Just Another Posterior Atlanto-Axial Arthodesis

In August of 2001, I was diagnosed with a broken neck and spinal cord damage. I was terrified of what the future held for me, but I didn't have any options other than surgery or paralysis. I couldn't find much information about my injury on the web, and even harder to find was the accounts of people who have endured what I was about to face.

I created a website using one of those free webhosting accounts, and posted a continuing blog (to my credit, this was years before blogs were even called blogs) that chonicled the happenings in my life leading up to, through, and beyond my surgery all the way to maximum medical improvement.

Life returned back to whatever normal is, or what it's become since my surgery, and I've neglected to keep up on this virtual diary. I was reminded of just how many people contacted me about my original site, from all over the world, and was moved to modernize the original text by reposting it here.

What follows is the text, as I wrote it, from months before my surgery to about two years after.

The Start of it All

One morning during August, 2001, I awoke with a sharp pain between my shoulder blades. Throughout the day the pain intensified, at times feeling as if a butcher knife had been plunged between my ribs. The sensation began to flare up, sending spikes of sharp pain radiating into my right elbow. I figured I must have slept in an odd position, but as the day progressed, I thought I should get it checked out. I drove over to the local ER where I was looked at, referred to an orthopedist, and given pain killing narcotics.

A few days passed before I saw the second doctor. He was young, maybe in his middle 30's, and insisted - without ever seeing a single x-ray - that my pain was caused by a herniated disc in my cervical spine. Without pause, he referred me to a neurosurgeon to be operated on. More time passed before I was able to see the next doctor.

Finally, I paid a visit to the neurosurgeon. At that point I was no longer suffering any pains and was completely asymptomatic. I was ready to return to full duty at work and to get away from the monotany of an office environment (which they had me doing until the doctor cleared me to return to patrol). From the beginning, I didn't care for the neurosurgeon's demeanor. He was abrupt, curt, and not much of a conversationalist. Let's face it, an individual whom you are going to let probe, prod, and poke around your body should really make a concerted effort to establish some type of repoire with you, shouldn't he? I was ordered an MRI that, as luck would have it, couldn't be scheduled for another two weeks. Off to work I went to report to my supervisors that even though I felt great, I could not yet return to full duty.

The day of the MRI finally came, and I went to the imaging center accompanied by my father. I needed him to drive because during my previous MRI several years ago, I discovered that I had become extremely claustrophobic inside that metal tube, hence the need for much Valium. Into the huge magnetic sleeve I went, where I quickly slipped into dreamland as my friend Diazepam sung me a lazy lullaby.

As expected, it took another week to see the neurosurgeon again to evaluate the MRI charts. After reading an outdated issue of People Magazine in the freezing waiting room of the doctor's office, I was called into the examination room where I must have waited another half hour before the bringer of all news bad came to see me. Isn't it great that we have to make an appointment at the most innopportune time of our day, yet we have to wait hours beyond that time if it's not convenient for the doctor? Upon examining the films, Doctor Personality's expression turned for the worse. He pointed out a problem - a major problem - in my cervical spine (C1/C2 to be exact). Rather rudely, the doctor told me that due to this problem, I will never return to my police career and that I will need immediate surgery or face the possibility of quadrapalegia or death. He shattered me. I didn't know what to think, say, or feel. I wasn't upset or angry; I was dissappointed. It was simply surreal. Being told that I could never return to my "former" life was a thought I had a very hard time swallowing. Forget the reason why I needed immediate surgery; that hadn't even dawned on me at that point. The severity of what he was actually telling me didn't immediately penetrate my skull. Despite my hope that this highly skilled, highly educated, highly experienced surgeon was obviously misdiagnosing me, I was soon to find out that he was dead to rights. I did have a big problem, and it was one that did, in fact, require immediate attention. Attention that promised to bring a lifetime of pain, aggravation, and discomfort with it.

The Injury

The doctor first noticed the problem when he looked at the regular X-rays of my neck in flexion (bent forward chin to chest) and extension (head tilted back). Here's a brief lesson in anatomy: The first vertebrae of the spine, C1(C for cervical), is located directly below the skull. It is the bone that supports the skull and turns and rotates when the head is moved, aptly called the Atlas. C1 sits directly on top C2, the second vertebrae in the spinal column, also called the Axis. These two vertebrae are almost solely responsible for all the turning and pivoting of the skull. The anterior side of C2, or the part that is closest to the inside (throat side) of the body, has a bony protrusion on its top called the odontoid. The odontoid sticks up from the body of C2, about the size and shape of the last joint of the pinkie finger. It actually protrudes into the hollow body of C1, and serves to guide C1 in the spine's movements and keeps the two vertebrae working in unison (along with several ligaments). The spine should look like a snake when bent - curved smoothly over its length with each vertebrae in line with the next. Obviously, the odontoid serves a rather important purpose and we could assume that a fracture to the odontoid could be catastrophic.

Fractures to this bone are classified into three types, appropriately called Type I, Type II, and Type III. A Type I odontoid fracture is when the bone is broken at or near its tip. A Type II fracture is a crack in the bone more centralized in its body. Finally, a Type III fracture is when the odontoid breaks below its base taking a piece of the main body of C2 with it. They're all terrible injuries to have and any odontoid fracture can have extremely serious ramifications. We're not talking mere fiberglass casts or soft braces. A fracture of this type can mean quadrapalegia or even death if not tended to immediately. My friendly doctor pointed out his first concern in my flexion view X-ray -I had a Type II odontoid fracture. Somehow, the odontoid had broken cleanly and completely off from C2 and was nowhere to be found. This left C1 subloxated, or dislocated, essentially free floating without a guide. Without its attachment to C2, C1 was moving fore and aft with each nod of my head, abrading my spinal cord like an edged pendulum to a straw rope.

How Did It Happen?

An odontoid fracture is most commonly caused by a trauma to the cervical spine or surrounding area. I can't recall exactly when I suffered any type of injury that could have had such a result. I spoke to my parents about it and they recalled an incident in 1976 when I was two years old. Apparently, I fell out of my crib and onto the hard floor, landing on my neck. After being rushed to the emergency room, I was x-rayed. The radiologist and examining doctor had conflicting opinions. It seems the radiologist felt that I had fractured this very same area discovered later in my 27th year. The doctor disagreed, stating that due to my tender age at the time, it was more likely that bones in my neck had not fully developed yet. Either way, I was sent home with Mom and Dad. To date, I have spent several years studying the martial arts with rigorous training that included breakfalls onto hard, wooden floors and taking full-on strikes to numerous parts of my body. I have been through two police academies and endured hours of physical training. I've been jarred and jolted through over five car crashes, including an incident in which the vehicle I was a passenger in rolled over twice. Throughout all of these situations, I never had any pain in the neck or shoulder area or exhibited any signs or symptoms of a cervical trauma.

Back to 2001. The doctor's attention focused on the MRI films. Those didn't look too good either. There was damage to my spinal canal and spinal cord. The area where the brain stem becomes the spinal cord is called the cervicomedullary junction. In that area of the spinal cord, which parallels the location of C1 and C2, there is a spot that is visibly different than the rest of the cord. Remember when I mentioned that C1 was rubbing against my spinal cord? Well, on the MRI film, the damage is seen as a light grey spot about an inch and a half or so in length, whereas the rest of the cord is darker throughout it's entirety. The damage to my cord is called myelomalacia, defined in medical dictionaries as "morbid softening (necrosis) of the spinal cord. There is a gradual onset of paresis or paralysis." It's also recognizable in the films by the way the cord tapers inward at that same location. The spinal canal, which houses the spinal cord within the spine itself, also shows narrowing by as much as over 50% in one area. All of this is indicative of a trauma, but when did this happen? When I was two? It still remains a mystery.

What all this means is that there is a serious instability issue in regards to my neck. When the doctor says "instability", he is referring to the spine's inability to support the skull as it is supposed to. Ultimately, one solid jolt, bump, or fall, could leave me crippled or dead.

Doctor Good News wanted me admitted to the hospital that same night with emergency surgery to be performed several days later. "But wait", I thought, "if I have had this injury for 27 years and have endured numerous falls, hits, impacts, and crashes with no adverse effect, why is there such a need for immediate surgery?" In a nutshell--I've been one lucky individual.

Being told I needed this painful operation that would leave me searching for a new career and a new style of living made me think of two words--second opinion. A family member in the medical field recommended two doctors, partnered neurosurgeons in the local area that have a reputation for being the doctors that other doctors go to when they need surgery on themselves. I made an appointment for the following week with the hopes that somehow, the first doctor was horribly wrong.

The Procedure

The procedure involves a bone graft - the taking of bone from one area to be transplanted to another. A large piece of bone will be surgically removed from an area of my hip, called the iliac crest, located above the buttocks in my lower back. This is the safest place from which to harvest bone because it serves no structural purpose. C1 will be pulled into alignment with C2, and the hip bone is set in place behind the two vertebrae. Thin gauge metal wire is then wrapped around both vertebrae and around the hip graft to secure them together where they will eventually fuse forming one large bone [Galli technique]. Two 3.5" long titanium screws are inserted upward through holes drilled into the bottom of C2 and into the body of C1, also permanently locking them together.

My doctor and his partner use a software program called "Stealth Station", which allows them to perform intricate procedures with the guidance and accuracy of a computer. The software assists them in placing their instruments within the spine with great precision while an infra-red sensor/processor mounted over the operating table pinpoints exactly where in the body their tools are on a video monitor. It's like a GPS system for surgeons. In my case, this program will help determine whether or not my bone structure will support the two screws which will be used to supplement the wire and bone graft in holding the vertebrae together safely and securely for the remainder of my life. This is all permanent, nothing will ever be removed. The hardest part to swallow for me throughout all of this is the fact that a Halo apparatus will be fastenened to my head to temporarily immobilize my neck and spread the weight of my head to my shoulders while my spine fuses and heals.

A Halo is comprised of several parts, the first being a heavy metal ring worn around the forehead . This band is secured to the head by means of screws,or pins, which pierce the skin and slightly penetrate the skull to fasten it in place. Two screws will be placed in my forehead and two will take a position in the rear of my skull. Four metal struts join the head band to the chest and back, forming scaffolding of sorts to support the head ring. The torso portion of the Halo is part of a larger fiberglass vest which finally ends mid-belly. It is made for anything but comfort, but that is the price you must pay for a healthy recovery.

I now have less than two weeks until the date of my operation, and to say I'm not nervous would be completely untruthful. However, I have the utmost faith in my doctors and in modern medicine. I don't feel very nervous, but I do notice I am sleeping a great deal more and biting my nails as if I've been deprived of food. Fortunately, I have the support of a great brother and wonderful parents along with some excellent friends. I probably won't be updating this page until the day before my surgery. After that, I will post any information as soon as I am able to return to my computer. Until then, my fingers are crossed.

Post-Surgery

It has been a week since I have last typed. It is now Friday the 24th, one week after the procedure. What came at a a snail's pace has shot by and left my head whurring and wondering where the time went. I'm into week two of recovery and what has unfolded until now, I shall now share with you.

I checked into the hospital on the morning of November 16th. It was a very nice, clean hospital. A tremendous lot of super-pleasant, very warm people that for some reason in this day and age, still seem to really have a true sense of pride in their purpose. It seems there are some people out there that truly care. Best of luck in coming across them like I did.

Honestly, details are moot. I prepped calmly, patiently, for what though I knew would be a "normal procedure for the medical staff", could have very well have been the last time I breathed on my own, or felt a touch below my neck. ...and that was it. I was administered my medications and sedatives intraveneously and very soon slipped into controlled unconcsciousness.

The surgery lasted about eight (8) hours. It could not have been more successful. The screws took perfectly, the bone braft went just fine, and obviously there were no complications. It was an alien Friday night, though. Waking up without movement of your head is just plain odd. The first thing I saw when I opened my eyes was a bar on each side of my head - the struts supporting my skull, attached to the halo. This device is heavier than I ever imagined it could be. I need help laying down and getting up. Sometimes I need help picking up my shorts in case I drop them in the restroom. Embarassing, but you get the point. This is anything but easy. This is anything but fun. But I am alive. I am well. I am making a good recovery with no ill effects.

On the first night I awoke surrounded by my father, brother, mother, step families and soon to be sister in law. I looked around, peering my eyes from corner to corner at all of their silent mouths. I cried. I was okay. I was not crippled. I was not damaged, injured, or hurt. It was still me. I couldn't help but tear up, instinctively, uncontrollably, and when my mother looked over my face with tears of her own escaping from her eyes and asked me why I was crying, if I was in pain, if I was hurting I said, "No Mom, I'm happy. That's all."

Saturday, I was on my feet from time to time. The first time I stood up, assisted by nurses, I caught a glimpse of myself in a reflection on the glass of a painting on the wall. I passed out.

I began eating on Monday I believe, and my stomach was settled calmly. I actually had some pretty good laughs at the hospital. The staff, for the most part, was so pleasant it was hard not to.

I will return to write. My goal is to assist others who have this procedure in maintaining a level of comfort to help get through it. As of now, I have not yet found it. I have much fewer true friends than I thought as I found out through this incident. Much more people that care with a tongue than with a finger, with paper not a gesture. I don't expect much from anyone. But you shouldn't have to from those that supposedly love you. I have learned who my closest, deepest friends are. To those of you, I can't tell you how much your love and assistance means to me. But those numbers are few.

Halodate: 29 November, 2001. I had my first post-operative doctor's visit today. I had all of my staples removed while I was there. That was an ordeal. The incision, despite the surgery being for C1 and C2, actually went all the way down to about T1, necessitating the removal of the halo vest to cut some of the nasty buggers out. But, they are gone and it is one less obstacle to stand in the way of my recovery. (note: the incision is 11"+ long and took 53 staples to close)

I started the day by going for an x-ray. I was assisted by a young woman named Krista who graciously got me in and out of there very quickly. The doctor read the film and reported nothing but the best of conditions. The screws were perfectly in place, the wire was in tact, and I still had some semblance of a brain floating around up there. So for now, I don't have a complaint in the world. Except of course, I have 10 weeks to go with this halo on. The spasms in my shoulders have increased a bit, but ice has been helping. Other than that, I will keep you all posted with any further information. January 3rd is my follow up appointment. That's a milestone date--it's my 6 week mark and my halfway point to halo freedom.

It is now Tuesday December 4th. This weekend has been pure hell. The pains in my neck have increased tenfold and I now have spasms in my shoulders radiating down my back. I've been trying to get into the doctor's office today because I think when the halo vest was reinstalled it was put on in a slightly different position. I can't sleep on my back anymore, not since it was adjusted. I feel like there are rocks digging into my back because of the hard contours of the vest. I've resorted to sleeping sitting straight up. I've been a little down and depressed over the weekend, too. It dawned on me that I have three more months of this to go, then the collar, then the therapy. I know there are people out there with permanent disabilities, "real" problems compared to mine, but three months of this is really going to be a test of will and inner strength. I'll let you know how the doctor's appointment goes. And for those of you who have e-mailed me, thank you. Your words mean more than you can imagine.

I want to shower, go outside for a long walk, enjoy the breeze and the scenery, or go for a long Sunday cruise. I guess in reflection, the point is: don't waste your life wanting, get out there and do it without hesitation because you never know when something will arise that can prevent you from living a "normal" life.

Saturday the 8th. Nothing really new to report. The latest X-ray shows continued progressive healing with the fusion and I'm adjusting as much as possible to the halo after only three short weeks. My family continues to be a huge help, especially my brother and sister-in-law. I still get spasms in my shoulders and neck and my hip has started to hurt from where the graft was taken. That pain is from healing I have been told. That being the case, bring it on!

Well, I passed the fourth week mark and I am now into my fifth. That leaves about eight or nine weeks left of having to wear the halo. As time has gone on, I have started experiencing a lot of weakness in my shoulders. This leads to pain throughout the day, mostly in the intersection of my neck and trapezius muscles as well as in my shoulder blade areas. I've made a few adjustments to the straps on the vest to make it slightly more comfortable now that I have learned that I can do that. It also aids in washing. My brother's wedding is in three weeks and I have to figure out how we are going to dress me for it. I'll let you know as soon as I find out because that will indeed be interesting.

Well, my luck had run out. I thought for the first three or four weeks that I was some type of genetic freak, some super-strong glob of testosterone that was somehow exempt from feeling pain. WRONG. The incision on my hip is the most recent addition to the list of gripes and complaints. And it is turning into a very lengthy list.

The doctor cut through my glutes to remove the piece of donor bone from my hip for the fusion. Well, that's a big mass of muscle, and on me, probably a little bigger than most. Each step I take sends a "Charlie-horse" like sensation right through my left buttock, starting from the incision, which is around the area of where vertebrae L5 would be, and flaring down to where the rear of my left thigh begins.

My deltoids are the newest addition to the "Nope, can't use those anymore" muscles. I wouldn't describe a lot of the sensations I feel in my neck, back, shoulders, and deltoids as pain, but they are definitely considered "aches". However, my muscles in the neck have become so weak that even swallowing causes a spasm in the rear of my neck and sometimes in my trapezius muscles. It's going to be a long road. I've finally come to realize that. Each day the halo seems to get heavier as my muscles become weaker from non-use and atrophy. Now, as opposed to just one week ago, if I lean too far forward, the weight of the halo combined with gravity, pulls me forward and off balance, but I don't have the strength in my upper body to proportion my stance so I had better not lean forward or I will fall straight down. And that probably would not be good. I did, however, run all this info by my Physician's Assistant, and he said that this was all a normal part of healing, and it will only get worse before it gets better. What a joy that is to know, because I am such a pleasure to deal with now. So, I will update again as anything occurs. Still waiting for January 3rd for my next appointment and X-ray. Happy Hanukkah and Merry Christmas to all of you! Hope everyone is healthy and pain free.

It is now January 2nd, 2002. The new year. For the most part, the spasms have subsided greatly, lessening pain with their disappearance. I have had a few rather intense spasms in my neck which were not only painful, but caused tingling in my fingers and toes. Frankly, they scared the hell out of me. My fifth week in the halo I had finally felt somewhat comfortable with it. My sixth week was a breeze; "Hey, this isn't that bad. Week seven: get me the hell out of this thing! It's enough. I now feel trapped inside a mobile prison. I want out in the worst way.

I have lost a lot of hair and I have found that my skin likes to dry up now as if I'm sunburnt. A medical field employee advised me that when the body undergoes major stress or trauma such as a surgery of this scale, it concentrates its resources on the areas in need, and sometimes it neglects the minute spots such as skin cells and hair follicles. So, these side effects are to be expected and will subside when the healing process is finally over. When it is finally over. My hip has healed pretty well. My neck is healing too but the scar, which is massive, is still a "valley", as if it still has yet to join together. I wish I could report it was a Happy New Year, but at this point, I will rejoice in 5 weeks when this hellish, medeival torture device is unscrewed from my skull.

One of my friends bought me a foam "eggcrate" and firm pillow for my bed. It made a world of difference. Now, instead of all the protruding parts of the halo vest digging into my back all night long because of the solid nature of the hospital bed mattress, they are absorbed into the foam, allowing me to lay pretty flat and actually as comfortably as I think I can get given the circumstances. Still, its removal is going to be the highlight of my life. To turn my head, to sleep on my side, to shower, to bend at the waist, to get in my car and drive to get meals. There have been days when I didn't eat because my roommates were working and no one was around to take me to get food. The clock is ticking.

On January 3rd I went back for x-rays and a follow up visit. All is wonderful. The fusion is continuing to heal "fast and well". Three weeks until some more pictures and then another two weeks until we will review the possibility of removing the halo. So, we're looking at the second week of February. That ought to be a moving experience. I will tell you something about this experience. I have done a lot of self-discovery, searching and thinking, as well as looking at people, handicapped or otherwise, differently. My outlook on many things has changed and I have discovered that there are some simply angelic people in my life. This operation saved me from what would eventually have left me a quadrapalegic, if I survived it at all. But all the pain and discomfort has been worth all the positives that have come from this, and I am not even thinking of the one I just mentioned. Regardless of your spirituality, despite your belief or disbelief in some type of God, whatever you choose to accept, this whole story goes beyond mere luck. I have been amazingly fortunate to have been given the opportunity to use my fingers to type this and share this with you all.

I've had some new pains in my neck. It now hurts to the touch. My surgeon said that is a great sign, that the feeling is coming back. My physical pain is a sign of further healing. Just another couple of months and I will be back behind the wheel of my patrol car and my beloved Mustang.

It is now the 20th of January and I should have 18 days left until the halo is removed, assuming the fusion continues to heal properly. I spent a few days in the past week visiting the hospital and speaking with spinal surgery patients. One was a 19 year old boy who had cervical surgery and halo placement. I think my visit did his parents a lot of good - relief that in just 10 weeks, their son will be up and about and feeling okay like I am. Adam, however, was drifting in and out as he was under the influence of morphine. I plan on revisiting next week. What amazes me is how much knowledge one can possess if something fascinates him or her enough. If you asked me three months ago what a posterior atlanto-axial arthrodesis with transarticular cortical screw fixation was, I would looked at you like you were Charlie Brown's teacher. Now, I can not only break down and define what each word represents in medicalese, but I can tell you exactly how the procedure was performed.

My family continues to be a great support as do my few close friends. I am counting down the days now. No more weeks and months. 18 to go and feeling good. From what I understand, the removal of the halo will lead to phase II of pain and discomfort as my cervical spine starts to support the heft of my large noggin again. Oh well, I've made it this far, and at this point, there is nothing I can't handle. My next report will be on or after the 24th-my next X-ray and doctor follow-up. After that, I will post pictures of the removal and start speaking of my rehabilitation and therapy.

It's the 26th of January at 1:14AM. I was sitting here at my dimly lit computer desk with "A Small Cigar" by Jethro Tull echoing throughout the apartment when my little MSN icon buddy told me that my Dad had sent me an e-mail. Happily and curiously, because of the late time, I went to read my father's words. I give you a quote from the wise man himself: "Update your website from the 24th, get a move on!!!". No matter how old you get, a good swift kick in the ass from dad always motivates you!

I went for more x-rays and a follow up visit on the 24th. It went wonderfully. Long and short of it: The fusion at the spinous processes (the points at the rear of the vertebrae) have already started union (bonding or fusing). Nothing has moved (a great thing)as far as the fusion and graft are concerned. The doctor seemed to have a proud look on his face when he assured me that as fast and beautifully as I am healing (very much to his pleasure being that this surgery doesn't always hold up too well), that the halo will be coming off on February 7th at 1pm as long as the flexion/extension x-rays show that the fusion is staying in place when my neck moves. After he told me that, he gave me a confident pat on the shoulder and said, "I think you're going to be 99% perfect". That was a full-on symphony to my ears, especially considering that's closer to 100% than I was before the operation. I had full faith in him going in to this due to his reputation, and to hear him say those nine words to me was one of the downright happiest memories I can recall in a very long time.

After the halo comes off, I have a week to physiologically destress and let my body adjust to the difference in balance and give my spine and muscles the opportunity to adjust somewhat to holding up my large cranium again after a three month break. Well, not much of a break for them I guess.

What almost made me teary is that he smiled when he said that after six to eight weeks of light duty, I will be ready to put my uniform back on and return to work. Remember now - my first doctor, I can hardly recall his name anymore, told me I would never be a police officer again and that I was looking at a year to recover while I ". Well, thank [insert higher power of choice here] for doctors like my surgeon who are true medical geniuses that pride themselves in their dedication to the advancement of medical science and actually care about their patients. He not only saved my life, but gave me the opportunity to live it how I want to live it. So, 13 days left and I am halo-less. Lastly, doc said after my one-year surgical anniversary, November 16th, I will be able to get back into a normal life just as it was.

Doctors, like police officers, can make you or break you. Either profession, no matter what the outcome of the dealing with that person, should be professional and as pleasant as possible. When I deal with citizens, I try to be as cordial and respectful as if it were my mother I was talking with. Well, when a doctor tells you that your life is in immediate danger if you even just bump your head and that you need immediate admittance to a hospital for severe spinal reconstruction, you'd think he could deliver the message with some tact.

I'm doing great and eagerly awaiting the big day. As always, Dad will be right there supporting me. I could not have made it through this without him. Anyone who has talked with me recently knows that. There's a lot of thanks that need to go around including my wonderful brother Matt and his wife Amanda, but I will stop there. The ride isn't over yet but I'm beginning to see the light at the end of the tunnel. Finally. Almost onto Phase II.

It's February fifth and in two days the halo is (crossing fingers again) coming off. Truthfully, I am not excited or relieved or anything other than what I have been throughout the latter part of this ordeal-taking things day by day. It's almost time to return to work at light duty, time for therapy, time for a new sensation of discomfort and pain that I'm sure the large amount of atrophy and muscle loss I have endured will tote along. There's a price to pay for everything and sometimes the toll is worth the trip. It will be a long road but my bags are packed and I'm ready to go. My father will be there with me in the x-ray room to photograph the event and to share this most momentous of occasions with me. My brother will be there in thought, because he is now scheduled for lumbar surgery in just a few short weeks and will be getting fitted for his back brace that day. The wonderful part of his situation is that he is in intolerable pain and his operation will bring him immediate relief. Another emotional day indeed as it has been ten years of suffering for him, and he is only 30 years young.

I'll be back shortly, and the next submission I contribute to this page will be without this metal crown fastened to my head. What a day it will be. What a day, indeed.

The Halo Cometh Off

It's Friday the Eighth. Removal went smooth and the doctor was extremely ecstatic with the amount of bone growth that has taken place at the surgery site. I was left scarred beyond the point I thought would be a "good war wound". Hopefully that will dissipate with time. I am in excrutiating pain as the muscles that have atrophied to nothing over three months are now being forced to work again. The worst is that because of that, they are now sore from overuse in addition to the pain attributed to being reintroduced to the world. Don't get me wrong, this beats that damned halo anyday because I know this will pass. But - I was completely overestimating how this would go. I can't move my head at all except for nodding down. I lost so much muscle in my shoulders that a light touch, even from behind, puts your finger right on my clavicle. That's about it for me for now. Therapy will be calling soon to start that route. What a joy that will be. Until I can type again...

It's been a while since I sat here in front of my keyboard and had the desire to type. It's been a long haul, but gradually I see small differences in progression. The first week without the halo was very rough, the second was only the slightest bit better. I had finally received a telephone call from my physical therapy provider at the end of the second haloless week and scheduled an evaluation. I was given stretches and light neck exercises to do, which now that I am in the third week without that horrible device I think I am noticing a little more mobility in lateral movement of my head. Still, my neck continues to be very tight.

I had my first official therapy appointment on Monday, the 25th of February. It came after a long day at work - my first day back since October. I am assigned to the Crime Scene Unit on desk duty until I am cleared for the road again. I have a feeling that will not be anytime in the immediate future. But, I am back at work, driving my Mustang, restoring my freedom and trying to enjoy myself again, despite the discomfort. I have more therapy scheduled for Thursday and Friday of this week (it is now Tuesday the 26th) so I will post with any progress over the weekend.

My brother, Matt, had a lumbar laminectomy of L5/S1 - the very bottom lumbar disk that separates the lumbar vertebral body from the sacrum - ten years ago. That procedure involved the "shaving" of the bulbous, protruding portion of the bulging disk at the L5/S1 junction. He suffered from sciatic, radiating pain for a long time since then, but it never was as horrible as it became after a car crash in October of last year, 2001. I never saw my brother in such pain - sometimes agony would have been a much better word. He visited the surgeon who toyed with my broken neck, and immediately upon reviewing my brother's MRI films, told him he needed to have surgery or face permanent damage to the nerve root.

On February 18th, 2001, my brother underwent a lumbar interbody fusion. The surgery technique used is relatively new to the spinal fusion community: only about two years or so. Our surgeon has still managed to perform over two hundred of these procedures in that time. The surgery involved approaching Matt's lumbar spine from the anterior side of the vertebrae. In other words, through his belly. He was incised from the naval to the pubic region, his internals temporarily relocated, and two cylindrical metal coils filled with cadaver bone were implanted between the vertebral bodies of L5 and S1 after the deteriorated, collapsed disk was removed. Matt is wearing a large brace now and is under the care of Dr. Wife now, but he is doing wonderfully. Obviously, he is having discomfort in his belly, but the sciatic pain that literally left him hobbling and limping on both legs is gone. I needed to share that here since it fits the theme of the site and also to express how wonderful it is to see someone I care about so much free from a suffering that was killing me to watch.

It's March now, and I have been back to work at a desk and attending physical therapy three times weekly for the past three weeks. It has helped tremendously. I have gained a lot of muscle back rather quickly in my shoulders and neck, but there is still a long road to go. My mobility is shot to hell for the most part. I can now look 62 degrees to my right. I will probably max out at about 70 at best. I can not look down and put my chin to my chest.- The fusion prevents that movement completely. It's hard to explain to people how that feels. Discovering a newfound handicap is rather odd, and I would definitely call not being able to look down a handicap. While there are people with worse afflictions, I get upset rather easily when I think about how uncomfortable my life has become since the surgery; especially considering I had no symptoms whatsoever prior to my operation. It's hard to remember what the alternatives to surgery were. Certainly, I can bend over using my upper back and see the ground, but I will never look at my chest again without a mirror. I can't lay in bed and prop my head up to watch television. I guess one day that will feel normal.

I still have a great deal of discomfort in my muscles, especially in the back of my head at the base of my skull. The muscles that start there at the occipital region of the skull connect to the trapezious muscles of the shoulders. It amazing how all of the muscles are somehow connected. Turning or nodding my head is an effort. I do the stretches my therapist gave me every day like I am supposed to and sometimes they are rather painful. Eventually, they should become easy to perform. That is a long way off into the future though. I am scheduled for my next x-ray and follow up appointment in six weeks. I will update then unless something noteworthy should occur prior to that date.

Here it is: April 21st, 2002. My 28th birthday is just a few weeks away and thinking about that puts a whole new twist on my sense of time. It was just a bit over five months ago when I checked into the hospital for what has led me to feel like I do now. Is that bad? Not necessarily. I constantly remind myself of how lucky I am, and today I was reading about Christopher Reeve online and felt even better about the pain I am feeling. Exactly, I am feeling something, anything, even the crappiest of days means I am feeling. That's not always an option after spinal trauma. So in that regard, I guess I can't complain.

My insurance company, Blue Cross Health options, decided that they were no longer going to approve physical therapy for me despite my therapist's recommendations. I do the gammut of exercises at home now with a couple of light dumbbells my dad picked up for me. Today I find myself sniffling with a sore throat so I haven't exercised, other than my neck and shoulder stretches, in a couple of days.

I return to full duty at work in two weeks. Am I ready? Well that depends. Psychologically, I have been ready for while. I really miss working out there on the road and getting out of the office. Physically, I don't think I will actually be ready for a long time. It still requires a great deal of effort to turn and pivot my head. The Doc said there is no risk of further injury to my spine due to the fusion, so physiologically I believe it is safe to go back to work. There are still a bunch of questions I have for the doctor, and those will be answered on May 2nd after my x-ray when I meet with him once again. At this point, let's hope with crossed fingers that the x-ray shows a solid fusion with no negative setbacks.

Back again, June 17th. It's been raining like it's a freaking biblical plague here in "sunny" South Florida. This weather has made me realize what a lifetime of miserable suffering I am in for. I'm in good spirits (really, I am) so don't get me wrong, but this pain has been intolerable at times. It feels as if there is an ice pick jammed into the space between the base of my skull and the top of my spine. I feel it when I least expect it, i.e. when I turn my head "the wrong way" or when I swallow. I've been researching pain managament clinics in town and found one that is affiliated with the hospital where I had my operation. I'll be checking that out very soon. Other than that, same ole, same ole. Well, not entirely, I did break my left pinkie finger in a tussle at work on Friday the 14th, but in comparison to everything that has been going on in my life, I would have noticed it just the same if I accidentally bit the entire finger off. Regardless, I have nothing new to report.

My brother is feeling great since his surgery, and today (the 17th), my mother underwent some pretty invasive surgery which turned out to go smoother and faster than anticipated with the results we had all hoped for. Dad is still Dad and as supportive as ever. See, all this freaking pain but I'm still one lucky guy, eh?

So, here I am almost ten entire months post-op. I consider my actual "post-op day to be February 7th, the day the halo was removed. That would make my post-op tenure approach the seven month mark. Either way, I'm still having my ups and downs. There are good days and bad; the good ones are so-so, the bad days really suck. I have a follow-up appointment in October. That will be my end-all x-ray and one year check up on the fusion. Keep your fingers and toes and eyes and everything that can be crossed crossed. The newest addition to the Neurological Center is a doctor that runs a pain management clinic. I think I'll need to have some words with him. That is, if I don't have to spend the next eighteen years of my life trying to get a referral from my PCP.

It's now Holiday Season 2002. December 15th specifically. I've been feeling pretty good for the most part. Occassional rain brings constant pain, but clear days are great. Aside from the limited range of motion, I wouldn't guess that I had this type of major operation. Well, that and the foot long scar down the back of my head. But hey, no one notices that right? Right? Ok, maybe not. But I like my "little" scar. It's like a reminder of how lucky I am.

I finished the testing process for a new police department last week. I should have the final word this week sometime. They sent me for an MRI to check on the solidity of my fusion. That's really a waste of money since X-rays would be quicker and serve to tell a better tale than the scan. I guess if they want to spend the $600 for the MRI, let them. I found out that I've become even more claustrophic. Great eh? Even the "open" MRI had me really jittery.

Overall, things are well. It's hard to believe I'm 13 months post-op. Two months from now will be my halo removal anniversary. Sometimes I don't even know I had the surgery. Aside from the limited range of motion, I don't have any side effects yet. It's 52 degrees now, chilly by SoFlo standards. My neck gets really stiff in this colder climate, but fortunately, it's hotter than hell here most of the year.

I'll post when I get the results of my job status. I avoided my one-year post-op follow up exam due to complications with my primary care doctor. But, the MRI looked good. The fusion is solid and it's hard to even see it on the films.

I'll be back soon, have a wonderful holiday season and a happy new year.

It's a Wonderful Life

It's now June 16th already. I can't really believe just how fast time has flown by since my surgery, and all the things that have taken place in my life seem somewhat surreal at times. There's been so much happening to me and around me lately it's hard to identify a point where I could start explaining without feeling like I'm leaving something out. I went to the surgeon for my final follow up a few weeks ago. I was worried because I'd been having pain in my upper back and shoulder, and being cognizant of a lurking herniation at C5/6, I was deathly afraid that all of my discomfort was caused by that. I was more terrified that the doctor would confirm my suspicions and recommend another surgery. I had every intention of telling him that I suddenly made a miraculous in-office recovery as there was absolutely no way in the world I was going through any of that again. My Physician's Assistant even said, "It would be nothing like your last surgery...after that, this would be a walk in the park". Well, you know, that's one park I can stay out of. I'm not one for the great outdoors anyway.

My neurosurgeon reviewed my MRI's with me and said the fusion was "perfect". Even I could look at the X-rays and see the union of bone at C1/2 that wasn't present immediately following my operation. Back then, there was a distinct separation of each vertebrae and the bone graft from my hip defined on the x-rays by varying shades of grey and white. Now it's just one large, solid white piece on the films. As for the pains I've been having, the Doc calmed my dizzying nerves by telling me that the herniation at 5/6 is so small, that there's no way it's causing the pain I've been having lately. It's all just a byproduct of my surgery, and as he informed me, it probably will be for the rest of my life.

When I was preparing to leave the office, the doctor said, "You're all set, looking good." I asked about working out, training, the risks of getting hurt at work, etc., and he politely said, "Todd, go live your life. There's no need to come back here anymore. You're totally fused." The phone calls I made immediately following that appointment had the same tone and spirit as those I made when the halo was removed after my 13 week sentence to "the hole". Relief. Finally, after all this time and all the pain and all the concerns, I was "fixed". I was back to normal for lack of better words. I still have residual pains and spasms, chronic knots in my shoulders and shoulder blades, and the occasional radiating pain down my right arm which brings it's friend numbness along with it. But my mind is rested, assured that I'm "okay" again.

So all in all, my life turned out pretty damned good. I thought I had it well made before this whole fiasco crashed down on me, but the ups and downs I've endured over the past 16 months have turned my life around in so many ways. So many cliches can be applied to this whole situation, but I think the best, most fitting, most appropriate one for me is "Whatever doesn't kill you makes you stronger". How true that is.

I don't think I have anything more to add to this page. My most recent doctor's visit concluded this episode with a final note of happiness and positivity.

...and now on to the rest of my life.

Labels: broken neck, cervical fusion, cervical halo, neck surgery

posted by Todd Grossman  # 2:16 PM