Targeting the Back
Advances in Spine Surgery
Before Laura Kaufmann’s surgery to correct a pinched nerve, all she could do to reduce her back and leg pain was lie face down in bed. “I couldn’t stand, walk or sit, and I stopped eating. Going down even a two-inch step was agony,” she said. “I couldn’t let my dog out without help.”
Most back and neck complaints will respond to conservative measures like medication, rest and time. But for those whose conditions, like Ms. Kaufmann’s, worsen or fail to resolve, AAMC spine specialists can choose from an ever-growing number of innovative techniques and technologies to treat a variety of spinal conditions.
Almost immediately after AAMC orthopedic surgeon Alex Speciale, M.D., corrected her condition using a dynamic stabilization system, Ms. Kaufmann noticed a big improvement.“I could sit in a chair and walk around a bit almost right after surgery. Two weeks later I was able to go upstairs and now I can ride a horse again, lift bags of stall bedding, do anything I used to do.”
Dynamic stabilization systems act like an internal splint to stabilize the spine after a discectomy or laminectomy surgery, and may help prevent further disc degeneration and instability. One device by Dynesys consists of titanium screws, which are inserted into the vertebrae, and are then connected by a polyethylene cord that supports the joint as the spine bends and twists. This avoids stresses that can result from a part of the spine being immobilized in fusion surgery.
Ms. Kaufmann’s age, active lifestyle and instability in her spine made her a good candidate for this technology. “This system bridges the gap between fusion and disc replacement, and is especially suitable for active patients with early degeneration,” said Dr. Speciale. “We can help the patient now and have more options for future treatment if it’s necessary.”
Symptoms indicating the need for specialized treatment include any weakness, tingling, or numbness in the back, legs and neck. “Patients with progressive neurological symptoms, especially pain radiating into the extremities, as well as patients who are having problems with bowel and bladder function should definitely be evaluated further,” said orthopedic surgeon Roy Bands, M.D.
Treatment for a routine disc herniation is often a microdiscectomy. In this microscope-aided procedure, the surgeon avoids cutting any muscle tissue by making a one to one-and-a-half inch incision in the middle of the lower back and moving the back muscles out of the way using a small trocar and a series of progressively larger tubes.
“We can sneak in and correct the herniation, and then the muscles move right back in place,” explained neurosurgeon Timothy Burke, M.D.
“Less muscle dissection and preserving normal anatomy usually results in quicker recovery times and less pain,” said spine surgeon Jospeh Sohn, M.D.
AAMC physicians are also using innovative devices for disc replacement that allow greater range of motion. The Bryan disc is a device that can be inserted into any of the cervical disc spaces between vertebrae 3-7. The Charite disc for lumbar spine degeneration and other lumbar disorders consists of a plastic core sandwiched between two metal endplates that are secured to the vertebrae above and below with small gripping teeth. “I think these devices will revolutionize spinal surgery the way joint replacement devices like hip and knee replacements have revolutionized orthopedics,” said neurosurgeon Brian Sullivan, M.D.
Spinal deformities may cause trouble because of the degree of deformity itself, and also because these deformities may contribute to arthritis and nerve compression. “When that happens, patients will need to be evaluated for the possibility of surgical correction, appropriate neural decompression, correction of the deformity using internal hardware, and fusing the appropriate vertebrae together to maintain the correction,” said orthopedic surgeon Stephen Faust, M.D.
AAMC physicians participate in clinical trials for spinal surgical devices and are helping device companies by testing and giving feedback in areas from design and workmanship to surgical techniques.
Laura Kaufmann’s feedback is all positive. “I could not have asked for better care and I’m grateful to be able to benefit from this technology. I’m thrilled with the results.”
Mettle for a Medal
For patient Mike Ballard, what began as a shock-like sensation when he sneezed progressed to almost constant tingling and pain in his legs, and then to problems with bladder function. He tried various treatments for almost a year before being referred to AAMC neurosurgeon Brian Sullivan, M.D. who removed a non-cancerous tumor from his spinal cord.
“The tumor would have eventually paralyzed me, so it was a big relief when I could move my toes after surgery. But it took months to learn how to walk again because positioning and sensation in my legs were affected,” said Mr. Ballard.
Although Mr. Ballard still has issues with balance and leg discomfort, he now climbs mountains, bikes, hikes and recently won a major award for his volunteer work with the Special Olympics. Last year he competed in a marathon, posting a better time than he had before his surgery—and gave his medal to Dr. Sullivan.
“I keep that medal in my office to remind me of what is possible,” said Dr. Sullivan. “When you look at Mike’s MRI after the tumor was removed, you would say that he should not be walking, let alone running marathons! The tumor was taking up so much of the spinal cord in his neck that there was only a thin ribbon left. I think it says more about his spirit and his desire to keep doing the things he loves.”
“I feel fortunate to move as well as I do, and I’m not sitting around, that’s for sure,” said Mr. Ballard. “When there’s a chance that you won’t have the use of your legs you’re inspired to go to as many places and do as many things as you can.”