Back operation / disc replacement?

The Hedgehog

After several years of increasing lower back and leg pain , I took the decision to have my S5/L1 disc completely replaced by way of an operation called TDR (total disc replacement). It got to the point that I'd have to take strong pain killers to ride my bike for 40 miles or so, but would be in agony for days afterwards.

The operation involved removing my 'old' disc (which had been worn thin) via the front (stomach) and having an artificial disc inserted. This was very recently. I haven't yet been back on the bike and probably won't yet for a couple of months until I'm given the all clear.

I'd like to hear from anyone who has had this done, or maybe had a spinal fusion, or knows of anyone who has had this done. How is it riding a bike or doing other routine activities?

andy_wrx

I had L5/S1 replaced at end of May 2006.

Apologies if this is something of an essay, but I hope it's useful : I know how I felt immediately post-op, worried if it was the right thing to have done, rather committed and concerned about the consequences.

My back went in December 2004, aged 41. Ruptured disc L5/S1.
I went from running marathons and cycling centuries to not being able to run at all, restricted mobility, constant referred pain down my right leg to the ankle and the inability to sit in a car for more than 20 minutes without pain that got progressively worse the longer I was in the car - I was literally screaming one day when caught in a traffic jam and one plane journey was 6 hours of hell.
I could still cycle, that position didn't seem to bother it anything like as much as sitting, but I'd had to cut-down distance and speed.

I had the ProDisc artificial disc implanted - my surgeon said he wouldn't use the Charite replacement disc, as he considered it didn't have a high enough success rate.
The problem though was that whilst through work I had BUPA, BUPA would not cover the ProDisc, although they would cover Charite (AXA, PPP, etc would do both...), so my surgeon had to put me on his NHS waiting list for the op.
And whilst I saw the same surgeon and am sure the quality of the operating room staff etc was top-notch on the NHS, the follow-up was not : I was discharged with one spare dressing and a first appointment with a physio 4 weeks after the op !
So I got back on the physio program with BUPA a week after the op, although the physios said I should have seen them sooner...
- so my first tip is, if you're not seeing a physio, a physio who is used to disc op rehab, try to get there asap because they reckon just after the op is the critical time where you can regain, or not regain, so much.

I was told **something like**
- week 1, limited time in a sitting position in a good supportive chair, short walks
- week 2, longer sitting periods, longer walks now maybe upto a mile (Jeez - obviously short in week 1 meant short !)
- week 3, longer again
- week 4, gentle cycling can start
- week 6, driving and back to work
- 3 months, running

I pushed this.
I was doing 1 & 2 mile walks in week 1, up to 4 miles in week 2 and then found I'd done too much : didn't collapse or anything, but was overcome with weakness & dizzyness and had to sit on a wall before walking back very gingerly and slowly.
So I backed-off a bit and then started upping it a bit more carefully.

I'm now not sure if this was the back op or maybe after-effects of anaesthetic, but I definietly felt poor after the op but over the next few weeks this improved.
It was Summer for me, so being off work and able to go out for walks in the sunshine was a major tonic.

My back felt sore, weak, strange, even a bit scary. I had a rather more lower back pain than I was used to at this stage, but far less of the referred-down-the-leg-to-the-ankle stuff. Any stumble or jolt to my back was a bit scary but nothing nasty actually happened. I was also worried about bursting-open my stomach wound (maybe 2-inches or so, vertical, between pubes and navel).

I was seeing the physio a couple of times a week and doing lots of strengthening and mobilising stuff, basically very happy to be able to raise my right leg straight for the first time in several years.
The physios were trying to reign me in, telling me to take it easy and not overdo it, stick to the schedule, but they admitted that I wasn't the first previously fit&active individual they'd had who they'd had to reign back as soon as they'd had the op.

After 4 weeks I got back on the bike on the rollers for a couple of miles. I figured that if anything happened, I could just stop, wouldn't have to walk back home.
No issues, so upped it to 5 miles or so and then out on the road.
Even though I live in rural Cheshire with little traffic, I was scared absolutely silly of coming off the bike by going out on the road on gravel or being clipped by a car, was very nervous of jolting over potholes, but everything was OK and I was up to 20miles by week 5.

I was just down to ibuprofen now and after 6 weeks I was cleared to drive and return to work - office based, not a heavy job : given strict instructions about sitting properly and not slouching, for no more than 30 minutes without getting-up and moving around, etc.
This went OK although I was pretty tired initially. My company were very supportive and let me leave a bit early for the first couple of weeks.

I managed a century 3 months after the op and started back to easy running, then after 4 months we went walking in Scotland.
Since then I've just carried-on stepping it up and now have 'a normal life'.

I had been told at the time of the op that it would take 2 years for my back to be at it's best - it would keep improving for 2 years, then what I had after 2 years is what I'd end up with.
It didn't feel like it, but they were right. 2 years is a long time, the changes and improvements were so slow and subtle that I didn't really notice them at the time.
But I keep a training log anyway, so I've filled it in with what exercise, physio, stretching, etc. I've done and when pain or discomfort stopped me - it's clear how much the improvement has been, and how it was so slow and gradual.

I still have referred leg pain, probably more than 50% of the time - but it's now mostly more of a background irritation and I'm only really aware of it when it's bad enough for me to notice, if that makes sense !
It causes me to adjust my position, get up and move about. It can be a problem if there's a lot of travelling, or in strange chairs, but it's manageable.
I take the occasional ibuprofen, but it's when occasionally necessary not all the time - a Transatlantic plane journey was fine with a few ibu's.

I used to do a lot of stretching anyway, but have found I need particularly need to stretch my sciatic nerve and hamstrings. I ought to stretch daily, but don't. I did attend a pilates class for a while and found that useful, I now do it on my own at home.

Running started-out difficult, got better, is now OK. It does irritate my back and I need to do stretching or cycling to put it right again afterwards.
Consequently I'm not back to where I was, but my wife runs too and we have lots of friends in the running club, so it was important to me to get back into it.
I don't think I'll ever run a marathon again but I did a favourite Half a year ago and then did it again last weekend only a couple of minutes off my pre-back course PB time from 4 years ago.

Cycling seems to help. I reckon it loosens something, by rhythmically massaging/stretching something. I try to cycle every 3 days or so max, even if it's just half an hour on the rollers, although getting out in the fresh air is better for me mentally I think.
Sometimes I'll not get out on the bike for a week and by Friday my back is really nagging away at me, I'll go out on the bike on Saturday and it'll be a twinge down the leg with each pedal stroke, but after 20 minutes it'll have eased and I'm OK again.

Doing less running, I've switched-over to more serious cycling.
I did 4 sportives in 2007 and 2008, had a week in Provence including an ascent of Ventoux - I'm currently getting my velodrome accreditation and doing Fred Whitton in May.
My back does bother me after a sportive - I'll be in pain for the rest of the day and definitely on the ibu's, but they are pretty tough and I'm not sure what state I'd have been in after one 'pre back'...

So do I regret the disc op ?
Simple answer is No, although there is a nagging worry that these things are not long-term proven and I don't know where I'll be with it in 30 years.
But I went from being a fit&active person to being a not-at-all-active person in a lot of pain and discomfort, prevented from doing all sorts of things, and I found that very difficult to cope with.
I wouldn't recommend a disc op to anyone, I think it's a seriously major thing to have done, and it's irreversible : my surgeon said that all sorts of therapies like chiropractic, accupuncture, painkillers, steroid injections, pilates, etc may help and if they do great, if they don't then they do no long-term damage, but a disc op, be it a replacement, fusion, or whatever is risky and irreversible.
So it should be done as a last resort, if someone has tried everything else.
But for me, I'm glad I had it done. It's not got me back 100% to where I was 'pre back', but I'm hugely improved and it's got me back to somewhere I'm a lot happier to be

I hope this helps.
Good luck with yours.

The Hedgehog

This is very helpful - thankyou fo taking so much time to respond. The emphasis you place on exercising has hit home & I will make a real effort to do this. Its also good to hear in many respects that it may be up to 2 years for my back to finally settle down. That will be comforting should I have a few set backs in the following weeks which may question my decision to go through with this. Thank again.

andy_wrx

No worries.
I responded because I know how worried I was about what was going to happen, whether I made the right choice, etc
Someone at work found out I was going to have the op and told me they had a friend who'd had it a few months before, so I was able to phone them and ask questions and so on, which I found very helpful to me.
Feel free to PM me on here or CycleChat if you need to ask anything else.

The Hedgehog

cheers - thanks very much