SURGERY DETAILS
So—tomorrow’s the big day. Surgery is at 8 AM and they say it’ll last between six and eight hours. I’ll be in the ICU tomorrow night (which'll be a ball, I'm sure), but I should be back to my regular room by Tuesday. (The regular room, by the way, is pretty nice—flat screen TV, DVD player, internet access… Not bad at all for hospital digs.)
And now, here’s what they’re doing (for those of you interested in the nitty-gritty of it all). Check out this nifty diagram of the cervical spine, (compliments of YourSurgery.com):
First of all, they’ll go in from my back to get at it, and then they’re going to do several things: A C6 and C7 laminectomy, a C8 foraminotomy, and they’ll remove as much tumor as they safely can from the C7 and C8 nerve roots.
Lami-what? you're asking. Forama-huh?...
The Laminectomy
The lamina are the plates of bone in your spine which sort of form a roof over your spinal canal. Above the lamina is the spinous process (the bumpy outgrowth of bone to which muscles and ligaments attach).
In a laminectomy, both the lamina and the spinous process are removed in an attempt to decompress the spinal cord. In the diagram above you can see these. The area inside the red box will be removed, but only on two vertebrae (C6 and C7). They say this doesn't cause significant weakening of the spine, really, and I probably won't even have to wear a neck brace. Which is nice.
"Do you put that back on?" I asked when they told me about this, "The bumpy thing? Do you put that back on?"
No. They don't put it back on. But they say that I might not even notice a difference at all.
The Foraminotomy
The neural foramina (or neuroforamen) are the holes between the vertebrae that allow the nerve roots to exit the spine (see inside the red box above)... My tumors have grown to the point that they've completely obstructed the neural foramina in C5, C6, C7, and C8.
In a foraminotomy, pieces of bone are cut away to enlarge the foramina and allow the nerve roots more room. The doctors are performing a foraminotomy only on the foramina of my C8 nerve root, which is located between the C7 and T1 vertebrae.
This is sorta funny: I keep calling it a "foramiTONOMY" rather than a "foramiNOTOMY." I know the correct terminology, but I keep doing it. Today I decided that it might be because here I am, Mr. Fiercely Independent, on the verge of weakness and pain and who-knows-what-else (which is to say getting ready to be very dependent on others for even the simplest things), and I am subconsciously making the procedure less about cutting away obstructions in nerve pathways and more about cutting away my independence, my autonomy: A "foram-AUTONOMY." (Ha.)
On top of all this bone-cutting, they'll also be doing their best to remove chunks of tumors, focusing on the tumor that is most significantly compressing the spinal cord. As you might already know, NF tumors grow in and around nerves (like marble cake, I was once told) and so it's not as simple as going in and cutting a single mass out. The doctor will be taking a little here, a little there, all the while exercising a great deal of caution so as not to harm the nerve roots themselves. There will be also neurophysiologists in on the surgery monitoring nerve conduction and motor pathways, which essentially means that they'll be keeping track of how my nerves are working as the surgery goes on.
Post-op information, like so many others things involving NF, is a little cloudy. I might be weak and numb and tingly, I might not. I might loose a little bit of sensation in my pinky and ring fingers, I might not. Rehab therapy is probably going to be necessary, but we're not sure how much or where it will focus.... Oh, well. I'm sorta used to the ambiguity. Regardless, I'll certainly keep you up-to-date on what they have me doing.
Finally, I want to send out a big, fat THANK YOU to those of you who've sent letters and cards and e-mails and gifts. And, of course, to everyone for all the good vibes-prayers-healing energy-etc. I really appreciate it. There's nothing like having surgery to realize how many incredible friends you have. Many, many thanks to you all.
Next: Time to meet Karl.
And now, here’s what they’re doing (for those of you interested in the nitty-gritty of it all). Check out this nifty diagram of the cervical spine, (compliments of YourSurgery.com):
First of all, they’ll go in from my back to get at it, and then they’re going to do several things: A C6 and C7 laminectomy, a C8 foraminotomy, and they’ll remove as much tumor as they safely can from the C7 and C8 nerve roots.
Lami-what? you're asking. Forama-huh?...
The Laminectomy
The lamina are the plates of bone in your spine which sort of form a roof over your spinal canal. Above the lamina is the spinous process (the bumpy outgrowth of bone to which muscles and ligaments attach).
In a laminectomy, both the lamina and the spinous process are removed in an attempt to decompress the spinal cord. In the diagram above you can see these. The area inside the red box will be removed, but only on two vertebrae (C6 and C7). They say this doesn't cause significant weakening of the spine, really, and I probably won't even have to wear a neck brace. Which is nice.
"Do you put that back on?" I asked when they told me about this, "The bumpy thing? Do you put that back on?"
No. They don't put it back on. But they say that I might not even notice a difference at all.
The Foraminotomy
The neural foramina (or neuroforamen) are the holes between the vertebrae that allow the nerve roots to exit the spine (see inside the red box above)... My tumors have grown to the point that they've completely obstructed the neural foramina in C5, C6, C7, and C8.
In a foraminotomy, pieces of bone are cut away to enlarge the foramina and allow the nerve roots more room. The doctors are performing a foraminotomy only on the foramina of my C8 nerve root, which is located between the C7 and T1 vertebrae.
This is sorta funny: I keep calling it a "foramiTONOMY" rather than a "foramiNOTOMY." I know the correct terminology, but I keep doing it. Today I decided that it might be because here I am, Mr. Fiercely Independent, on the verge of weakness and pain and who-knows-what-else (which is to say getting ready to be very dependent on others for even the simplest things), and I am subconsciously making the procedure less about cutting away obstructions in nerve pathways and more about cutting away my independence, my autonomy: A "foram-AUTONOMY." (Ha.)
On top of all this bone-cutting, they'll also be doing their best to remove chunks of tumors, focusing on the tumor that is most significantly compressing the spinal cord. As you might already know, NF tumors grow in and around nerves (like marble cake, I was once told) and so it's not as simple as going in and cutting a single mass out. The doctor will be taking a little here, a little there, all the while exercising a great deal of caution so as not to harm the nerve roots themselves. There will be also neurophysiologists in on the surgery monitoring nerve conduction and motor pathways, which essentially means that they'll be keeping track of how my nerves are working as the surgery goes on.
Post-op information, like so many others things involving NF, is a little cloudy. I might be weak and numb and tingly, I might not. I might loose a little bit of sensation in my pinky and ring fingers, I might not. Rehab therapy is probably going to be necessary, but we're not sure how much or where it will focus.... Oh, well. I'm sorta used to the ambiguity. Regardless, I'll certainly keep you up-to-date on what they have me doing.
Finally, I want to send out a big, fat THANK YOU to those of you who've sent letters and cards and e-mails and gifts. And, of course, to everyone for all the good vibes-prayers-healing energy-etc. I really appreciate it. There's nothing like having surgery to realize how many incredible friends you have. Many, many thanks to you all.
Next: Time to meet Karl.
posted by Dan at 12:58 PM
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