If you're not into x-rays or thinking about surgery and stuff like that, you can just skip this one. Many people have had me promise to show them pictures of the artificial disc that was implanted in me three months ago once I got them, so - well - here you go. This is a pretty amazing and relatively new (in the USA anyhow) area of medicine.

The Kineflex artificial lumbar disc is a three-piece metal-on-metal mechanical replacement, which is used to treat chronic and severe lumbar pain due to degenerative disc disease. It's in FDA trials right now, which makes me a bit of a guinea pig. It's not the kind of surgery you decide to do without a lot of serious thought and only after trying every other option. It replaced my natural disc, and now my severe back and leg pain that I lived with 24 hours a day for years is practically gone - and as a bonus I am a little bit taller than I was before the surgery. As I've said here before, I have my life back thanks to the doctors and the people that built this little device.

How'd they get it in there? The made an 8-inch horizontal incision just below my belly button (yep, they approach the spine from the front), spread the bones apart, removed the disc that was damaged, and put this new one in place.

You can click each image to view them larger-sized. I've removed any sensitive personal information.

It's been seven weeks since I underwent surgery on my lower back up near Seattle, Washington. I was the recipient of a Kineflex lumbar artificial disc, a three-part, all-metal mechanical replacement for the torn, herniated and collapsed (degenerated) disc between my L5 and S1 vertebrae. That's the lowest one in your spine.

This surgery has truly given me my life back.

Before the procedure, I was always - and I quite literally mean always - in pain. Real pain, the kind that wears you down every minute of every day. The kind of chronic pain that people can't fully understand until they've lived with it themselves. It wears you down, chews you up, and eventually spits you out. "Normal" for me was a lot like the "normal" road noise is for someone who lives right next to a freeway: Spend your whole life around it and your brain tunes it out just to cope, but it's always there. Sure, louder noises still annoy you, but the mind has a way of coping with whatever you throw at it, at least as best it can. But that background pain still has an effect, progressively more so over time. When the sound is gone, it's almost deafening. And when the pain is gone, you finally realize just how bad it's been.

I feel ten times better than I've felt in more than ten years. Seriously.

Yeah, I am a guinea pig of sorts - the artificial disc I was fortunate enough to receive was provided to me as part of an FDA trial - not very many people have this hardware in their bodies. I did more than a year of careful and critical research on artificial disc surgery before I decided to take the leap. I considered bone fusion (which is the classic and most common treatment for my condition) and I tried every other treatment that was available to me - physical therapy, exercise, medicine, cortisone injections, minimally invasive procedures, you name it. When it came down to it, it was a choice between bone fusion or ADR (artificial disc replacement) procedure. the ADR device allows the joint to remain mobile instead of locking it up permanently, and I am only 38 years old (well for a few days anyhow), so staying mobile is  important to me. Because I had a 50/50 chance of receiving either a Charite or Kineflex artificial disc (they split the patients randomly, half and half), I also had to become confident in both technologies (the Charite is two metal plates with a plastic core, while the Kineflex is the same basic idea, but with a different design and a metal core). I can tell you that I was lucky and got the one I really wanted (the Kineflex), but either would have been okay with me.

Not everyone is the same, and surgery is rough stuff. The procedure is a serious one with potential side effects that one has to be ready to accept. Everyone's body is different and surgery is in large part an art, which means they all go slightly differently. Many people benefit from the new technology, while some are not so fortunate. That said, I am so grateful for my decision and to my doctors and the staff that have given me so much back. I did not fully realize how bad off I was until now, and still each day I keep feeling better. It will likely be many months before I can say I am healed and recovered, but I can see and believe that day's coming, which is something I had almost given up hope on before.

I write this from what used to be one of the most painful places in my life: An airliner seat at 37,000 feet. And guess what?

It doesn't hurt anymore.

Many of you who read this know that I had back surgery recently. The surgery was an Artificial Disc Replacement at the L5/S1 level, with a Kineflex artificial lumbar disc. It's been almost three weeks, and my current assignment from the doc is plenty of rest (and so I am at home almost all the time), combined with walking as much as I reasonably can, but without overdoing it. I'll soon be able to go into work part of the time for very light duty. Right now I am able to do some work from home, which is one of the things that helps to keep me sane day after day.

Progress milestones while healing - big and small - really stand out in a recovery like this. I was able today - for the first time - to walk the half mile trek to my mailbox and back. It's the longest single outdoor walk I have done so far. I live at the end of a long gravel driveway, up and down two steep hills. As I was climbing the first hill and neared the top, it dawned on me that I was not slowing any, and that it didn't hurt!! Wow! By the time I got back to the house, I was quite worn out (exhausted, really), but no worse for the wear physically. Progress! Not to mention it's a great psychological milestone. Before the surgery I would have been staggering, clumsy and in pain before I got a hundred yards into it. Three weeks ago I was re-learning muscle movement just to walk at all for the first few days.

So, slowly but shurly, getting better. I just have to make very, very sure I don't over-extend myself or bend the wrong ways (I am limited in certain motions for now), and I have to pace myself so I don't wear out. Unfortunately when I do wear out it happens quickly and I tend to crash from an energy standpoint. Other than that, I feel much better overall than I did before the surgery and, despite some surgical side effects that take time to work themselves out, I'm encouraged.

One of the things that has made this whole Artificial Disc Replacement surgery thing bearable is an online forum called the ADR Support Forum over at at ADRSupport.org. ADR is a newer technology in the United States, although it's been prevalent in Europe and other places for many years. There are lots of great people on the forum who have either gone though ADR surgery or who are looking into it and wanting to find out more, so it was a great resource for me pre-op and it still is after surgery. Highly recommended for reading and participation if anyone is considering an ADR procedure.

(This is not a techie post, but since there are many people out there asking how I am doing after surgery, I'll write about it here. It will also help me remember how things went and what happened when)

It's two days after my surgery, and I'm heading home this evening from the hospital, which I am looking forward to. This hospital is great (truly), but somehow the idea of having a fire in the fireplace and being in familiar surroundings is more appealing.

My body hurts, pretty bad. Like I got hit by a truck. but it's not the old pain, which is great. I can walk a short while (well, it's a lot like walking, but it's labored at best), and the physical therapist had me walk up and down a flight of training stairs. Who would have known it could be so much work? This is a lot like learning to walk all over again.

I was able to take a quick shower today (they do some fancy stuff with the incision when they close you up, and showering is actually a good thing to do once you're up to standing for that long). Thank goodness! The hot water helped relax some of my tense muscles.

Yesterday was hell. Starting with X-rays (which came out just fine), standing up was very painful - I had terrible muscle spasms in my lower back and legs, along with pain and nausea. Nothing like feeling nauseas and (forgive the graphical discussion) having to puke, which of course hurts like hell since your abdominal muscles contract hard each time. I'm glad that phase seems to be over with.

More than a few people have asked me what exactly they did to my back during this surgery. I've decided its not a big secret or anything, and that in fact it's really very interesting. First they removed the inter-vertebral disc in the lowest part of my lower back, at the L5/S1 space. Discs in your back are the softer tissues between the bony vertebrae that act as shock absorbers and allow your back to move in all directions. think of them as like a little pillow filled with squishy stuff (well, sort of). Mine was herniated (torn and pooching out into the space where the nerves run) and degenerated (loss of water and height, thinner than it used to be). In other words, pretty much all ragged and shot. The medical term for the thinning and drying out of the disc is "Degenerative Disc Disease." You body won't correct it on it's own - the physical damage is done and it usually just gets worse over time.

Once they removed the bad disc, they put in an artificial disc replacement implant - a spinal prosthesis, you could say. It's called a Kineflex lumbar artificial disc, and you can see a quick video of what it looks like and how it works here. The Kineflex device is a newer design, and I received it through a study program that is comparing the Kineflex disc to the Charite disc as part of a FDA clinical trial in the United States (email or call me if you want some details - contact info is in the right-side menu bar). I did a lot of research - on fusion options, artificial disc options, do-nothing options, individual surgeons, etc - before I decided to go this route. Artificial discs are - in the right patients - an alternative to fusion of the two bones. The ADR devices don't act like a shock absorber (neither does fusion, for that matter), but they do retain close to natural motion in the joint. As you might imagine, it's a fairly expensive procedure, and at least for now insurance companies in the United States are rarely paying for the procedure because it's too new for them (the first model to get FDA approval was the Charite and that was in the fall of 2004), and they instead prefer the fusion route. That's the way health care works.

And for those people looking here for technical posts - well, sorry. They'll be back soon enough.

Aches and pains and muscle spasms aside, I feel great. Today I had surgery and received a Kineflex lumbar artificial replacement disc. The doc says everything went perfectly. I'm in bed (and will be for a few days), but I took a few steps tonight.

I know it's completely sick that I'm online now, but they have free WiFi at the Hospital here in Everett. And if you're ever in need of a top-notch hospital with terrific staff, Evergreen Hospital Medical Center is freakin' great.

More on the implant device later sometime. I'm going to sleep.

If the knife doesn't kill me, the stress just might... On Wednesday at around 7am I'll be up in the Seattle area on a table in a surgical suite, and with any luck about an hour and a half (or so) later I'll be hallucinating and stuff in the recovery room as the proud and successful recipient of a artificial disc replacement at the L5/S1 joint in my lower back. I get to lay around in a hospital bed for a couple/few days, then can head home to lie around a whole lot more.

It's not quite Steve Austin style stuff, but the plan is to replace a collapsed, herniated and generally failed lumbar disc with a mechanical replacement. I'll be like a scaled-down version the bionic man. Not quite six million dollars worth of work (more like in the tens of thousands), but I am told they can rebuild me, they have the technology.

Truth be told, I'm just a bit scared. I've never been through surgery anywhere near this extensive before, and the decision to do this has been a long and tedious process involving a lot of risk and personal decisions. In the past I've had epidural injections of cortisone, lots of physical therapy, a minimally-invasive microdiscectomy surgical procedure, more physical therapy, medication, rest, exercise, you name it. But when a body part's shot, it's just shot.

Since then I decided - after meeting with a few highly regarded and experienced surgeons who told me I'm just delaying the inevitable fusion or artificial disc surgery - to stick it out for a while and see if I could just deal with the pain. The problem is, in order to do that I've had to keep myself from doing a lot of the things one needs to do in a normal life from day to day, as well as a lot of the things that help make life enjoyable, and that's no good.

So, here I am. Surgery could mean a great improvement in my quality of life. Of course it's not without risks (you really want someone operating on your spine?), and the past year has been mostly about deciding whether the risks of the procedure are worth the potential benefits and avoiding surgery. The pain has not improved much if at all, it always limits me, and at many times it's quite unbearable. Life's no good like this. So, it's time. My doctor is very experienced and I have lots of confidence in him. The facility is great. No more excuses.

As always seems to happen (Ask Murphy why, I sure there's a law about it), workplace and life situations, stresses and pressures are coming to a head right about the time I have to do this surgery, but I've decided that I really only get one life, and one body for that life. Jobs are something that can flex and be molded and true friends will wait, so while I'm wanting to get back to work and life as soon as it's realistic, I have to take care of this other stuff first, slow and steady as they say.

But I'm not just worried and scared. I'm also excited. The prospect of healing and being able to do many of the things I used to take for granted is truly something to look forward to - things like loading the trash cans into the truck to take to the dump, or walking the dog more than a quarter mile, or riding a bike or my motorcycle, or sitting in a chair for more than 15 minutes at a time, or even just being able to pick things up off the floor. 

That and not falling flat on my face in the hallway because I twist or step the wrong way, or because I drag my leg and pain shoots out my foot - That's just one of many things I am looking forward to no longer experiencing.

Anyhow, It'll be lighter than usual posting here probably for a little while 'til this is behind me. Maybe a little bit more to write over the next couple days, but some Wednesday I think I'll be rather out of it. Cross your fingers for me.