This week I was with the senior back surgeon in the practice. As far as ortho goes backs and hands are the areas that I know the least about so I was looking forward to this week. The first day with back guy was about what I expected. We did office visits all day which was boring but I did learn a good bit from him. I learned that back pain basically has 3 origins: disc, vertebra, or muscle. (I guess you can throw tumors in there too.) Disc problems generally cause the numbness, burning pain, and tingling with bending in certain positions. Vertebra can cause similar symptoms but can be from degeneration, fractures, or spondylothesis. Muscle pain usually hurts in one general area and doesn't have nerve type pain. That is in no way an exhaustive list of causes of back pain but the average person's diagnosis would be one of those.

My last day with the back guy was in the OR and boy was it a long one. On first glance the schedule looked pretty nice, only 2 cases! I should have known better. Nobody who has OR time for the day only schedules 2 cases unless they think they will use all their time. We had 2 lumbar fusions on for the day. I have done a whole lot of joint replacement surgeries but this was my first back surgery so I wasn't exactly sure what to expect. The first case was a 4 level lumbosacral fusion on a 50 y/o female who had a previous lumbar decompression done years ago and also had a bone stimulator implanted years ago. Oh, and she was around 250lbs. I later learned that that was a significant thing to note. When I feel my own spine I can feel it pretty well, it's right there just under the surface. This wasn't the case on this lady. It took us 3 hours just to dissect down to the spine and find all the landmarks we needed to do the actual fusion itself. We were looking down into a 7 inch deep 12 inch long hole. That only exposed the spinous processes, not the entire vertebra. After 2 hours of meticulous placement of screws and rods and digging around under her butt fat for 30 minutes to find and remove the bone stimulator we were finally ready to close...6 hours later! I don't know if you've ever stood in one place looking down into a hole for 6 hours but it gets tiresome. And this was only the first case. The second case was an even larger lady but fortunately she was younger and had not had any previous back surgery nor did she have a bone stimulator that needed to be removed. This procedure went much like the first except it included a discectomy and was only a 2 level fusion. During this operation the doctor told me to take the probe and "poke this". So being the good student that I am I did as he said and her left leg jumped right up off the table. He told me to do it again, so I did. He asked what I thought I was doing to cause that and I answered that I was poking the L5 nerve root. SCOOORE 5 points for LeAnne. That was the most fun I had all day. Makes you want to run right out and sign up for a lumber fusion doesn't it? :)

I might have to do more back stuff at my other ortho rotations but for now my back days are over. Thank goodness. I do not see a future in back surgery for me.