Appointment With the Orthopods

Yesterday we saw the orthopedic surgeon’s Physician’s Assistant, Chad Swaims.  He’s a very impressive medical professional.  The entire office was running late, but once it was our turn he made it clear we would get as much time as we needed. As you no doubt recall, Jim’s L5 vertebra is displaced and the disc is bulging.

Jim has pain down his leg, weakness in the leg as well as foot drop when he walks.  The pain is due to a pinched nerve.  It’s a double crush at L5.  The nerve from L4 that travels down to L5 is crushed by the displaced vertebra, and an L5 nerve is compressed by the bulging disk.  Leg weakness and foot drop are caused by the pinched nerves.  The nerves can not signal to the muscle fibers to contract.  Worse, the nerve receptors in the muscle fibers die when they are not stimulated.  Once they are dead, they’re dead; there is no regeneration.  No amount of exercise or physical therapy will overcome this.



As the discussion developed, Chad wondered if the vertebra was fixed and displaced, or if it was moving when Jim moves.  Two more x-rays were ordered, one with Jim standing and one bent over.  The films done at the hospital were static.  Moving is bad.  Jim’s disc is moving.

What does that mean?  It means that the relatively non-invasive microdiscectomy (removal of part of the disc) is off the table.  We’ve now progressed to requiring spinal fusion to fix this.  For the life of me, I don’t know why it’s mobile.  Either he didn’t say or I can’t remember.  It’s a lot to take in.

Anyway, this is spinal fusion.  The disc is removed completely.  They screw into the vertebrae to anchor plates that hold the vertebrae in the correct position.  Cadaver bone which has been rendered totally dead is inserted as a spacer between the verterbrae.  Over time, Jim’s bone cells will migrate in to the cadaver bone, displacing those cells.  After a year or year and a half, the two vertebrae and Jim’s bone cells will fuse.



Currently, Jim is scheduled for an epidural steroid injection on July 28, which seems like an eternity from now.  This will reduce the inflammation in the crushed nerve.  I’m hoping (unencumbered by facts and data) that inflammation reduction will allow the nerve to start firing again and will decrease any further receptor death in the leg muscle fibers.  Surgery will follow at least two weeks out from the epidural. We will see the PA after two weeks and Dr. Chris Howe six weeks after the procedure.  It’s looking like we’re going to be here for part of the rainy season again.

It’s a six week recovery.  During that period there will be no Bend, Lift or Twist.  There will be walking.  I doubt if there will be bicycling.

Interestingly enough, this entire progression started around November 2016, but we didn’t know what we were witnessing.  When Jim would ride more than 20 miles, the bottom of his big toe would go numb.  Over time, the numbness covered more of his left foot.  Damage was occurring then.  I tell you this, because:  who knew?  Spinal degeneration starts in 100% of the population at age 20.  Over the years the discs dessicate and shrink, the ligaments that run along the spine grow lax, the vertabrae respond by producing osteophytes to protect their edges.  Jim now has a small degree of scoliosis because he has degenerated more on the left than the right.  Hence all the pain is left legged.  Pay attention to your symptoms when they develop.  Toughing it out, aggressive stretching and all the positive thinking you can muster will not fix a significant problem.

Dr. Howe trained at Harborview Hospital in Seattle.  It’s a level one trauma center.  In 2006 Jim endoed on his road bike, and shoved his femur through his acetabulum.  He was fixed by Dr. Chip Routt.  Dr. Howe immediately recognized Dr. Routt’s handiwork in the x-rays they took.  Dr. Routt has since moved to Texas.  Apparently there was some sort of staff reorganization at Harborview, and Dr. Routt moved on in 2013.  I can not believe they let him go.  He has done more acetabular repairs than anyone on the planet in the history of time.  It’s all he did.  So- keep that in mind if calamity strikes in the Houston area.

So, that’s what’s happening with us.  I will close this out with a picture of a Bee Hummingbird.  They are the size of bees.  Cute cute cute.