Dec. 27--St. Louis Firefighter Christopher Sichra talks about his years with back pain like a bad dream. "It's hard to believe, but it's like nothing happened," he said.
Sichra this year had a relatively new type of surgery that repaired an injured back that had pained him since 2005. The surgery returned him to full speed for the first time in more than seven years.
Sichra was on a routine call during an ice storm in January 2005 when he slipped and fell flat on his back.
"I hit and immediately knew something was wrong. My left side wasn't working, I couldn't lift it ... a lot of pain," he said. "I felt numb from my (midsection) to my feet; I couldn't move this (left) leg."
The fall had ruptured a disk and fractured bone in his spine. Despite surgery, he would spend the next seven years walking bent over, feeling pain, sometimes balancing himself with his hands while moving desk to desk in his office while other pain radiated down his legs.
He still was able to perform his duties as a paramedic. He was transferred to the Lambert-St. Louis International Airport station during the time.
In January, the original pain returned and it was more severe than in the past. "I thought it was over," he said. He considered medical leave, but shunned permanent disability. The St. Louis Fire Department was in the midst of a controversy about the fiscal future of the pension fund. And "I didn't want to be a drain on the pension, not at my age," he said.
"When he came to me, he was worried that his firefighting career was over," said Dr. Armond Levy, a neurosurgeon with SSM Neurosciences Institute in the St. Clare Health Center in Fenton. "He's a very big, muscular tall guy with very heavy labor requirements."
Fearful of paralysis
Sichra wanted something that wouldn't disable him months or even a year. But, "My biggest fear was that I'd be paralyzed," he said. "Ninety percent of the guys on the job (with severe back injuries) don't come back from this. I thought I was finished."
"The measure of success is whether the patient can get back to meaningful work," Levy said, "the job they were doing before, particularly with a guy who was his size and the extreme labor he was going to do."
Levy found that years of walking bent over to accommodate the back pain had worn out a disk in Sichra's lower back. He needed spinal fusion, medically welding two vertebrae together so they wouldn't move around and irritate the spinal cord and other nerves.
Sichra sought out Levy because the doctor used a relatively new laparoscopic spine fusion method. The surgery is done through three holes smaller than an inch each. Instruments beneath the skin allow the work to be viewed on a screen.
Beneath the skin, Levy constructed two clamps to hold the "lumbar 3 and 4 vertebrae" motionless. Then between the vertebrae, he inserted a relatively new off-label bone material made from the pulverized pieces of Sichra's bone and some cadaver bone in a special mesh bag called "OptiMesh." The bag fills the gap between the two bones and hardens.
The OptiMesh bag is approved by the U.S. Food and Drug Administration for other bone-repair procedures, but not spinal surgery, Levy said, but it's used more frequently in spinal procedures. FDA approval is expected soon, he said.
'Better for the patient'
Levy is one of a few surgeons who use "minimally invasive" spinal surgery, he said. Some surgeons don't know it, some don't care for it.
Levy says it accounts for the majority of the surgery he performs, several hundred in the last few years. "There's much less blood loss, recovery time is much faster, it's better for the patient," Levy said, "especially a patient like Chris, a firefighter who wanted to get back to work.
"That's what we think when we see a patient for the first time; how do we get him back to work?"
Sichra said he got his wish about down time. "I worked until June 6, the day before surgery. I had the surgery on June 7 and I was back to work on Aug. 22," Sichra said. "I was back on the squad."
In fact, Sichra walked from his gurney to the X-ray table for his post-surgery checkup. Then he walked to a restroom two hours after surgery. "I had been bent over. Now I stood up straight," he said.
During his rehabilitation, he wore his firefighter's gear while working around the house.
He laughed about it. "My neighbors used to think I was crazy. But I'd be working in the yard, around the house, cleaning up the alley ... The (surgery) wasn't worth it if I couldn't walk around in 100 pounds of gear."
Levy said he'd been concerned about Sichra's size, about 6 feet and 300 pounds, but his fitness level made that a nonissue, he said.
Levy signed off on Sichra's return to work in late August.
"It felt good; I haven't felt like this in years," Sichra said. "But then we got a call to carry a 250-pound woman from an airplane along one of those ramps between the plane and the (airport waiting area).
"No problem. That's when I really knew I was OK."
The next test was in October when he was unloading some nitrogen gas tanks from a fire truck. Something shifted and one fell on him as he stood upright.
"I dislocated my shoulder, but my back was fine," he said.
"The hardware will be with me forever," Sichra said. "The doctor said in a few years, he may have to fuse the level below it."
That could be a few years down the road or never, Levy said. The condition is called "adjacent segment disease," when parts of the back adjacent to the fused vertebrae wear out because of the unnatural movement of the fused bones. The bones would need realignment or another fusion, he said.Sichra said it's a small price to pay, 10 years down the road, for a tune-up for his back.
"I thought I was going to have to go into another line of work," he said. "With this, I can do what I want to do and finish out my career doing what I love to do."
Copyright 2012 - St. Louis Post-Dispatch
