My experience with Dr. Schuler at Virginia Spine Institute was much different than anywhere else. The work-up of my spine problems was by far superior to any other institution that I had visited. Dr. Schuler actually examined my back. It was unfathomable to me that other surgeons had recommended surgery and had not even examined my back. Especially my back, since it provided a lot of clues as to what was going on. As primarily a pediatric provider (which is very hands on) for 18 years, I had a difficult time understanding how surgical recommendations could be done with so little clinical data. I finally found a spine surgeon that I could trust.
My workup at the Virginia Spine Institute was not easy, but I understood the importance of the procedures and necessity of them to correctly identify the disabling pain generators. Over the next two months it was clear that conservative treatment was not improving or even stabilizing my condition. I was experiencing a domino effect. I went from being a very fit, strong, 52.5 year old woman to someone who could barely make it through a short grocery store trip in a matter of about 8 months.
I was very scared. I did not want to have my spine fused and I especially did not want posterior instrumentation. I have little soft tissue coverage on my back and at the time I had even less than usual. However, because my walking endurance and activities were so limited, I felt like life was passing me by. After discussions of possible surgical options, Dr. Schuler suggested a double anterior lumbar interbody fusion (ALIF). He felt that I had an excellent chance of having my unstable, misaligned lumbar spine fixed with only an anterior surgery. If I did need posterior decompression, it could wait until after the bone fused, that way I could still get away without posterior screws. This was a plan that I could accept.
On June 8, 2015 I had my double ALIF. All went well with the surgery. I was realigned, stabilized and was up walking with a walker the evening of the surgery. I was walking on my own the next day. On post-op day 3, I was discharged from the hospital with no bending, lifting or twisting restrictions for three months. My main pain medication was extra strength Tylenol and usually a single 5 mg dose of Oxycodone. My walking endurance improved within days of surgery. By my two week post-surgical visit, I was walking 4 miles a day. By 2.5 weeks I was decreasing the amount of pain medication that I was on. During post op week 3, I even went on an overnight trip to Ocean City, MD. I was doing great. On July 7, 2015 I started aquatic therapy.
Exactly one month post op I learned everything I ever wanted to know about the SI joint. While making dinner one evening, I was startled and twisted abruptly to the right. I felt a lightning strike pain shoot down my right leg. It felt as if my right pelvic bone rotated and clipped a nerve and then got stuck. It did. Over the next several days, I subsequently irritated the nerves (L5 and S1) when turning and stepping over objects. I was miserable. The Physician Assistant recommended seeing the massage therapist, which definitely helped. After a couple weeks the foot pain and tight muscles around the right hip improved, but then stagnated. The area around the right hip repeatedly became tight. At two months post op I started on land Physical therapy at Virginia Therapy and Fitness Center (VTFC). Much of that time was spent trying to realign my SI joint with stretching, massage and muscle energy techniques. I was learning how to get the SI joint into a better position, but keeping it there proved challenging. At my three month post-op I could sense that I should have been doing better than I was. Since I was well on my way to being fully fused and my bending lifting and twisting restrictions were lifted, I had more techniques available to me in Physical therapy. None the less, the right extremity nerve pain persisted.
My 6 month post-op appointment was supposed to be in December. I rescheduled my follow-up appointment for a month earlier. I had the feeling that Dr. Schuler was not surprised to see me back a month earlier than originally scheduled. After getting up to date with my latest signs and symptoms, Dr. Schuler had me see the pain management specialist, Dr. Bharara at VSI. December was the start of my next major work-up. I had three visits with Dr. Bharara in December and a 4th in January. Early in January, I felt literally uncentered. I saw Dr. Schuler five more times. My work up included two new MRIs done in January. By the end of January I was having additional disconcerting symptoms of nerve compression. Finally a CT scan the week before my second surgery completed the work up. By the time I came into the hospital for my February 17th posterior decompression, I felt prepared for anything, but dreaded the thought of posterior screws in my lumbar spine. I especially wanted to avoid at all costs fusion of my SI joints. I knew without a doubt that this surgery was not something that could be put off any longer. My EMG studies showed acute chronic denervation of three nerves back in December and I was clearly getting worse. I wondered, could I really be fixed without screws?
When I woke up out of surgery I felt pretty good. When I got to my hospital bed and was able to get out of bed unassisted, it was clear to me that I still did not have any screws in my back. I did not feel any decreased range of motion.
I restarted massage and physical therapy at VTFC the very next week. Sitting was now much more comfortable. Soon, my low back felt sturdy and I felt like I was in perfect alignment once again. I can easily squat and put my shoes on. The nerve pain in my legs and feet continues to decrease and my sacral iliac joint has stabilized. At three weeks post op, I was back to work and soon after that my SI joint was feeling normal, something I had not felt in almost 1.5 years.
It is frightening to think where I would be if I hadn’t pursued treatment by Dr. Schuler and the rest of the team at Virginia Spine Institute. Dr. Schuler takes on the difficult cases that other surgeons would rather avoid. He certainly did not need me as a patient, but he did see someone in need of his expertise. He is not only an exceptionally talented and versatile spinal surgeon, but also a physician that really listens to his patients. Through thick and thin, he maintains his enthusiasm for his innovative work and dedication to successfully treat his patients. He is the art and heart of medicine. I feel incredibly fortunate to have Dr. Schuler as my spine surgeon.
When it is necessary for me to have my cervical spine decompressed, a problem that started with an injury in 2000, but had been clinically stable for about 14 years, I know that I have the best spine surgeon in the Mid-Atlantic region to do the job!
To read "The Core and More" in it's entirety, please click here.