Lumbar Degenerative Disc Disease
As a primary care sports medicine specialist, Ann built a successful career by helping college athletes stay off the injured roster and on the playing field. If a Division I player under her care came in complaining of severe back pain and leg numbness, she'd bring all of her resources to bear to quickly pinpoint the problem and prescribe the proper treatment, even if it meant sidelining a star player.
But when Ann – a dedicated athlete in her own right, with 25 marathons under her belt – found herself at the mercy of these symptoms, she knew her spine was the culprit but continued to work and run through her discomfort. "Back pain had always been a part of my life," she says.
"It turns out I have a congenital condition in my lower spine, so the pain had always been there," she explains. "But even though I'm in the medical profession, I just didn't pursue it, in terms of diagnosis. My pain threshold is extremely high and as much as I run, well, everything else hurt anyway, so I thought it was just part of life."
Ann continued to dismiss the persistent ache in her lower back until it started to interfere with her running ability.
"Eventually, the pain started getting worse when I ran downhill," she says. "I still pretty much ignored it. Then my leg started going numb and I developed a motor problem called 'foot drop.' That's when I finally decided to get it checked out."
After consulting with several neurosurgeons and orthopedic surgeons, Ann found she had spondylolisthesis, a condition – congenital, in her case – where one vertebra slips over the other. She also was diagnosed with degenerative disc disease, spinal stenosis, and foraminal stenosis, all of which may result in back pain, leg numbness, and loss of mobility.
For several years, Ann chose to work with a physical therapist instead of opting for surgery, as the surgeons who'd examined her had advised. A self-described "reluctant patient," she didn't want to deal with the work and training downtime that spine surgery might require.
"I stuck with my physical therapist because I didn't want to take the time out," Ann admits. "I continued to run, and also started a heavy program of abdominal, core-strengthening exercises to try and give my back some respite. I also took NSAIDS (nonsteroidal anti-inflammatory drugs) faithfully, along with glucosamine.
"That, and incantations, prayer, voodoo – anything to avoid spine surgery. I'd always heard you didn't want to have spine surgery until you'd run your chassis to the ground and exhausted all your other options."
Eventually, her symptoms became so debilitating that it became difficult for her to do her job or maintain any semblance of a normal training schedule.
"We have 21 Division I sports teams that we take care of, and I'm frequently standing on the sidelines," she explains. "When my back would hurt, I'd bend over to make it feel better. It's really hard to squat on the sidelines at a football game and then run out on the field to take care of an athlete. Or all of a sudden there's a receiver followed by a cornerback heading right for you. Crawling away just isn't a good strategy."
A "friendly intervention" by some concerned running buddies also helped Ann reconsider her stance against spinal surgery. "My running partners really got tired of the slapping gait of my foot drop. They're not sports doctors, and even they knew something was really wrong. When the problem's become so obvious that everyone's urging you to get it taken care of, it's time to bite the bullet and finally do something."
Ann's first step was to find a spine surgeon she could be confident in and comfortable with.
"Because I'm in the business, I know there are several important things to consider when choosing a surgeon," she says. "You want someone who can identify the right operation for the right person, and at the right time. And they also have to have technical expertise."
Her search ended with Dr. Kevin Foley with the Semmes – Murphy Clinic in Memphis, TN, who recommended a lumbar spinal fusion. Spinal fusion involves removing the degenerated disc material and fusing – or joining together – the vertebrae on either side of the disc space. This requires a bone graft, or small piece of bone material, to help promote bone growth at the fusion site.
Traditionally, surgeons obtain this graft material either from a donor (allograft) or from the patient's hip (autograft), which requires an additional surgical procedure. Ann's surgeon, however, performed the procedure using Infuse® Bone Graft with a lumbar cage.
The active ingredient in Infuse Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2), a manufactured version of a natural protein already present in the body that stimulates bone formation.
By using Infuse Bone Graft/LT-Cage® Device, Dr. Foley was able to achieve the goals of spinal fusion, but without the additional bone harvest procedure.
Following her surgery, Ann slept through the night as her anesthesia wore off. "The next morning, I woke up almost without any pain at all," she says. "Maybe some operative pain, but not that deep, deep pain in my lower back that I had before."
Ann was able to leave the hospital 3 days after surgery, and was able to manage her post-op discomfort with regular-strength pain relievers. Within a week, she was able to return home to Arizona.
Ann admits she didn't fully realize how bad she was feeling until the pain was gone.
"It affects you in ways you're not aware of at the time. Before surgery, I'd lost 15 pounds because I wasn't eating or sleeping enough," she says. "Since then, I've gained back the weight I'd lost, and people say they can tell I feel good – I no longer have that 'chronic pain grimace' anymore. And I can move normally; before that, I just kind of hobbled around, holding my back."
Ann says her only problem now is bearing in mind that her back is "better, not bionic."
"Once you have a spinal fusion, you need to be mindful that the areas above and below the fusion may be more vulnerable," she explains. "So I do have to rein myself in and be more careful than perhaps I would have in the past.
"But I'm very glad I had the surgery. I feel fine, and I'm back to doing the things I love, but being smart about it. I've done 25 marathons, and I'm thinking that's enough. As long as I can run and cycle for daily relaxation, I'm OK. Once a week, I do a 10-mile run, and that's fine for keeping my head straight. And the cycling is really good for my lower back, and easier on the feet."
This story reflects one person's experience. Not every person will receive the same results. Talk to your doctor about your treatment options.