10-10-2011 Another Follow-up, Hardware Pictures

We had another trip to Chicago for a follow up with the Neurosurgeon.  This time we spent an enjoyable weekend with my parents prior to today's appointment.  It was our first overnight trip since leaving the hospital.  I was a bit anxious about handling some things (like not having his high back chair to rest his head against, and some other items that have just made stability and daily tasks easier) but everything went very well.  Sam is at the point where we are no longer pushing him to move more, but instead trying to slow him down a little.  Aside from the neck brace, one would never guess what he went through less than 6 weeks ago.  It is a constant balance of helping him try to enjoy many of the things he always enjoyed before, and cautioning him that he still has a long time until he is considered recovered.  He shows often now the full of spunk, grinning boy we have always known him to be.

Upon arriving at Children's Memorial we had a new set of x-rays taken.  These are then transferred over to the Doctor to look at.  Dr. Alden had a brief examination of Sam and felt he was doing very well.  He always gets a pretty good laugh out of Sam (and us) by repeatedly whacking Sam's reflexes while insisting he hold still.  He said the incision site looks great.  I have to agree.  The scar will be as minimal as possible.

Dr. Alden was very pleased with the x-rays as well.  He said the rods, plates and screws looks very solid and well aligned still.  I have shared some x-ray images below.  They are both post-operative, just slightly different positions.

In the one on the left (taken today) Sam's body was just tilted enough that you can see all of the screws if you look closely.  On the right (taken Sept. 19th) the x-ray was taken in such a position as it was straight on and you can only see the closest set of screws.  I will describe what you are seeing below the picture.

This is obviously a side view of the body.  The really bright white parts are the Titanium pieces that were placed during surgery.  Starting at the top:  At the back base of the skull there is a titanium plate attached with very short thick screws, two on each side.  From that plate extends two rods.  You can see they are bent in order to follow the curve under the skull and down to the spine.  Next is a set of long screws holding the rods to the second cervical plate.  Right above the image of these screws you may (but probably not) be able to see very faint bone mass.  It will look very light in comparison to the other bone visible in the x-ray.  This is the bone that was placed that should grow dense and strong and eventually grow fused between the skull and cervical plate.  This is what they consider the desired permanent fusion.  The titanium, while it will not be removed, is only considered the short term fix.  Below that set of screws you will see another set of long screws.  These secure the rods to the third cervical plate.  These screws gave the doctor the good, solid hold on the rods that he wanted.  The area where you see the titanium placed is the length of neck that Sam will now be unable to move.  The rods, and eventually bone, will prohibit any flexibility or rotation throughout that area.  We are still very hopeful that as young as he is, Sam will learn to compensate for that loss by developing greater flexibility in other areas.  Kids are usually highly adaptable to circumstances.  We are blessed and thankful to already see it happening a little.  He already turns his entire body pretty well and doesn't seem to have too much difficulty adjusting himself to see things not in his direct line of vision.

Our next follow up will be in 6 weeks.  At that time Dr. Alden will take a similar set of x-rays.  If he is still happy with how everything looks at that point he will send us back to radiology for another set of x-rays that will take pictures of Sam's neck in various stages of flexion and extension.  The idea is to see in an x-ray that everything is staying where it should as the lower part of the spine bends back and forth.  If he is happy with these x-rays, we will be given a plan to wean Sam off of the neck collar.  Over about an additional month we will begin to take off the collar starting with an hour at a time and increasing until he has regained sufficient strength to be without the collar full time.  Sam was very excited to hear the doctor talk about taking off the collar at some point even though it was still 6 weeks away.  He was also a little disappointed and suprised (as were we) to find out it would take a month of weaning him off after that before he was rid of it for good.  But in the end we all understand why.  Major surgery and three months in a neck brace would certainly diminish the muscles he uses to hold up his head and it only makes sense that they would have to have time to strengthen.

Thanks for continuing to hold up Sam throughout his recovery.  We pray that the alignment would stay straight, and that the bone would grow strong.  Please pray as well that Sam would remain patient and not push too hard to resume activities that will not be safe for him for quite a while yet.  Please pray as well that as he has resumed a lot of normal activities that he would not fall, be bumped hard or otherwise have any accidents that would comprimise his surgery before he is fully healed.  (The expectation is that it will be about 5 more months before he has fully recovered and a year to be back to 'normal' or at least the new 'normal')

We continue to praise God for holding our family firmly in His grip.  We praise Him for all the wonderful friends and family who have sent cards, gifts, meals, the list goes on and on.  (It was actually about 2-3 weeks before we had a day that the mail did not bring at least a card, usually two or three, for Sam.  Thank you, thank you, thank you for showing so much love to my sweet boy!)  We continue to praise God as well for His sovereign plan and the work He is doing in our lives.