Thursday, August 24, 2006

Neurosurgeon Says...

Today I went for my first visit with the neurosurgeon who will do my spinal cord stimulator surgery (my Physical Medicine and Rehab doc did the trial run of the SCS). We arrived at the office at 9:00 a.m. for a 9:30 a.m. appointment, and the doctor came in my exam room around 11:20 a.m. He was delayed due to emergency surgery. Once he entered the room, the frustrations from waiting disappeared. First he took my history and of note were:

#1-He believes I had cauda equina syndrome along with the herniated disc I had back in 1993 that started all this, based on my description of the symptoms as well as the timetable for surgery and recovery.

Definition of cauda equina syndrome:
Cauda equina syndrome (CES) occurs when the nerve roots of the cauda equina are compressed and disrupt motor and sensory function to the lower extremities and bladder. Patients with this syndrome are often admitted to the hospital as a medical emergency. CES can lead to incontinence and even permanent paralysis.

The collection of nerves at the end of the spinal cord is known as the cauda equina, due to its resemblance to a horse's tail. The spinal cord ends at the upper portion of the lumbar (lower back) spine. The individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar region. These nerves send and receive messages to and from the lower limbs and pelvic organs.

#2-He is concerned with my history of frequent infections and especially my recent abscess. Of special note are the recurrent proteus bacterial infections. He plans to give me stronger IV antibiotics and oral antibiotics because of this. He said the risk of infection is the biggest risk we will face with this SCS surgery.

#3-He said the glucose intolerance also makes me at a higher risk for infection.

#4-He plans to keep me overnight since I'm at a higher risk for complications. This will allow him to keep me on IV antibiotics longer. Also they can monitor my lungs because he said I might not breath as deeply due to the pain and this could cause my lungs to have a problem. Also, since I have restrictive lung disease, even though it is doing well now, he said the trauma of the surgery might cause it to flare. This is a relief because many SCS patients have the surgery as an OUTPATIENT!

And here is the good news:
He will be using glue to close my incisions rather than sutures, so I will get to take showers after two days rather than two weeks. How cool is that?! Not only will I feel clean, but the warm showers will feel good if I'm stiff and sore from the surgery. Also, I'm hoping this means I won't need to wear dressings as long as I would have had to do with stitches (if at all). If I can avoid tape, my skin will thank me.

I will have about a 2-3 inch incision around my bra-strap line-at the T-11 location-where they will do a laminotomy to get into the epidural area, and then they will install the electrical lead wire. Since they are doing a laminotomy, this will be much like back surgery. During a discectomy, they also do a laminotomy to gain access to the area.

A laminotomy means they remove a piece of the lamina (the bony part of the spine). Here is a graphic of a laminotomy used during a lumbar discectomy. My incision will be similar to this, only higher on the back, and the laminotomy will look like this-then they will proceed with the implantation of the spinal cord stimulator.

They will make a 3-4 inch incision in my right abdomen, below my waistband, where they will install the device that contains the battery. There will be a special tubing between the lead wire and the pocket for the battery, going from the front side to the middle of the back.

One last bit of news: the surgery has been rescheduled for September 12th. I was going to have it on September 14th but the doctor has a craniotomy scheduled for all day that day. Nice to know my doctor does such technical surgeries. He does quite a bit of these SCS surgeries. The worst part is that the surgery isn't until 3:00 p.m., or later if he gets delayed like today.

He is also ordering an AFO (ankle foot orthotic) for my left leg, to help with my foot drop (my foot sometimes drags and then I stumble). He said I can't afford to be jarred or to fall once I have the SCC in place. Any sudden movement could damage the equipment or dislocate the lead wire. I don't have to wear the AFO all the time, but he recommends it any time I will be up on my feet for long, or when I notice more muscle fatigue. He also recommended good support shoes, or even high top athletic shoes.

Photo of AFO:

Tha-tha-tha-that's all folks!

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