I sought out the neurosurgeon, and after redoing my x-rays and MRI (it had been about a year since my prior images), I went to see him in September. Within 10 minutes of reviewing my images and examining me, he suggested a different strategy. He said that, for my case, since my spondy was low grade and stable, and since I was very fit, that he would recommend a simple decompression procedure that would involve a hemi-laminectomy, foraminotomy, and removal of the broken facet joint fragment that was pressing on the nerve (Gill procedure). Recovery would be quick and much less involved than fusion surgery, and he said that I was not in need of a fusion at this point given my overall health and level of slip. And while he couldn't guarantee that I wouldn't need a fusion at some point in the future, he agreed that it didn't make sense to "start the clock" on the adjacent disk degeneration at this stage either.
This revelation was like jumping into a cold, refreshing swimming pool on a 100 degree day. Wait a sec...I wouldn't need to fuse my spine and lose mobility, face a long recovery with no bending, lifting or twisting for 6-8 weeks, and I would be able to go back to my activities (within reason - more on that later)? Seriously? My wife (who is also a doc and accompanied me on the visit) and I looked at each other in disbelief. Was it even a question?
Within a few days I went ahead and scheduled myself for the decompression procedure at the end of October. My surgeon said I would be in the hospital overnight and could go home the next day, and would be OK to go back to work after a 10 days - 2 weeks. This sounded good to me.
On the morning of my surgery, I was scheduled as first case (yay), and arrived at the hospital before 5am, was prepped and ready to go by 6am. At 7:45am I was wheeled into the OR, given a spinal block and some sedative, and was back in recovery before 9am. After regaining feeling in my legs (yikes that sensation was weird) by the middle of the day, I was feeling pretty good and recovering in my room. The pain in my incision was fairly significant, and the muscles were tight and in spasm, but I didn't end up taking much of the pain pump since I hate pain meds and they drop my blood pressure (that's a whole other story that I won't go into).
I was able to get up and walk around the room a bit that afternoon, and I noticed that the reduction in my leg pain was significant. It wasn't completely gone, but it was already greatly reduced. My surgeon told me that my nerve was very severely compressed, and that I should expect gradual improvement over months as the nerve takes time to heal completely after being under such compression. After a fitful night's sleep, and some lousy hospital food, I was home by lunchtime the next day. Though I took a prescription for pain meds, I ended up only taking Advil after leaving the hospital.
Per the discharge instructions, I began walking around the house over the first couple of days, and iced my back several times a day. By the end of the first week, I was walking up to a 1/2 mile around the neighborhood, and within a couple of weeks, I was walking up to a mile. The reduction in my pain and numbness, even in those first couple of weeks, was remarkable. It was like getting a new leash on life.
During that first month, the nerve continued to improve, with occasional twinges or soreness, as the back gradually loosened up. But what a difference from pre-surgery!
During my post-op checkup, my doc declared that he was impressed by my recovery and told me that I could gradually begin more movement and exercise, but to still be careful as I wouldn't be considered "healed" until at least 3 months out. He also told me, at this point, that I should avoid weight lifting going forward. Well, if you're reading this blog, chances are you know what my response was. Right. So, while I didn't get into a lengthy discussion on the merits of lifting and CrossFit, the nuances of proper lifting technique, and Mark Rippetoe's opinions on the matter, I did ask him to give me some guidance on what would be considered "lower risk" lifting. Of course, he said deadlifts should be avoided and that I should keep weights under 50 lbs. OK, well, sure. With that, I said I would modify and be careful and keep the weights down, but press forward.
Feeling good, by the beginning of the 2nd month following the procedure, I began to work on my core strength again, doing abdominal bracing, planks, side planks, glute bridges, birddogs, etc. and rebuilt my core (which fortunately hadn't really declined much even through the surgery), and I kept walking (which is great, by the way, regardless of your fitness level or other chosen fitness activities). My incision began to feel less painful each day and the leg pain continued to disappear.
By the third month, I returned to my CrossFit box and began some basic modified WOD's with movements that would keep my spine stiff and not involve repetitive bending movements (air squats, pushups, pullups, step ups, lunges, etc.). I also avoided jarring movements like box jumps, double unders, running so as not to irritate the healing nerve and spine. My fitness began to return as my leg felt good.
Over the last two months, I have gradually reintroduced many CrossFit movements into my repertoire, at gradually increasing weights, such as squats, cleans, jerks, deadlifts, etc. Though I am not going near as heavy as I did before the injury and surgery, I am definitely working hard on strength, at least in low-rep sets, and continuing to push the metcons. During metcons, I go lighter and I substitute for certain movements that are likely to irritate the nerve or put me in significant extension. For example:
- for high rep snatches or clean and jerks, I might sub KB swings
- for high rep deadlifts I might sub rowing on damper of 10
- for GHD's, situps or Toes-to-bar, I'll sub knee raises or weighted plank holds
So far so good. Through the increased activity, I do have some sore days where my lower back gets tight and the muscles spaz a bit, but fortunately I have not had any leg pain or numbness return. I was wavering on participating in the 2015 CrossFit Games Open, but in the end decided to give it a go, and it has mostly gone pretty well for me, without any major setbacks in terms of pain or dysfunction.
I am keeping my fingers crossed that I can sustain this current state and that the slip does not progress nor compromise the nerve root again. I continue to focus relentlessly on:
- technique ("chase technique and the weights will come!")
- scaling appropriately and checking my ego
- core strength and stability
- mobility work
- spinal deloading and decompression
I have been using what I have learned on my journey to help others in my CrossFit box and I am happy to answer questions as well.
That's it for now. Hope this has been useful. I will post periodic updates as time goes by. Good luck to those of you going through a similar journey. Just remember - there are always ways to move forward and improve. Never stop looking for answers!!!
#crossfit #weightlifting #spondylolisthesis
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