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April 22, 2019
TCO Comeback Story – David R.
When you accidentally cut through a tree trunk, you just don’t know how many branches will die until the leaves start falling…
My medical crisis on my neck and left shoulder, and subsequent rehabilitative journey the past four years, have been nothing short of remarkable. I owe a debt of gratitude to the Mayo Clinic surgeons and Twin Cities Orthopedics physical therapy team at Viking Lakes for literally saving my life. I’m now well into the process of rehabilitating a five-level cervical spine and my previously paralyzed left arm after 11 surgeries and infinite hours of physical therapy.
Downward Spiral. I served in the Army for just over 33 years, primarily as an aviator, which put a lot of wear and tear on my spine. After injuring my cervical spine during a deployment to Iraq in 2009, I underwent my first of eleven major surgeries in late 2011… a single level C7-T1 fusion. The army then unsuccessfully stacked three total disc replacements (TDR) above the initial fusion through four surgeries in 2014, however the outcomes were very poor and unstable. After gaining confirmation at the University of Washington Medical Center that the current TDR configuration was unstable, the army removed all TDRs in lieu of a lengthy anterior C3-T1 fusion plate/screws with posterior hardware rods from C3-T2. However, this particular 11-hour surgery on April 13, 2015 resulted in the severing of my left C5 and C6 nerves and several complications that rendered my left neck, shoulder and arm paralyzed. Moreover, I awoke prematurely from sedation, alone, and self-extubated myself in a panic. I underwent an emergency surgery 4 days later to reposition the suspect posterior hardware on my cervical spine, but my paralyzed arm never responded. Atrophy started. My entire life changed.
Hope. The army referred me to the Mayo Clinic in Rochester, MN, and initiated medical retirement proceedings since I no longer met army retention standards. It was critical to attempt nerve transfers within the first six months following nerve damage or risk losing my entire left arm forever. I underwent the first of four surgeries at the Mayo Clinic to salvage my cervical spine and left arm on August 14, 2015, during which I received four nerve transfers and commenced a painful recovery process:
- Left spinal accessory nerve transfer to suprascapular nerve;
- Left triceps branch to anterior division of axillary nerve;
- Left ulnar fascicular transfer to biceps branch;
- Left median fascicular nerve transfer to brachialis branch
After several months in a sling and passive physical therapy in the army, my biceps and elbow flexion showed subtle movements. I returned to the Mayo Clinic for my first post-op assessment in February 2016. The Mayo Clinic then performed the second surgery by removing the posterior hardware in my neck. This enabled a little more range of motion and removed some of the torque on my upper thoracic spine. My anterior hardware remained in place; however, my left deltoid and trapezius muscles continued their atrophic decline. I retired from the army in June 2016, and we relocated back to my home state of Minnesota, where we could maintain continuity of care.
Setback & Determination. Over the next few months, my biceps and below continued to gain strength but my shoulder continued to decline. I slipped and fell on the ice in February 2017 and fractured the humeral head of my left shoulder, as I could not utilize my left arm to break the fall. After assessments by the Mayo team, I underwent my third surgery at Mayo, where Dr. Bassem El Hassan commenced reconstruction of my left shoulder on September 27, 2017:
- Pedicle pectoralis transfer to reconstruct the anterior deltoid.
- Attachment of the lower part of the sternal head of the pectoralis major to the proximal outer aspect of the humerus.
I spent the next 4 weeks in a Minnesota Vikings’ colored purple & gold spica cast, followed by 4 more weeks in a hard brace. I commenced physical therapy in Brainerd and began making progress, along with a simultaneous aqua therapy in a local swimming pool. While the transferred deltoid worked to prevent my left arm from further dislocations, my trapezius and rhomboid muscles on the backside continued to deteriorate and lose function. I returned to the Mayo Clinic for my fourth surgery—a double tendon transfer--on April 27, 2018 to address left scapula dysfunction secondary to subtotal trapezius paralysis with evidence of atrophy and poor contraction of the rhomboid major:
- Transfer of levator scapulae to the lateral spine of the scapula just medial to the acromion;
- Transfer of the rhomboid minor medial to the levator scapulae insertion;
- Advancement of the remnant upper trapezius laterally to also augment and help with transfers.
Revival. I spent another 8 weeks in a hard brace. Due the necessary complexity and uniqueness of my multi-faced reconstruction of my spine, nerves, muscles in my neck, chest, left shoulder and back, I was referred to Twin Cities Orthopedics for a new approach to physical therapy, and I was fortunately introduced to Dr. Christian Dawson (PT) and Mandy Towers (PTA) at the Viking Lakes facility in Eagan. Over the course of the following year, Dr. Dawson’s team crafted a tailored physical therapy regimen that combined dry needling, laser, massage & muscle manipulations and a comprehensive aqua therapy plan to help me retrain and rejuvenate transferred nerves and muscles into a functional left arm. After the first few months of restoring muscle functions, we have recently added light weights to commence strengthening. We still have a long way to go, however I am well underway in achieving an unbelievable comeback story that I never deemed possible back in 2015. I am so glad I met Christian and Mandy at TCO in Eagan. Although they have never encountered such a uniquely reconstructed set of nerves and muscles that my case offered, my TCO team’s ability to think “out-of-the-box” and apply feasible rehabilitative strategies have provided provide solutions that have helped to revitalize my physical health.