Six months after her minimally invasive spine surgery, former low back pain sufferer Joanne returned to running marathons.
When Joanne first sought help for her low back pain, her doctor initially attributed the mild but persistent ache in the 55-year-old computer software consultant's spine to arthritis.
"He just said it was 'something to be expected at my age,'" says Joanne, an avid runner who at the time was training for and competing in marathons and other road races.
For several years, Joanne was able to manage her pain with over-the-counter medication. "I just took whatever I had around the house at the time, and didn't think too much about it," she says.
But when Joanne's pain continued to worsen and also started radiating down her right leg, she returned to her doctor to determine the cause and find an effective treatment that would give her some relief. For almost a year, Joanne worked with her doctor to try and manage her pain with non-surgical therapies, including cortisone shots and a series of epidurals. "None of them worked," she says, adding that she even checked with her podiatrist to see if, since she was a runner, her feet or shoes might be the problem. "I didn't know exactly what was wrong or what could be done about it, but I did know that I couldn't function with the pain I was in any more," she says.
Sitting was especially uncomfortable, which made doing her job difficult since a typical day involved long hours at the computer. Traveling to meet with clients also presented a challenge. "Sitting on an airplane was the worst — I could never get comfortable. And driving was pretty miserable, too."
Despite her pain, Joanne continued to keep up with her physical training and work commitments. Staying active, she says, provided some respite from the low back pain and also helped keep her spirits up. As time passed, however, her discomfort really started to wear her down. "As long as I was moving or lying down, I was OK, but it got to where I was lying down any time I had a free moment. Running hurt some, but I think I kept at it because I felt like, 'As long as I can still do this, I'm not dead.' And once I got going, the endorphins would kick in and make things more bearable."
Eventually, a diagnostic tool called magnetic resonance imaging (MRI) pinpointed the source of Joanne's low back and radicular pain: spinal stenosis and degenerative disc disease in the L3/L4 vertebrae of her lumbar spine. "My understanding was that my disc was basically gone," she says. As a result, vertebral bone and spinal disc fragments were placing pressure on Joanne's spinal nerves, causing pain both at the damaged disc site and down her leg.
Diagnosis in hand, Joanne's next step was to explore her surgical treatment options. At the urging of a relative in the healthcare industry, Joanne contacted Dr. Jeffrey Winfield with the Minimally Invasive Neuro-Orthopedic Spine Institute in Syracuse, NY, who, based on a physical examination and the results of her diagnostic testing, recommended a minimally invasive version of a spinal procedure called a transforaminal lumbar interbody fusion (TLIF).
Traditionally, surgeons have performed spinal fusion procedures such as the TLIF using an "open" surgical technique that involves making a long incision and then stripping bands of muscle away from the spine and retracting the surrounding soft tissues for clear access to the vertebrae to be treated. Recent advances in surgical techniques and instrumentation, however, now allow surgeons to use a less invasive approach, making open surgery unnecessary in many cases.
After discussing the minimally invasive spine surgery thoroughly with Dr. Winfield, Joanne says she saw no reason not to go ahead with it. "I'd had other kinds of surgery before, so I wasn't really worried about another one," she explains. "That may sound a little flip, but I was in so much pain I was just ready for it to stop. I also learned the longer I waited, the harder it might be for my nerves to heal. If I'd let my condition continue to deteriorate, the nerve damage might have been permanent, or might not heal completely."
As ready and able as Joanne was to undergo the TLIF her doctor was recommending to relieve her pain, she also listened carefully as Dr. Winfield explained that in addition to the possible benefits, there also were potential risks associated with the procedure and the technology used to perform it. They include, but are not limited to, transitioning to conventional open procedure, early or late loosening of any or all of the components; and disassembly, bending, and/or breakage of any or all of the components. Pressure on the skin from component parts in patients with inadequate tissue coverage over the implant could possibly cause skin penetration, irritation, internal scarring, tissue death, and/or pain. Additional risks include joint inflammation; tissue or nerve damage caused by the improper positioning and placement of implants or instruments; and postoperative changes in spinal curvature, loss or correction, height, and/or reduction. Potential risks also include fracture, microfracture, bone loss, damage, or penetration of any spinal bone and/or bone graft or bone graft harvest site at, above, and/or below the level of surgery; and nonunion (or pseudarthrosis), delayed union, or mal-union.
Her confidence was further bolstered by another runner in the last race she ran before going into the hospital. "I was wondering if this would be my last one ever," Joanne recalls, "And then a woman ran by me and commented on her time. I told her she was right on target, adding that I was running more slowly than usual due to my condition and that I'd be having surgery in a few weeks. She said, 'Oh, would you believe I've had back surgery, too?'
"As I watched her press on ahead, I thought, 'Now that's a good omen — my back surgery is going to work and I will be running again."
A TLIF involves approaching the spine from the side through an incision in the back, removing all or part of a damaged disc from in between two adjacent vertebrae (to relieve pressure on the spinal cord and/or spinal nerves) and then placing bone graft material in between the vertebrae to promote fusion, or bonding together, of the vertebrae. By accessing the spinal canal through the openings (foramina) in the side of each vertebra, fewer nerves are manipulated, thus reducing the risk of damage.
Because Joanne's back surgery was minimally invasive, Dr. Winfield only needed to make a small, two-inch incision over the vertebrae to be treated, with a couple of tiny "snake-bite"-type incisions on either side. Through these small openings, Dr. Winfield removed Joanne's damaged disc, relieved the pressure on her nerves and then inserted the bone graft and instrumentation needed to stabilize her spine. Her surgery was performed under general anesthesia, and she was able to leave the hospital the next day. She remained in New York for a week following her procedure, and was instructed to wear a small, corset-style brace for about six weeks to help keep her lumbar vertebrae stabilized during the healing process.
It didn't take Joanne long to realize the benefits of her decision to have spine surgery. "It took about two weeks, but one morning I woke up and my low back pain was just gone," she says. "And it's been gone ever since. For several months, whenever I'd sit down I'd think, 'Oh, it's going to come back.' But it never did. I can sit in front of the computer, fly and drive, and no longer get distracted by how uncomfortable I am."
Because her incisions are so small, she's not distracted by any significant scars, either. "I can barely see them now," she says. "If I really want to cover them up, I'll just get a little tattoo. A butterfly would be nice."
Six weeks after spine surgery, Dr. Winfield cleared Joanne for training. By her six-month follow-up, she was back to running marathons. "Now I just run and run!" Joanne says. "The only aches and pains I have are your standard running aches and pains, and I know the difference.
"I'm so glad I did this — considering where I was and how far I've come, as far as I'm concerned Dr. Winfield can do miracles! I'd never tell anyone they should just jump into spine surgery, but for a condition like mine this procedure certainly did help."
It is important that you discuss the potential risks, complications, and benefits of the CD HORIZON® SEXTANT® Rod Insertion System with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.
After reading this please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, or nerve damage are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.