refused to accept a life where his foot no longer worked.  We talked about it and I prepared him for the worst case scenario—having another surgery without any improvement in his paralysis. Together we decided to move forward with revision surgery 3 months after his primary procedure.

In surgery I had to clear away scar and bone spurs which were crushing the nerve. It was a tedious dissection but went smoothly without complication. I could tell that the nerve was still impinged and started to have hope he would recover. Although he did notice improvement in his pain after the surgery, the recovery of his foot paralysis was slow. However, within several months and to my dread, he was back pushing the limits of his spine restrictions (restrictions I put on all patients after spine surgery that include no bending lifting and twisting).  Soon he was doing wind sprints and other highly athletic types of workouts. Although I am proud of his recovery, his activity level should be considered as an outlier for a typical rehab period following spine surgery.

Here he recounts the rest of his recovery: 

“Once your successful surgery eliminated my pain and allowed me to heal and begin to walk again, I embarked on an aggressive rehabilitation and strength-building program. I had been in a strength-training program with a personal trainer for six years prior to developing my back problem, and was a lifetime athlete, but couldn’t believe how weak my right leg and foot had become in the three months my nerves had been impinged. As you’ll recall I had extensive numbness below my knee and a dropped foot (that was my biggest concern).

I initially tried conventional physical therapy, but quickly realized it was too passive and ineffective. It basically was a series of baby steps, and I couldn’t see how that could restore my former function any time soon. It wasn’t geared for someone of my background. So I reconnected with my own trainer and we began an aggressive program of strength building with weights, plus distance running, interval training, and outdoor basketball, with particular emphasis on the leg and foot. It was hard work; two hours or more almost daily. But it worked. Today, I have full function of my right leg and foot and probably 95% dorsiflexion. I am running pain-free sprints, still playing basketball, and last week turned in my fastest time in the 150-yd sprint in over four years.

(I don’t mean any of this as a slight against the physical therapy business, but I just knew it wasn’t right for what I needed.)

My theory on athletics is: Don’t ever stop. Don’t get lazy, don’t eat junk, don’t ever quit, at anything. Age, of course, is inevitable, and its advance is relentless, but to use a military analogy: Give Ground Grudgingly!

Pete Rose had a quote I’ve always loved. When asked how he could still hit major league fastballs at age 48, he said, “Don’t ever stop. The minute you walk away you age 10 years.”

Without your care and surgical skill none of this would ever have been possible. I wouldn’t even be able to walk normally. I am thankful and grateful every single day.”

-Tom Duncan

Takeaways:

-Never stop moving. Athleticism is a life-long pursuit.

-Revision surgery of the spine can be successful but there are increased risks.

-Hard work is required to rehabilitate yourself after spine surgery.