Skiing after back surgery

[jdk99]

@Patmaster - not exactly sure what you mean by "stabilizing implants…that avoid fusion all together". I'll assume you mean dynamic instrumentation that somewhat preserves the motion segment and theoretically prevents adjacent segment disease. Jury remains out on that approach as the technology is new and the evidence is not overwhelming at this point (although it could be in the future). Throw me some specifics and I'll add my .02

[6balls]

@jdk99 cool we have a neurosurgeon baller. Before med school I worked with a research doc in the bone healing lab...one of his research interests and projects at the time was artificial discs. Interesting that I began med school in '95 and the standard approach continues to be discectomy/fusion.

What's your take on adjacent segment disease post fusion? I'm sure I will be in trouble above/below my fusion at some point...but the whole mess was degenerating anyway so will the fusion be to blame or my ongoing degenerative process? I tend to believe the latter in my case.

[jdk99]

@6balls…fellow 99 grad eh? what's your specialty? And fyi I barely qualify as a baller…just started in the course end of last year. Cleared 15/30 and 15/32 this year but stuck at 4 @15/34. Off side lean kills me!

 

…To your point, the question in adjacent segment disease remains whether it's simply natural history of a diseased spine or actually caused by the fused segment. Likely a combination of both. I quote my patients a 10-20% of future adjacent segment failure.

 

As to dynamic systems, results are not absolutely conclusive yet that they actually prevent ASD…which may argue for natural history as the source. The other issue however is that of failure rate of dynamic hardware. Think moving parts…with time the risk of failure likely goes up, just like joint replacements in ortho. So then you're left with the possibility of one of two future surgeries: 1) fix the adjacent segment OR 2) revise the old dynamic instrumentation. From experience I will tell your that #1 is far less complex than #2. My sense is that most of us aren't quite sold on the dynamic systems….yet.

 

 

 

 

 

 

 

[Patmaster]

@jdk99, here is what was recommended in Europe:

http://www.zimmer.com/en-AU/hcp/spine/product/dynesys-dynamic-stabilization-system-ous.jspx

 

and in the US:

 

http://www.coflexsolution.com/content/what-coflex

 

Any feedback is more than welcome. I'm 53 and in reasonably good shape (not overweight but not a top level athlete either).

[jdk99]

@Patmaster, familiar with and have reviewed the literature on both. See the last paragraph of my response to 6 balls above. Long story short, dynamic systems may be the future but have yet to be shown as definitively superior to fusion. Keep in mind that there is a great deal of tech push in medicine - not a bad thing but often leads to fads that pass with time after the evidence doesnt pan out. If you're an early adopter, go for it.

 

 

 

 

[6balls]

Agree with @jdk99 which is why this doc had his doc do the standard approach. It's true in all areas of medicine that there is a push that new is better, when often times old stands the test of time. Can't find better approaches, meds, techniques though unless pushing the envelope.

 

@jdk99 good chance myself and the two other goofball Ross Ballers (and some good friends) end up at Midwest Regional Alumni tourney in Wilmington next year...if we end up going and you are free stop by...we're University of Iowa Hawkeye Alums.

[Patmaster]

Thanks guys. I will keep researching before going to the point of no return...

[Patmaster]

Decided I have no time to waste, did not want fusion or any implants. Found a doc who specialises in that and had surgery 48 h ago. Feel sore but better. No pain positions easy to find. It was minimally invasive so I need to be quiet for 6 weeks only. No guarantees that things will be good, let alone perfect. Still, I wanted a gradual approach, a second chance and an opportunity to get back to good quality of life without screws and metal parts in my spine. I'll keep you guys updated. Here is where I did it:

http://www.spinecenter.com

 

[Patmaster]

Two weeks post surgery. Did not move or exercise much. Can sit on a bike as long as I want, no pain. Walking is a different story. On the right side, where more work was done, there is still discomfort. No longer pain but discomfort. I'll report back in a month, hopefully with good news.

[Marco]

@Patmaster - What type of surgery did you have if it was not implants or fusion? I am 8 weeks post op from my fusion, and see the doc on Friday. Hopefully he will have good news on my recovery so far. My pain is gone, but still have some discomfort at the surgery site, but no nerve pain.

 

Good luck with your recovery. I hope it goes well!

[gregy]

@patmaster I watch the Doctors video. Looks interesting, was it as easy as the women's surgery? Local anesthesia only, walk out of the Dr office an hour later.

[Patmaster]

Not quite as simple. I was a borderline case, but a really complete stenosis at L4-5. It was my choice to opt for a removal of protruding disc parts and bony structures that could be removed. It was needed to work on both sides of the spine, so about 2 hours in total. It had to be total anaesthesia. Still, walked out the clinic the same day. Now, let's see how the recovery goes. I may very well need implants one day, but so far I did not want the ligament (ligamentum flavum) touched, since that holds the spine (while bothering the nerve at the same time. My hope is that I bought some time (and space) and that workout and lifestyle change may make further surgery unnecessary. I will not ski for the next few months and then we'll see. So far so good, but it is way too early to foresee the long term results. Will keep you guys posted. IMO, this is a very good solution for someone who has a less complex problem than I have. Removal of the bulging disc part is a piece of cake in this clinic.

[Patmaster]

Time for an update guys. No good news to report. 54 years old spine needs stabilisation. Walking is not a problem anymore, but that's about it. Spondylolisthesis grade 1. Cleaning up a bit does not cut it. Now the big question is what kind of stabilisation - COFLEX or screws & wires along with fusion. @Marco, how are you doing? Anyone else skiing after fusion? Anything more specific would be appreciated - I need to choose a procedure very soon so help please!

[Marco]

@Patmaster - Sorry to hear your procedure didn't solve the problem. As far as I understand, the only fix for spondy is fusion with hardware. I am 5 months post op, and although the nerve pain is completely gone, I am still sore at the point of fusion after strenuous activity. I was cleared a month ago to do things with no restrictions, so it felt good to get back in the gym and start to live a normal life again. I'll start skiing in another 5 weeks, but will probably take it easy for a good part of the summer.

 

My procedure was a lamintectomy/disectomy with instrumentation. Basically they removed the lamina to decompress the nerves, removed the disc, inserted a spacer between the vertabrea and filled the area with leftover bone from the laminectomy, supplemented by cadaver bone. Then installed 2 rods with screws to hold everything together until the fusion is complete.

 

The downside is that the fusion puts added stress on the joins above and below the fusion level. I have been diligent about my PT, and working on core strength to stabilize and strengthen the adjacent joints.

 

All in all, I am glad I had the procedure. If I didn't, my skiing days were over. Now I feel like I can have a life again. Last week, I even went snow skiing, and skied the steeps and bumps. It felt good to get active again.

 

As I mentioned before, one of the best spine surgeons in the US is in Colorado. Let me know if you want his contact information if you don't mind traveling for the procedure. Good luck!

[Patmaster]

Many thanks @Marco. You just gave me hope and brought me closer to the "right" decision. Please give me the contact of the doc and keep us all updated on your skiing progress!

[Marco]

@Patmaster - The surgical center is called Spine Colorado located in Durango, Colorado at the Mercy Medical Center. The surgeon you want is Dr. Jim Youssef. The phone number is 970-382-9500, or 1-800-524-982. They will want a copy of a recent MRI, and after they review it they will call you to discuss the next steps. Good luck and let us know how it goes!

[Patmaster]

@Marco how's it going man? I will undergo (most probably the same as you) surgery in June, and I'm wondering if you are skiing?

[Marco]

@Patmaster - My back is doing much better. It has been almost 7 Months since surgery, and although it doesn't feel completely normal yet, it doesn't hurt either. I almost put the boat in to start the season yesterday, but it was snowing so I waited. I'll probably start skiing next weekend. I'm going to take it easy and stay at -28 until I get a feel for things. Definitely don't wan't any OTF's this season!

 

Good luck with your upcoming procedure. I think you'll be glad you did it in the long run. Keep us posted.

[Roger]

I had two fusions in my cervical spine (C5,6-C6,7) in 1996, no hardware and they used bone from my hip for spacing. Cleared to do anything I had done before at 6 weeks. Returned to skiing without issue and still ski (I'll be 62 next month). Other than some loss of range of motion, particularly looking upwards, I have no issues.

[Marco]

@Roger -That's reassuring! Did you mean to say cleared for normal activity at 6 months? 6 weeks is awful fast for a fusion to mature.

[Roger]

I'll have to check on that. I know it wasn't 6 months though. I was back at work in 2 weeks, neck collar was taken off at 4 weeks.

[Patmaster]

@Marco, thanks. Do you feel a big change in the range of motion? Curious to know what I should expect, as you may imagine!

[Marco]

@Patmaster - It's noticeable but not a hindrance. I am actual a bit more limber than I was prior to surgery because I have gotten on a good stretching routine. My lower lats are still a bit tight, and when I am exerting, I can feel the extra strain on the joint just above the fusion. I'm working my core hard to try to minimize any additional wear on adjacent joints.

[Patmaster]

@Marco, I will be in California for the next 3 weeks, maybe I could call you over Skype or phone at some point. You have very valuable insight for me! sdp@online.be

[Marco]

@Patmaster, I would be happy to talk to you. I'll PM you my contact info.

[Marco]

Well, its been a little over 6 months post op from my spinal fusion, and I have gotten in my first few sets of the year. Other than not being in skiing shape, things are feeling pretty good. First set just free skied, the next 3 sets just kept it at -28. It feels so good to be on the water again, and feels great to be pain free (other than my sore muscles).

[ChuckD]

@Marcothis is a pretty old thread, but I’m hoping you may still be dialled in and can let me know how things are 9 years on? I’m 58 and have something called a pars defect at L5 which has created instability and spondiolisthesis at the L5/S1 level so I get pins & needles and pressure in my right foot which is getting worse and is aggravated by skiing. The fix for this is a fusion, but something I’m pretty cautious on given mixed results amongst the few people I know who have had one (incl my mother). You and others on this thread seem to have mostly fared well, but I wondered how things have been over a number of years post-op? 

[Buxrus]

@ChuckD,  so many questions:  MRI scan?   EMG of lumbar spine and right lower extremity?

weakness of lower extremity, difficult to stand/walk on toes or heels?   Atrophy of calf, glute or quads?  Lumbar xrays; lateral neutral, lateral flexion, lateral extension done weight bearing?  

Pars defect, bilateral or unilateral is pretty common.  If the L5 vertebra doesn’t translate forward or back more than 4 mm during the lateral flexion/ extension of the lumbar spine,  the segment is not considered unstable.   What grade is the spondylolisthesis, probably GRD I.   The nerve pain in the leg, (sciatic) can be caused by several factors: obvious disc pathology, stenosis of central canal, stenosis of lateral recess or at the IVF L5/S1.  However, another causation especially if skiing is the only thing that exacerbates it, could be increased inflammation at the disc site or the facet joint L5/S1.  

So back to questions:  what have you done thus far?  PT?  Reconditioning the spine, hips and LE?  Conservative treatment?  Anti inflammatory med?  Boost therapy, prednisone?  Injections at the site?   

Spondylolisthesis is a complication of this problem, not the primary.  Yes, if there is subsequent surgery, it will have to be dealt with especially if the nerve dysfunction is directly coming from L5/S1.  

Get multiple opinions, neurosurgeon preferably.   Do your due diligence, ask questions, work hard with strength training, flexibility training.   

 

Good luck.  

Pursuant to your first question, if no complications post surgery (if you have it) you should be fine to ski.  

[ChuckD]

@Buxrus thanks a mill for taking an interest in this. Perhaps I can get in touch with you directly, but I don’t have any movement limitations or weakness in walking on heels/toes. I do Pilates once a week and a short set of stretching and planking exercises every morning and evening. Usually the nerve nuisance settles after a few weeks, but it’s been more persistent this year. Anti-inflammatories help to some extent.  I haven’t had perineural injections yet and the last MRI is from April 2022. I can share the scan and report with you, but it’s a bilateral para defect with Grade 1 spondy and associated significant restriction of L5 nerve roots and “de-roofing” of the disc between L5 and S1. I have had two appointments with a neurosurgeon who specialises in spinal surgery. 

[EFW]

Be sure you get a couple opinions. ( without fail ) Make sure surgery is the --- LAST--- option!!! 
An Osteopath blew my disc at L5/S1. The neurosurgeon was of the same persuasion - surgery 
absolutely last option. All conservative treatment first. My entire left lower extremities were withering 
away. The neurological deficit was increasing --there were NO more options. 
  I had diverticulitus really bad one time. ( almost killed me due to misdiagnosis ) Two surgeons are standing
next to the bed telling me how they will resection my digestive tract put a colostomy bag on me and YOU WILL BE
FINE. They leave the room. The GI Dr. comes up who was in the back of the room listening comes up to me. 
" Mr.Weber, what do you do for a living?"  I responded "I'm a truckdriver" To which the Dr. asks " Do you like driving trucks?"  "Yes I do." I replied.   His response "They are surgeons- they like doing surgery. You do not need surgery."
I never forgot that - don't you either.  If you need, you need it  FWIW

[chrislandy]

13yrs on from a double microdiscectomy and I can say that, yes it helped the tingles, muscle weakness etc and I'm 1000% better than I was prior to surgery. BUT it is not a fix all, I still get tingles in the legs, I can ski still but nowhere near the same level as a couple of seasons preop.

 

Fitness is everything, I don't get time to do as much as I want to, but when I can and do get into the rhythm of daily gym, it needs to be at least an hour each day. Mainly concentrating on flexure and core strength.

[ChuckD]

Thanks very much guys, appreciate your additional perspectives. Clearly there is no silver bullet, one-way cure-all and I’ll also be keeping strength and fitness up and doing whatever I can to delay surgery. But at some point, given the instability of the structure at L5/S1, I’m likely to have to address it with surgery before I start having motor or other issues with the L5 nerve supply.

[S1Pitts]

@ChuckD

I postponed surgery for 15yrs trying to avoid "the knife". I did all the suggested PT, pilates, etc till I got to the point that nothing but surgery was left. For me it was a BIG MISTAKE TO WAIT.

Now 6yrs post surgery and continued training my back is a non issue and I ski better than I ever have. Waiting for so long I feel like I gave up a lot of years of great skiing potential.

[ChuckD]

@S1PittsMany thanks for that perspective - was your issue also instability where you needed fusion surgery or something a bit different? Great to hear the outcome was so good and encouraging for my own situation. I’m ok at the moment, but it feels that the time for the knife is drawing nearer as the problem flares up more frequently and easily these days. Happy skiing !

[S1Pitts]

@ChuckD I don't know what you would call it but I attached a copy of the x ray showing the compressed disc and 14mm missalignment of the vertibrae. I just call it messed up. It was no wonder my core felt so weak regardless of what I did to try and strengthen it.

I have hardware, screws and a kitchen sink tossed in for good measure. Surgeon reduced missalignment by approx 50% and then locked it all down.

"flares up more frequently and easily these days." To me this says it all. It does not get any easier to recover as we age.  

[ChuckD]

@S1PittsThanks for that, looks v similar to my problem, just one level down in my case. Technical term is spodiolisthesis, which means nerve roots to legs get compressed by vertebra that has slid forward and associated disc wear. Great to hear about the successful surgery.

[herseyj]

Looking for anyone willing to talk!  Little lost and scared with some of the pain I am having.  Would like to at least get back to 32 off but l would love to ski 35 or more.    I’m 10 weeks out from a 3 level fusion.  S1/L5, L5/L4 and L4/L3.  Putting the course in this spring was the straw that broke the back.  It’s been a rough year and took a bit to give into fusion.  Tried chiro, PT, injections and rest to no avail.   Figured I’d add some before and after pics in case anyone out there has similar.  Please pm if willing to talk or even email.  Wonder how I’ll be next year. Surgeries were August 8th and 10th.  Front and back cut into.  ION screws instead of rods which I think is a win.

[DonT]

Continuing this discussion for my wife.  Significant disk compression at L1-L2 and L2-L3.  We are taking a conservative approach with injections, decompression, core strength building and non-surgical options.  That all being said, 2 level fusion will probably be in the future.  For those of you that have had similar procedures, the questions become:

1.  While my wife is not into shortline (now)  - what was the overall outcome, time to return, and other outstanding issues?

2.  Would you follow the surgery path again?

3.  Any thoughts on immediate surgery, or putting it off?

I understand that most here are not able to offer qualified medical opinions, but rather we are looking for general experiences.  Quite often when spinal fusion is mentioned, all that is heard are the horror stories.

Thanks in Advance

[thager]

@6balls?

[herseyj]

17 hours ago, DonT said:

Continuing this discussion for my wife.  Significant disk compression at L1-L2 and L2-L3.  We are taking a conservative approach with injections, decompression, core strength building and non-surgical options.  That all being said, 2 level fusion will probably be in the future.  For those of you that have had similar procedures, the questions become:

1.  While my wife is not into shortline (now)  - what was the overall outcome, time to return, and other outstanding issues?

2.  Would you follow the surgery path again?

3.  Any thoughts on immediate surgery, or putting it off?

I understand that most here are not able to offer qualified medical opinions, but rather we are looking for general experiences.  Quite often when spinal fusion is mentioned, all that is heard are the horror stories.

Thanks in Advance

Sent you a PM with my information if you would like to talk.  I’m still hoping someone else will reach out to me as well.  It is the experience, timeline and I can tell you there are several black hole periods where having someone to talk to will be helpful.  Physical Therapy has been helpful now that it has started.  Positive input during the healing process is going to be important.