Spine Surgery - Don't Panic!! ACDF & Mobi-C Prosthetic

Spine Surgery

C6-7 ACDF and C5-6 Mobi-C Disc Replacement.

If, as I was, you are facing spinal surgery and are a bit stressed about it, there is no need to panic! I've just been through the experience and (for me) it was the best thing I could have done. I'm hoping that I may help to settle nerves and allay some fears by writing about my experience for you and answer some questions about the process and it's outcome. For me, it changed my life for the better, so here goes! Read on...

Introduction:

About 6 years ago I started work at a large college in Melbourne's Northern suburbs, working in the Maintenance Team. We carried out all sorts of maintenance tasks, setups for assemblies, fixing leaking taps, gardening, unblocking toilets (it's amazing what you find in toilets at a school!) and working alongside contractors like plumbers, glaziers, electricians, etc. I worked with a great team and loved the work, and learned a lot.

In December 2015, whilst erecting a large marquee, I was straining to lift the frame into place and lock it in position on one of the corner legs when I felt a sudden pain in my neck. I didn't think too much of it initially, but the pain increased during the afternoon to the point where at the end of the workday, I was in a bad way. I had pain in my neck and down my right arm and pins and needles in my right hand. After visiting my doctor, I was given time off and put on anti-inflammatory drugs and sent in for a CT Scan. The scan showed that I had bulged a disc in my neck.

After a month at home, I returned to work on light duties and had physiotherapy for a few months. This helped the injury heal to an extent, but it never felt quite right and I suffered from pain on occasions, mainly after carrying out physical tasks.

In October 2016 I re-injured my neck whilst we were setting up around 1000 chairs for a school assembly. The plastic chairs had to be stacked 15 high so they could fit in our storage area, which meant that when setting up or packing up, we had to reach up high to unstack or re-stack the chairs, and this repetitive action caused a repeat injury to my neck. More scans (CT & MRI) showed that I had again bulged a disc. This time I felt the pain down my left arm.

I again had time off work and ongoing physiotherapy to try to deal with the injury, along with anti-inflammatory and pain medication. This worked up to a point and allowed me to carry out some of my normal tasks, but as time went on, the symptoms became worse. Physiotherapy went from monthly to fortnightly, to weekly, until in December 2017 I was sent by our WorkCover Insurer to have an Independent Medical Examination, as they were wondering why I was still seeing the physiotherapist after all this time. In their understanding, I should be fixed and my case discharged.

The Independent Medical Examiner (IME) asked me a lot of questions and carried out reflex and strength tests. He was very surprised that I was still working full time considering the pain and discomfort I was suffering, but I explained that over the last couple of years I had changed my role at work to cater for my injury. Knowing that I could no longer carry out all the physical tasks required in my role with the maintenance team, I had applied for a role assisting in woodwork and engineering classes, where I could help teach without having to do too much physical labour.

The IME concluded that my original injury had not been resolved, and recommended that nerve root injections in the spine or surgical decompression may be required. Once his recommendations were received by the insurer, they approved me to visit a neurosurgeon to assess my options after having another MRI scan.

In March 2018 I went to see Mr. Greg Malham, a neurosurgeon at his offices in St Kilda Road, Melbourne. I found Greg down to earth and very easy to talk to, and he took the time to go through some options to fix my injury. He showed me the bulged disc on the scans and pointed out other damage that he found. He told me that due to the length of time I had the injury, and the fact that none of the previous treatment had worked, the only real option was surgery. Nerve root injections would only offer short-term relief (if they worked at all). He suggested that we do an ACDF (Anterior Cervical Discectomy and Fusion) at C6-7 which means cutting out the disc and inserting a spacer which will in time fuse the two vertebrae together, and a discectomy and disc replacement at C5-6 with a prosthetic disc, which will still allow me a good range of motion. He went into detail explaining the implants and the operating procedure so that I understood it fully and could make an informed decision.
I'll give a brief explanation of the surgery: The A in ACDF refers to Anterior, or from the front, so the surgeon makes an incision in the front of the neck (in my case low down, as he will be working on the discs in the lower part of my neck). The skin and muscle are separated and retracted, the esophagus and trachea are pushed aside, and the spine is accessed directly from the front, as the discs are located at the front of the spine. The damaged disc is cut out and the vertebral faces are cleaned up and a spacer is placed in the gap to replace the disc and provide the correct spacing between the vertebrae. The spacer is held in place with a couple of screws, and the bone will eventually grow into the spacer and fuse the vertebrae together.
The Mobi-C is fitted using a similar process, but instead of the vertebrae being fused together, the prosthetic sits in the disc space and provides similar function to the original disc. It locks in with small teeth on the metal surfaces, and the bone of the vertebrae will eventually grow onto the plates and lock them in place permanently.

Mobi-C Prosthetic Disc

Integrated Spacer with screws

I agreed to this, so Greg's office sent a letter to our WorkCover insurer. By this stage, my symptoms had worsened, and I was in a lot of pain. Everything I did at work (which by this stage also involved teaching engineering classes) caused aggravation of the symptoms to the point where I could not stand up straight and had to hold my neck and head forward with shoulders hunched to avoid massive shooting pain down my arm. I had uncontrolled muscle twitches in my biceps, triceps and pectoral and bad pins and needles in my hand and had lost strength in my left arm and hand. I started most days off with a headache, which became horrible by mid-morning which made it almost impossible to concentrate properly. I called on my doctor for some extra pain relief, anti-inflammatories, and muscle relaxants to help relieve the symptoms, and she gave me a certificate saying that I was not fit for work until after surgery.

The next couple of months were spent sitting at home doing as little as possible to allow my symptoms to settle with the help of more meds and try to be in good shape for surgery. At this point I was feeling pretty low, not knowing how long it would take to approve surgery, or even IF it would be approved, and doing Google searches on the subject brought up horror stories of people waiting years for surgery through WorkCover. I didn't really need to see this...

The insurers requested records from my doctor, letters from my physio, questionnaires from me, all sorts of paperwork, This didn't do much except stress me out even more whilst I waited. My doctor and physio explained that WorkCover checks out your medical history to make sure that you haven't hurt yourself at home on another occasion and tried to claim it as a work injury, which is completely fair. In my case, there were no other injuries, so I was clear.

Finally, after sending my case to the medical board at WorkCover to be reviewed again to ensure the proposed surgery was suitable for my injury (a necessity due to the major surgery involved) I had my request approved and called up Greg Malham's office to book the surgery. To my relief, I had a booking within two weeks, so the nervous but excited wait began!

Surgery!!

The two weeks went quickly, and I had decided to back off the meds I was taking for the pain a couple of weeks prior to the approval for surgery, as I had read that sometimes the pain meds given after surgery can be less effective if you have been taking meds for a long time. As my symptoms had backed off a little due to the fact that I had not been doing much for two months, this was bearable.

I had to get blood tests and an ECG done a couple of days before surgery, so trundled off and had these carried out. The surgery could not be performed until I was checked out and deemed fit enough, and all tests came back fine so I was right to go!

My wife accompanied me via taxi to the Epworth Hospital in Richmond on the morning of Friday, 29th of June and I signed in at reception. After a nervous wait, I was ushered into a small examination room where a lovely, friendly and bubbly young nurse took my blood pressure and asked me some pre-op medical questions. I must have given the correct answers because I was fitted with an ID band on each wrist, issued with my surgical clothes and ushered into another waiting room where a handful of other nervous people were sitting/standing/roaming around. In a change room I put on a nice open-backed gown (luckily I could keep my jocks on so I didn't scare anyone!) and some very sexy long white compression socks and little paper booties and a white robe that had sleeves about the right size for a 12-year-old (I guess to allow access to my arms if required for meds, etc.). I was second in line for surgery and had one lady ahead of me having similar surgery to mine.

Nice outfit Mister!

Finally, I was taken into the pre-op ward and asked to lay on the bed ready for surgery. I put on another fashionable piece of kit - a paper hat. The bed was warmed by a heater pumping warm air under the blankets, and as I normally run hot and like to wear shorts most of the year round, I was cooking underneath! The nurses explained that this was to warm me up before surgery, as the theatre is kept at a low temperature so that the theatre staff doesn't overheat underneath all the gowns and garb they must wear, and I would lose a bit of body heat during the operation which sounded logical to me.

Warming up with my trendy hat on...

I had a visit from the anesthetist and his nurse, my physician and my surgeon. At every step of the journey, I had someone explain where I was, where I was going and what was happening, which I found very reassuring as I was feeling a little anxious (this being my first major surgery). All of the hospital and surgical staff were fantastic and very professional, and I was asked numerous times if I had any questions.

Well, the time came, and I said goodbye to my wife and was wheeled into the bay before the doors of the theatre. I could see machines, lights, trolleys of tools and all manner of stuff inside the doors as the anesthetist and his nurse came out to prepare me. They inserted a cannula in the back of my left hand, and as we chatted they told me exactly what they were doing. I had a strip of sensors attached to my forehead so that my level of consciousness could be monitored, which made me a bit more relaxed, as I definitely did not want to wake up half way through! The anesthetist said "A bit of happiness coming your way now" and injected a large syringe of liquid into the cannula. I don't even remember going to sleep, We were chatting one minute, then I opened my eyes in the recovery room. I had missed all the interesting stuff!

It's done!!

Back from surgery, more out of it than usual.

I awoke in recovery drenched in sweat. My gown was wet, the bedding was wet, and I could feel a strange tingling, pulsing sensation in my lower legs. A nurse came to talk to me and explained that I was in recovery and they were making sure I was ok before sending me to my room in the Neurosurgery ward. I was pretty groggy, and vaguely remember the nurses mentioning they would change my gown and some of the sheets for fresh ones to replace the ones drenched in sweat. My calves were wrapped in some compression sleeves to reduce the risk of blood clots, and they were connected via hoses to a machine that alternately inflated and deflated them, explaining the strange feeling in my legs. I drifted off to sleep again and woke up in my room with my smiling wife saying hello. Greg (my surgeon) had called her to let her know that my surgery had gone really well and he was very happy with the results, even though he had found more damage in my neck than anticipated. The surgery took around two and a half hours. Once I had woken fully I was expecting to be in quite a lot of pain, but surprisingly I only felt some mild pain in my neck and across the back of my shoulders, which slowly disappeared and was almost gone in a few hours. I was given Targin (slow-release Oxycodone with some extras to counteract the side effects of standard Oxycodone) every 12 hours and Panadol Osteo slow release. Once the slight muscle soreness left my shoulders I honestly felt as though I hadn't really had anything done, apart from a slightly sore throat from the breathing tube and a dressing on my neck with a drain tube hanging out attached to a bag. The drain was removed on Sunday as it only collected about 25ml of blood over the two and a half days. This didn't hurt, I didn't even feel it. I asked the nurse if she would grab the end and run across the room to take the drain out, and she looked at me like I was crazy and told me not to be silly, and that they tie it to the door knob and slam the door! The incision site at the front of my neck wasn't even sore. The nursing staff were brilliant and always vigilant to my pain levels so they could offer extra pain relief if needed, and were a bit surprised when I said that I really had no pain at all.

Incision site with drain tube.

Drain removed.

One thing that I must mention is that the meds can cause some constipation, so I was also given a mild laxative to counteract this. They worked well, but also gave me plenty of  "Wind in the Willows", so apologies to any of the staff that wandered in and had to deal with any "fallout" during my stay!

I tried to sleep Friday night but was wide awake for the whole night. I think it may have been the drugs or anesthetic in my system. I hadn't been sleeping well before surgery due to the discomfort I was in and thought that because I was no longer in pain and pumped full of meds I would drift off and sleep like a log, but this was not to be. I kept myself occupied by watching TV and listening to podcasts on my phone and looking out the window at the city lights, then watched a lovely sunrise over the suburbs (my room was on the fourth floor). Nurses came in throughout the night and took my blood pressure and temperature at regular intervals, so staying awake probably helped them out a bit! 

Night lights through my window.

Sunrise.

By Saturday night after being awake since about 4.30am on Friday, I was feeling pretty tired, so slept on and off, but had some very strange and vivid dreams. I slept much better on Sunday night. I was offered sleeping tablets but decided against them once I felt tired.
The ward I was in at the Epworth was only about 18 months old and very modern. I had a touch-screen computer on an adjustable arm above my bed. With this, I could order my meals, watch pay TV and do all sorts of things. I reckon I need one at home, but I don't think my wife would appreciate me laying in bed all day ordering meals and watching TV... I was on a soft diet due to having tubes jammed down my noise hole (proper medical terminology) during the operation, so I had porridge, yogurt, jelly, soft boiled vegetables, grilled salmon, juice... there was an impressive range of tucker available! I was beginning to hope that I had to stay a bit longer than the anticipated 3 days.

Menu on the touchscreen. Nice!

Grilled salmon and veggies with aioli, jelly for dessert!

I watched quite a lot of youtube videos before my surgery so that I would know all about the procedure and what to expect during recovery. I love hospital shows, but my wife didn't sound too impressed when I mentioned that I should have got my surgery recorded so I could watch it later. It seems that some people experience quite a bit of pain post-op, and the lady that had similar surgery to mine in the next room was on a pain pump so she could self-administer pain meds when needed, but throughout the night and the following morning, I still had no pain. The nurses kept asking how my pain levels were, and I kept saying "None!"
I had a visit from the pain specialist who was ready to write me out a script but was very happy that I didn't need any extra meds.
My voice was a bit low and croaky for the first couple of days post-op and it felt like I had a bit of a lump in my throat, but nothing uncomfortable, and I handled the soft diet without issue.
Greg, my surgeon called in to see how I was doing on the Sunday after surgery. He told me that he had found more damage in my neck during surgery than what we had expected from my last MRI scan. There were 2 badly herniated discs and quite a bit of nerve damage (the discs had pushed against and compressed the nerves over a long period of time) and I'd also had some bone-to-bone contact due to bone spurs and disc collapse. This would explain the crunching noises I could hear when I turned my head from side to side! Greg was confident that the nerves would repair themselves over time and I should notice a gradual return of feeling and function in my arms. He took time to explain that I may have some pain in the Trapezius muscles above my shoulders for a while but this would pass. He has a fantastic bedside manner and explains everything thoroughly, and is just a really decent bloke. He treats patients and staff with kindness and courtesy, and from what I could tell is liked and respected by all.
Even straight after surgery, the difference in symptoms (or lack thereof) was amazing! The constant aching and pain down my left arm were gone. The range of motion in my neck had dramatically improved, and I could lay my head flat against the bed WITHOUT A PILLOW, whereas before I needed to keep my head propped up and neck forward to reduce the pain, and if I attempted to move my neck back to somewhere near straight I had a massive jolt of pain in my neck, through my shoulder and down my arm into my hand.
As I'm writing this, I'm one day shy of two weeks post-op, and the only symptoms (apart from a little muscle soreness as everything settles back into correct position) is some slight numbness in the index and middle fingers of both hands. If this improves, great! If it doesn't, I couldn't care less, as I'm in no pain!! The incision site is clean and healing well with no sores or scabs, and the cut is a little raised due to the dissolving stitches under the skin holding the muscle together. I can see already that by the time the stitches dissolve in a few weeks time, I'll be doing well to see a scar.

Healing well!

I skipped my pain meds on the Tuesday morning (4 days post-op) to see how my pain levels were faring (as directed by the pain specialist) and felt fine. I took a tablet Tuesday night to make sure I slept OK, then stopped all pain meds on Wednesday and haven't needed any since.
I'm truly amazed at the difference! I've gone from being in constant pain to pain-free in one easy step, and I feel like a different person!
To Mr. Greg Malham, you are an extremely talented and knowledgeable surgeon and a genuinely decent bloke, and I thank you for what you have done for me. The results you have delivered far outweighed my expectations!
To the staff at Greg's offices (Sharyn and Brooke), thank you for answering my numerous questions and emails and keeping me in the loop. You are friendly and professional and complement the rest of the team.
To Dr. Nigel Munday, thank you for very ably assisting Greg during my surgery, your skill and knowledge are very much appreciated!
To the theatre staff, anesthetist (Dr. Arthur Penberthy) and nurse, thank you for your professionalism and kind words pre-op which made me feel comfortable and in the best of hands. I really liked the "Happiness in a syringe", any chance I could get some to take home? *wink*
To the nursing staff (Laura, Tracey, Max, Bella, Lauren, Sean and all the others whose names I could not remember) on the Neurosurgery ward, thank you for being so kind, considerate and professional and looking after me so well! Please enjoy the goodies I dropped in ;-)
To the wonderful, friendly staff who brought me my meals every day and came to clean the room, thank you! It felt like I was having friends call in for a visit every time...
To Dr. Craig Barnett, thank you for the wonderful pre- and post-op care!
I can imagine some people being extremely stressed and anxious facing surgery such as this. I was a little anxious, but I think the excitement of the possibility of being "fixed" overcame a lot of the nerves. Even so, the staff at the Epworth Hospital in Richmond made the journey from admission to discharge and everything in between an easy, relaxing trip, and I would highly recommend them without reservation if you are facing something like this and have the option to chose your hospital and surgeon.
The Epworth should be very proud to have staff of this calibre on board.

Thanks again to all involved, you have changed my life!

You can find Greg and his team here: www.gregmalham.com.au

And the Epworth Hospital at Richmond here: Epworth Richmond

Here are photos of some of the wonderful team of people that helped to fix me up:

Mr. Greg Malham (Neurosurgeon)

Dr. Nigel Munday (Surgical Assistant).

Dr. Arthur Penberthy (Anaesthetist)

Dr. Craig Barnett (Pre- and Post-op care)