Having Low Back Surgery at 40: A Clinician’s Perspective

Aug 19

Well, a lot has certainly happened since I published my last blog about managing a severe disc herniation in late May!!

Thinking back to that time makes me shiver to remember the immense pain that I was in and the fact that I could barely walk.

I literally borrowed an old cane from my dad just to get around and it barely helped me. The only time I had relief was when I was lying on my left side and had very little gravity acting on me.

Twas a chapter of my life that I have no desire of repeating and I will never take my mobility for granted ever again! I remember looking at people walking down the street around me and being so jealous that they could function normally!

I was able to get a second cortisone shot in late May which took the edge off my pain for a week or two but when it started to wear off by week 2, it became very apparent that I was still in a bad shape and that surgery was my only option.

I was able to get another surgical consult with another Toronto surgeon but his wait times were going to be worse then the Fall date that I was looking at with Dr. Rampersaud at Toronto Western Hospital. When I made the decision that surgery was going to be inevitable I had started to look for someone who could locum for me when the time came.

I had been in contact with a very experienced Manual Physiotherapist in Toronto (Roxy Azoory) who was just returning to work post maternity leave. She was free to start at the beginning of July and because I had no idea when the surgery was going to happen, I offered her the position as I wasn’t sure how much I’d be physically able to work in the summer regardless.

I emailed Toronto Western that afternoon to check to see if there had been any surgical cancellations and by a sheer stroke of luck, someone had just canceled for the following Friday and I was offered the spot!! I cannot tell you the feeling of relief that instantly washed over me which was quickly followed by a feeling of anxiety of holy crap I’m about to have surgery on my spine!

I onboarded Roxy in a whirlwind and then on June 21, 2024 I had a microdiscectomy at Toronto Western.

I have truly never experienced the level of anxiety like I had the day before and day of the procedure. I was at the clinic until 10:30 pm the night before fussing about watering plants and trying to get a bunch of little things done as I knew I wouldn’t be able to come in for a while.

Let’s be real though, it was literally just to keep my mind occupied! Dr. Rampersaud was really great about explaining in detail what he was about to do and answering all the last minute questions I had and then before I knew it I was waking up in recovery.

I immediately asked my husband Mark how it went and he told me it had been successful. The surgeon had called him after the operation and explained that when they got there they had found that fragments of the end plate of the disc made of cartilage and bone had broken off and were sitting on my nerve! No wonder I could barely walk!!

To give you a quick anatomy lesson below, the disc is like a jelly filled donut with an outer layer called the annulus fibrosus and the jelly filling in the middle called the nucleus pulposus. The end plates sit on the top and bottom of the disc and are made of a layer of cartilage and a layer of porous bone (Lotz et al. 2013). They connect the disc to the vertebrae above and below and are how nutrition (blood flow, bone marrow) is passed between the disc and vertebrae within the spine.

They also play a role in protecting the vertebrae so therefore “end plates must balance conflicting requirements of being strong to prevent vertebral fracture and porous to facilitate transport between disk cells and vertebral capillaries.

As a result, end plates are particularly vulnerable to damage.” (Lotz et al. 2013).

The entire unit of disc/endplates create space between the vertebrae to allow ample space for the spinal nerves to exit the spine and act as shock absorbers as load is placed upon your spine.

In a typical herniation or at least how I’ve always thought of it, the outer layer of the donut (the annulus) develops a crack and the jelly filling seeps out and occupies the space where the spinal nerve exits the spine causing problems.

The jelly filling is typically reabsorbed by our body over time which is why many people are able to rehabilitate their disc herniations conservatively with physiotherapy and other allied health professions.

What I did not realize was that with degenerative changes to the spine, the end plate could eventually break into fragments that could eventually migrate into the space called the lateral recess where the spinal nerve exits!

According to Lotz et. al (2013), the innervated end plate damage can be a source of chronic low back pain, but the damage is poorly visualized with diagnostic imaging. So the surgeon had no idea that the end plate fragments were the primary source of my debilitating pain and why I couldn’t stand up straight until he operated.

I felt so validated when I found out that surgery was the only option that could’ve restored my function as

I had bone and cartilage sitting on my nerve! I had literally tried everything under the sun - physiotherapy, osteopathy, acupuncture, Gunn IMS/dry needling, exercise and NOTHING helped which felt so embarrassing considering what I do for a living!

During the procedure, they were able to remove the large cartilage fragment causing most of the problems and a number of other fragments of bone and cartilage within the disc that were loose and had the potential of causing more problems in the future.

From the moment I stood up after the operation the leg pain was gone - it was incredible!

The numbness and tingling were still present because a damaged nerve can take months to repair, but that has continued to improve week over week.

I am 7 weeks post op today and am so happy to report that I’m recovering quite well! I haven’t physically worked since my surgery in order to allow my body to heal and repair properly and plan to return to work in a part time capacity in another week.

I’ve been working on a bunch of administrative tasks like writing blogs for my SEO person to publish ;).

My primary rehabilitation orders for the first six weeks were to walk as much as I could without provoking symptoms and since my post operative appointment last week I’ve got the green light to dive into some progressive core, glute and stability work to rebuild my strength once again.

I am sooo unbelievably grateful to Dr. Rampersaud and his team at Toronto Western as they literally gave me back my function and ultimately my life. I have never understood lumbar disc degeneration and disc herniation so intricately and have never had my physical and mental resilience tested to this extent. This experience has undoubtedly made me a better clinician and someone who patients can ask first hand about what a lumbar surgery is like. To be clear, surgery is not a first line option in most cases of disc herniation. As physiotherapists it’s something that we actively try to prevent, but in some cases it’s very necessary as not everything can be fixed with allied health. You can bet that I’ve already seen my Toronto Physiotherapy colleague Michelle Lee for some clinical pilates and acupuncture and my osteopath to help work through the scar tissue and adhesions.

Physiotherapy and allied health is so important even after you’ve had a surgery to help with a full recovery! Thanks for letting me share my journey and I hope you found it interesting!!

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