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    Old 08-14-2009, 12:33 PM   #1
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    Question My daughter & Back surgery

    Here is a more accurate description of my daughters surgery. Please give us advice and suggestions on how we can help her. She is 34 years old and will be staying with us.
    Lumbar four-five laminectomy Discectomy, and Fusion, harvest illac bone graft, instrumentation, posterior lumbar interbody fusion with milled bone prosthesis, bone growth stimulator, and intraoperative monitoring system. Can someone shed some light on all this, she's in great pain all the time now, and having really hard time sleeping. We already are getting the toilet lift for her, and some other things. What can she expect after surgery and when we bring her home. I'm taking 5 days off work, will that be enough?


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    Old 08-14-2009, 08:24 PM   #2
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    Re: My daughter & Back surgery

    I had a very similar fusion surgery on L4/L5 about 10 weeks ago.

    Recovery from back surgery is very different from person to person, and from surgery to surgery. I had a terrible recovery about a year ago from a decompression surgery when I was barely able to walk after surgery and had to be sent home with a walker. However, this spinal fusion was a much easier recovery from the surgery pain and I was walking quite a bit the day after my surgery. I really didn't need much help from anyone else upon returning from the hospital after a 3-night stay. It's hard to say how your daughter will do until she actually goes through the experience, so the best we can tell you is to be prepared no matter what happens. I was told after this fusion that I shouldn't spend more than 30 minutes in any position, so it would probably do her good to have to get up to get a glass of water or meals, etc.

    On another part of your daughter's surgery, you mentioned below that the surgeon is planning to harvest iliac bone graft. This basically means that they will be cutting some bone from her upper hip to use as a spacer for the fusion. Most surgeons are moving away from this method and instead using sterilized cadaever bone. Using her hip bone has a slightly higher fusion chance, but many patients have reported that their hip pain far surpasses their back pain for up to six months after the surgery. Also, they can cut some important tendons and muscles to get to the bone graft area. If there is time, you might want to inquire with your daughter's surgeon whether or not using cadaever bone is an option. I had cadaever bone used and am very glad I didn't have to deal with any more incisions having to be painful and heal.

    Also, to disect the terms you used:

    "Lumbar four-five laminectomy Discectomy, and Fusion, harvest illac bone graft, instrumentation, posterior lumbar interbody fusion with milled bone prosthesis, bone growth stimulator, and intraoperative monitoring system"

    Lumbar four-five laminectomy Discectomy, and fusion - removing the disc and fusing the bone between the L4/L5 vertebrae, laminectomy meaning to remove part or all of the lamina which is the bone to toward the back of the spinal canal (needed to access the spinal cord area).

    instrumentation - rods and screws needed to hold the two vertebrae together until fusion happens. Most people leave their hardware in permanently.

    milled bone prosthesis - when they remove the disc, the space is replaced with a bone graft spacer (your own or cadaever), then the remaining space is filled with ground up bone, often left over from doing the laminectomy.

    bone growth stimulator - a substance they have started adding that increased the chance for bone to grow to form a fusion

    intraoperative monitoring system - this must have something to do with monitoring while the surgery is being done, perhaps the live X-ray.

    Warm wishes!

    Old 08-15-2009, 10:15 PM   #3
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    Smile Re: My daughter & Back surgery

    Thank you. Me and my husband don't feel so "in the dark" now about what will take place.

    Old 08-19-2009, 12:30 PM   #4
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    Re: My daughter & Back surgery

    Brenda gave you some great info, especially about taking her own bone from her iliac crest. One little correction: a bone growth stimulator is an external unit which sends electric waves across the fusion area to help get bone growth going. I think what Brenda was referring to was actually BMP, which is bone morphogenetic protein. It's a substance that is added to the bone harvest or cadaver bone, whichever is used, and has proven to be effective in promoting faster fusion. I had cadaver bone and BMP and also a bone growth stimulator and was showing bone growth in only 6 weeks. I was fully fused at 6 months, and I was at higher risk of non-fusion!

    Now that your daughter has made the big step of deciding to move ahead with this surgery, it’s time to prepare. I'm so glad she has you around to help her! It sounds like you're already preparing. The more you prepare ahead of time, the easier and more comfortable her recovery will be. Be sure to read the thread at the top called “Post Surgery Tips.” It’s got lots of very helpful suggestions that will make a big difference for her.

    Out of all the suggestions people gave me, the best one was to get a grabber tool. My grabber was worth what I paid for it the first day home from the hospital. Do spend the money to get a good one. Mine was $30 at my local pharmacy. I tried one called “The Gopher,” too, because it was a third of the price, but in my opinion it wasn’t worth a nickel. It was really flimsy. I ended up returning it and got a good one instead. But that’s just my opinion. Others here have used that one and had no problem with it.

    Also, get her a little notebook to keep track of her meds. She’ll be groggy and in pain, so it will be easy to lose track of what she took and when. Write down everything she takes! She’ll need to stay on top of her pain by taking her meds exactly as ordered. Don’t try to wean off them too quickly. She’ll heal better if her pain is under control. I kept a running list of questions for my doctor in the same little notebook, as well as notes to myself so I wouldn’t forget things in my fog during those first weeks.

    I got a set of satin sheets (well, a cheap imitation) for my bed and some slippery pj’s. It was SO much less painful to be able to slide to turn instead of fighting the friction of cotton. This really was one of the best things I did for myself! I did end up taking off the satin top sheet and put the cotton one back on. The satin one slid out from being tucked in too easily, and it was way too hard for me to re-tuck it myself.

    For the same reason, that is to make it easier to move, put a plastic garbage bag in your car for the ride home from the hospital. She can slide on the seat getting in and out and it will be much easier. Also, put a ziplock bag in the car in case she feels nauseous on the way home. If she needs to throw up, she can just zip in the mess and no one will have to clean anything up.

    Check with her insurance company to see what equipment they’ll provide. My insurance company provided a portable bedside commode, which can be placed right over a regular toilet. You just take out the bucket and don’t use it. No one has to clean anything out, but your daughter will have a higher seat and arm rests to help her get up and down. Flushable wet wipes are also very handy. She’ll be weak and it may be hard to reach, so she’ll feel a bit cleaner if she uses those. The hospital or insurance company may give her other little goodies, too, like dressing tools and stuff. I found my grabber much easier to use than the dressing tool, but she can try it and see what works for her.

    If she has a front incision, keep a small, firm throw pillow handy all the time. She can also use a folded up blanket or towel. Place it directly over the front incision. (Well, over her clothes, of course). When she needs to turn, cough, sneeze, or laugh, she should press down gently but firmly on the pillow to “splint” the incision. It really helps to lessen the pain!

    She can expect to be mostly lying down for the first weeks, maybe even 2-3 months, depending on her particular case. Most of our healing takes place during sleep, so she really needs to get enough rest. (That’s one reason why little kids heal so fast and old people heal much more slowly.) She needs to walk, though, to get a good fusion going. Walking increases blood flow to the spine, which is essential for bone growth. Getting up and down from bed will be hard at first, so encourage her to take advantage of already being up anytime she needs to use the bathroom and walk, walk, walk. Even if she just does laps around the bedroom, she should walk for as long as she can tolerate. At first, that might only be 10 minutes. That’s fine! Then lie back down and rest.

    I didn't need help from anyone to get myself up and down and around by the time I got home. It was hard, make no mistake! But I never needed help in the bathroom or getting dressed. My husband did not take any time off work except the actual day of surgery. My kids were in high school. I homeschooled them, so they were around for at least part of the day everyday, but they had part time jobs, so they often left, too. There were quite a few times I was alone. They made sure I had food and drink I was able to reach before they left, and I had the phone within reach all the time in case I had a problem. I had two neighbors who I gave keys to ahead of time and put in my phone memory. Both were ready to come in and help me if I ever needed it. I never needed to call them, but it was nice to know they were there just in case.

    Your daughter is blessed to have parents willing and able to help her! Thank you for being there for her! Please let us know how it goes! And if you have any other questions, someone here almost always has a good answer from our own experience. Nothing is out of bounds, so ask away!

    I wish her the best,

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