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Old 12-21-2008, 08:37 AM   #1
Adam Harris
Member Adam Harris is offline
 
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Join Date: Dec 2007
Location: Seymour  TN
Posts: 6
Post Surgical Rhabdo

Sorry for the long post, but I think a thorough explanation is necessary.

I'm not sure if the title of the thread is the correct terminology, but the rhabdo was not due to exertion/exercise. It is likely more similar in nature to a compression injury or something seen in a trauma patient that survived being pinned in one position with lots of pressure for a long time such as a car wreck, surviving a collapsed building, etc.

A good friend of mine, we'll call him Robert, had back surgery two weeks ago his Tuesday morning. Specifically, he was fused at L4-L5. The procedure was considered minimally invasive. Everything was inserted and completed via 4 small incisions. The physician was a neurosurgeon, not an orthopedist. The surgeon commented that the back was far more compacted then he had thought based on the MRI from 8 weeks prior. The surgery was to correct spondylothesis, or instability in the aformentioned vertebrae. He also had pars fractures, or spondylolysis. See WFS link for a far better explanation than I can provide(http://www.hss.edu/conditions_16351.asp). It was not due to an acute inury. Robert is 50 years old and has battled back problems off and on for a long time.

That is the background. Now for the real issue. Robert was diagnosed with rhabdomyolysis in his quads post surgery. Apparently this was a due to many variables coming together at once, but the main ones are that the surgey lasted nearly 6 hours instead of the 4 hour predicted time, low phosphorus levels, and the positioning during the surgery. An Andrews table of some design was used. WFS link to a jackson table, http://www.erothitan.com/radiolucent..._state_en.html. Apparently the style used during this particular surgery contained a wide thigh strap to stabilize the position. This is what caused the pressure and resulted in the trauma.

Robert was in the hospital for 9 days, the normal length of stay is 4 days post fusion. The first 5 days no one could explain the severe swelling of the thighs and tremendous pain he was in. Just as mentioned in the rhabdo articles, the pain meds couldn't touch the pain. Robert was on morphine, then dalaudid, and finally neurontin. All given to him through a continous drip pump. By the time he was on neurontin, they had diagnosed the rhabdo and were flushing his system with IV fluids and diuretics. His CPK levels were extremely high and his urine looked like coke. All of the blood work indicates his kidneys are functioning very well now.

Recently he was finally able to get some relief and the swelling subsided for the most part. He is obviously extremely weak now and can hardly support his body weight. He can take a few steps with the assistance of hiking poles or a walker. He has been discharged and is trying to recover at home. However, he continues to have knotted muscles or charliehorses. During the day it is manageable, but at night Robert says his quads cramp and the huge knots don't allow him to sleep. He is still in pain, 4-5 out of 10, but the sleepless and more uncomfortable nights are the big challenge now.

Does anyone out there who has battled rhabdo personally or has encountered it in a clinical setting, have any ideas, suggestions, or things that worked for you/the patient? Heat, light massage, more or less activity, anything?

He is going to PT and will continue to do so. He's a fighter and was in very good shape going into the surgery. He did not crossfit, but certainly for his age was extremely active which will hopefully help.

He is still on oral pain meds and valium to help him sleep. The physicians have apparently told him outside of pain management, there is nothing they can do. Sure, his body needs to repair itself, but what can be done now to promote recovery outside of the aformentioned physical therapy.

The good news is his back is doing great.

Thanks for reading.
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