Lumbar Degenerative Disc Disease
When Josh was diagnosed with sponylolisthes, or vertebral slippage, after he sustained a back injury while playing rugby in high school, his doctor recommended spine surgery to stabilize the segment. At the time, Josh’s response was a resolute, “No way!”
“I’d heard that it would take me a year to heal, and that I wouldn’t be able to do any of the things I was into at the time – the rugby, and the biking, running, and snowboarding,” the now-31-year-old registered nurse recalls.
“At that age, the concept of having to give something up that I liked doing for a year was just something I couldn’t wrap my head around. I wasn’t willing to wait a year for anything.”
Josh continued to play rugby and other contact sports, as well as bike, run, and snowboard, into his college years, managing his pain with physical therapy and stretching exercises. Eventually, this strategy stopped working for him.
“After a couple of games, my lower back hurt so much I couldn’t get out of bed for a day and a half,” Josh says. Spine surgery, however, was still not an option, as far as he was concerned.
Instead, Josh decided it was time to reduce the time he spent playing contact sports and shifted his focus to lower-impact activities, including strength training, calisthenics, and “soft-style” martial arts practices that focused on flexibility and meditation.
“I did this several times a week, and I think it allowed me to keep going longer than I otherwise would have," says Josh. But I couldn’t let the snowboarding go – I just cut out the high-impact moves.”
Josh entered nursing school, and after graduation became an emergency room nurse. Two years into the job, he loved his work but also realized it was taking a toll on his lower back. “I was on my feet all the time, and my lower back pain was really getting a lot worse.”
Josh’s condition deteriorated further after he was hit by a car while riding his motorcycle. His femur – the large bone of the upper leg – was broken in the accident, and stabilized with a titanium rod.
“It took me a couple of years to recover from that,” he says. “I was able to get back to some of my activities – the stretching, meditation, and martial arts. But things were never quite right. I still had this pain in my lower back and sciatic area, and it got to where it felt like someone was holding a blowtorch to my hip.”
When Josh’s lower back pain and hip pain persisted even after the rod used to repair his leg was removed, he sought a second opinion from another doctor, who said “Let’s take a look at your back.”
A physical exam, along with diagnostic testing that included x-rays and magnetic resonance imaging (MRI), revealed the source of Josh’s problems.
The spondylolisthesis he was diagnosed with in high school had progressed to the point where the facet joints (the joints that connect adjacent vertebrae) of his L5/S1 vertebrae were completely disconnected, and the disc between the two vertebrae was damaged, as well.
“I had near complete loss of disc space and height, along with degenerative disc disease and slippage,” he says.
Josh was now ready to consider his spine surgery options.
“Back when I was first diagnosed in high school, I didn’t know anything about spine surgery other than what my doctor at the time was telling me," says Josh. But once I started working in healthcare and also started doing some research on my own, I found there were a lot of back problems that could be managed very successfully with spine surgery. And what I’d been doing just wasn’t working anymore”
Spondylolisthesis is a condition in which one vertebra slips forward on the adjacent vertebrae. In some people, the slippage is so slight they never know it’s there and experience no symptoms. In others, like Josh, the slippage is so severe the vertebrae almost or completely detach from each other, compressing the spinal cord or spinal nerves, with back pain and/or leg pain the most common symptoms.
Degenerative disc disease is part of the natural process of growing older, and essentially is a collective term for the conditions that may develop – a herniated disc, for example, or spinal stenosis – when intervertebral discs lose their flexibility, elasticity, and shock-absorbing characteristics.
Josh’s doctor said his disc slippage condition most likely developed when he was a child, and his disc degeneration exacerbated over the years by the contact sports he played through high school and college.
Josh was referred to Dr. Jeffrey Kleiner with Spinal Consultants in Aurora, CO, who recommended a surgical procedure called lumbar interbody 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, this graft material is obtained either from a donor (allograft) or from the patient's hip (autograft), which requires an additional surgical procedure that may be painful and not in some patients’ best interest. Josh’s spine surgeon, however, used Infuse® Bone Graft with a Medtronic titanium threaded interbody fusion device.
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.
Because Dr. Kleiner used Infuse Bone Graft/LT-Cage® Device, Josh was spared the additional bone harvest procedure for graft material.
Josh’s spine surgery was performed under general anesthesia, and he was able to leave the hospital after a 2-night stay. Over the next 3 months, his symptoms eased as his back started to heal. Within a month, Josh was able to walk 3 miles a day.
“Recovery from surgery takes some time and effort,” Josh admits. “What helped is that I was really religious about my restrictions, and redirected my energy not so much into functioning more, but functioning better.”
Each month, Josh had a follow-up appointment with Dr. Kleiner, who monitored the bone growth at Josh’s fusion site.
“I was told it takes at least 3 months to see any real bone growth, and I was actually kind of worried about that because in my mind, you need weight-bearing exercise for bone density, and I wasn’t able to do that during my recovery,” he says. “But after 3 months, there it was.”
Today, 9 months after his spinal surgery, Josh says he’s “pretty close to normal.” Because his nursing job was so physically demanding and he was forbidden to do any bending, lifting, or twisting during the recovery period immediately after his procedure, he went on medical leave for a couple of months.
Now he’s back at work and has resumed many of the physical activities that have always helped him stay in peak condition, both mentally and physically.
“I’m back to doing my martial arts – no hard stuff, mainly the stretching and meditation. You touch your toes, sink down, and relax, really feel your body and get in touch with your breathing. It’s a healthy thing to do for yourself and your back," Josh says.
“I also swim now, and go hiking and biking – I bike everywhere I possibly can. I’m also back on the snowboard, although I’m going to wait a few more months before I try any jumps.”
Because spinal fusion bonds two vertebrae together into a single unit, Josh initially was concerned he might lose some movement at the site. “In my case, this didn’t happen,” he says. “I can put my palms flat on the ground in front of me, so the flexibility is still there. And it just keeps getting better.”
To those for whom spine surgery has been deemed appropriate, but who also have the same reservations he did, Josh says that what helped him was to focus on “the big picture” of the life that he wanted to lead rather than on fears that most likely would not come to pass.
“Three months of my life versus a lifetime of decreased function and pain?” he says. “This was the way I was able to totally avoid that.”
For those who have decided to have spine surgery, he also has a few tips.
“As far as your restrictions go, follow them exactly; if anything, go above and beyond,” he says. “Don’t lift a gallon milk jug that’s only had a sip out of it. Buy half-gallons instead.
“And as for your activities, make a plan. Plan ahead for stuff you can use or things you can do to entertain yourself and still be active. You don’t need to lie around all day. You have to keep moving, but at the same time adhere religiously to your restrictions," Josh says.
“As for me, the meditative, tai-chi, yoga-type activities really helped me get in touch with my body and maintain my flexibility and conditioning. I found meditation to be one of the best ways to help maximize my recovery and future performance after my procedure.”
This story reflects one person's experience. Not every person will receive the same results. Talk to your doctor about your treatment options.