Patient Looks Forward to Getting Back on Track After Disk Surgery
This article was first published in Health View, June 2002.
If he wasn't running marathons, he was competing in mountain bike races or rock climbing or backpacking. For Joe Lewis, life was synonymous with physical activity and the more challenging the activity, the better.
Pictured (l-r): Joe Lewis and Dr. Bill Edwards of Pee Dee Orthopaedics
When a herniated disk made pain a part of everyday life, and even putting on his socks and shoes became a challenge, Lewis watched his lifestyle slipping away from him. "I didn't stay active. I couldn't stay active. My mountain bike sat on the rack," said the 52-year-old Darlington resident and wedding portrait photographer.
All that changed on April 24 when Lewis underwent a microlumbar discectomy at Carolinas Hospital System. Five weeks after the surgery to repair his herniated disk, he is virtually pain free and preparing for the rash of weddings that he photographs every summer. He's also relieved that a long history of back problems has finally been resolved.
Lewis didn't initially seek medical help when he first started experiencing difficulty with his back. When wrenching muscle spasms hit his lower back once or twice a month, he toughed it out like an athlete. "I'd walk bent over like an old man for two or three days, but time and ibuprofen would always remedy the situation," he said. Yet after a particularly grueling 18-mile training session on a mountain bike trail three years ago, the pain didn't go away with his standard remedy. He was referred to Dr. Bill Edwards, an orthopedic surgeon on staff at Carolinas Hospital System, whose treatment included a series of epidural steroid injections.
"Steroid injections are an effort to try to decrease the inflammation around the irritated nerves that occurs with a herniated disk," said Dr. Edwards. Each of the spine's disks has two components, an inner jell-like part called the nucleus and an outer fiber mesh part that holds the nucleus called the annulus. With a herniated disk, the annulus tears and the inner disk material pouches out through the weakened mesh. This irritates the nerves that travel through the area, causing pain that can run from the hip down the leg.
"I tell my patients that God gave us some extra room in there. The disk herniation uses up some of the extra room, but the nerves can get along fine if you can decrease some of the inflammation," Dr. Edwards added
Lewis improved considerably after the steroid injections, although he still continued to experience painful episodes on an intermittent basis. He also couldn't dive into recreational pursuits the way he wanted to do. Then came the day four months ago that he won't easily forget. One minute he was sitting on his riding lawn mower going across his yard; the next minute the vibration from the mower propelled him into agonizing pain. This time, the injections didn't touch the leg pain that now accompanied him on a daily basis. "It was so bad that I had to maneuver everything," said Lewis, recalling a particular incident in which it took him 45 minutes to figure out how to get out of bed.
Lewis asked Dr. Edwards about addressing his problem surgically. Dr. Edwards recalled their discussion. "Joe had a very high activity level from both a work standpoint and a recreational standpoint. This was a quality of life issue for him." Dr. Edwards was quick to note that the majority of patients with a herniated disk never require surgery. "Probably less than 20 percent of people continue to have incapacitating symptoms despite conservative care," he said. When a microlumbar discectomy is recommended, it usually follows four to six weeks of conservative treatment, which can include medication, physical therapy, limitation of activities and in some instances, epidural steroid injections.
Lewis chose to go ahead with the surgery. Performed under general anesthesia, the procedure involved a two and one-half-inch incision made in his spine. The nerves were gently retracted to the side, and the herniated disk material was exposed and removed with microscopic instruments. "We tell patients that we are not removing the entire disk, just the ruptured portion that no longer has a purpose," Dr. Edwards explained. During the 45-minute operation, any other loose pieces of disk material are also removed. "This minimizes the risk that another rupture will occur," said Dr. Edwards.
Dr. Edwards told Lewis that he could expect to be up walking the same day as the surgery. "Generally when they wake up in the Recovery Room their leg and buttocks pain is gone. They don't experience post-surgical pain because of the small incision and the absence of any dissection that weakens the spine," Dr. Edwards said. Lewis remembered, "Within an hour and a half after returning to my hospital room, I was up and walking the halls. I walked a little slowly the first time, but later that day, I went for another walk and it was just like I was going full tilt at the mall," Lewis said.
While he only required an overnight hospitalization, Lewis was quite impressed with the Carolinas Hospital System staff during his short stay. "They were absolutely so attentive to me. Anything I asked for, I had it. My experience couldn't have been better. They were so on top of everything," he said.
A day after he was discharged from the hospital, Lewis was in Columbia at a skateboarding demonstration with his two teenage sons. He was determined not to miss the event with pro skateboarders, which his sons had been looking forward to attending. "From the time I hit the ground after surgery, I have just done things at a little slower pace, but haven't missed out on much," he said.
While the excruciating pain down his leg has been eliminated, Lewis will admit that he does have some minor aches. "It feels like when you first go to football practice, and the next day you are sore. It's not pain, just that soreness," he said. Dr. Edwards added, "Once a disk ruptures it is never normal, and this operation will not make you normal. There may be the soreness and stiffness, yet the surgery is very effective in relieving the pain in the legs and buttocks." He also noted that while the chance of a disk rupturing again is low, it is not an impossibility, so he encourages his patients to keep their back and abdominal muscles in good shape. "I'm a great believer in therapy to strengthen those areas," Dr. Edwards said.
Lewis should be ready to start physical therapy in a couple of weeks. In the meantime, he's walking two-mile laps around the lake in his subdivision, and looking forward to getting his mountain bike off the rack and back on the trail. "Physical fitness has just always been a major part of my life," he said. Thankfully, pain is no longer a major part of his life as well.
by Diane J. Epperly, Contributing Writer
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