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John is a 47-year-old who loves to golf, ski, and hike. He is a manager at a local office of a large defense contractor.
In college, John played ball. At age 22, John experienced a low back disc herniation at the L4-L5 level and was successfully treated with microdiscectomy surgery. He did well for about 20 years. However, severe low back pain has progressed over the past 5-years.
John explained he wakes up very stiff and cannot stand for more than 30-minutes without severe back pain, which forces him to sit or lay down. Pain prohibits him from activities he loves, such as playing ball with his 13-year-old son and gardening. John’s back pain has made airplane travel difficult. Sitting through a 2-hour office meeting is misery.
John tried to manage his back pain with a robust exercise program, which included periodically working with a personal trainer during the last few years. For pain, John routinely took Advil. His general practitioner prescribed Percocet®. Although he disliked taking Percocet, occasionally he did.
At times, chiropractic care provided temporary relief. Although a friend suggested herbal remedies, he was not sold on the idea. John also tried the DRX9000™ spinal decompression system, which made his condition worse.
John developed progressive and severe left leg / shin pain combined with intermittent numbness and feelings of pins and needles. An epidural steroid injection relieved his leg pain for about one-week and soon he was back to square-one and fed up.
Referral to Colorado Comprehensive Spine Institute (CCSI)
A friend and past CCSI patient referred John to a surgeon at CCSI. John’s thorough evaluation included a physical and neurological examination, x-rays, and an MRI.
A CCSI physical therapist consulted with John and educated him about how to maximize his exercise program. Other treatments included bracing, acupuncture, and massage. A selective nerve root block relieved his leg pain for about 2-months. Unfortunately, his low back did not improve much and eventually pain returned. John stated he "wants his life back" and to "fix this." John and his CCSI surgeon discussed surgical treatment.
Second Surgical Opinion
CCSI’s surgeon urged John to obtain a second opinion, which he did. The second opinion surgeon recommended spinal fusion using a traditional open approach. The disadvantages of an open approach, which is maximally invasive (i.e. cutting through muscle, long incision) worried John and he related his concerns to his CCSI surgeon.
Minimally Invasive Procedure
CCSI’s surgeon recommended minimally invasive spinal fusion performed through 2 small incisions and an expandable tube the diameter of a quarter. Such an approach preserves muscles and minimizes soft tissue trauma. The compressed nerve could be freed from the scar and disc material using a minimally invasive approach.
John’s surgeon explained that after the damaged disc is removed, the empty disc space is replaced with a plastic polymer spacer. A special protein - Bone Morphogenetic Protein (BMP) - is inserted into and around the spacer to stimulate bone growth. Although this is an off-label use of BMP, further discussion and personal research, John and realized BMP was a good choice to achieve a successful fusion while avoiding trauma associated with harvesting bone graft from his hip bone.
2014 NASS POSITION STATEMENT FOR rhBMP2
John’s Spine Surgery
John’s surgery took about 3-1/2 hours. He stayed overnight in the hospital, although surgery could have been performed on an outpatient basis.
Advanced imaging, such as fluoroscopy and intra-operative CT scanning (O-arm) were used to navigate the spine and view implantation of instrumentation. (Below)
John’s minimally invasive spine surgery only required two 2-inch incisions to visualize the spine and perform the decompression, instrumentation and fusion procedures. (Below) Below is an example of the tubular retractor and the specialized fiber optic lighting systems. (Below)
The fluoroscopic image below represents what John’s surgeon saw when the tubular retractor was "docked" onto the spine at the L4-L5 level.
Below is a view down through the tube. The rod, screws and set plugs (instrumentation) are already in place.
The fluoroscopic view (below) shows the polymer spacer implanted in the disc space. The spacer is indicated by the "H" pattern between the pedicle screws.
The spinal decompression, instrumentation and fusion procedure was completed. Below, pink, healthy muscle was seen as the tubular retractor is removed. As the tubular retractor was removed, separated muscles and soft tissues simply returned to their original place. John’s minimally invasive spine surgery eliminated the need to cut through or damage muscle fibers.
John’s two small incisions quickly healed. Note the old, longer midline incision from the (not so) microdiscectomy done decades ago. (Below)
John’s Recovery Milestones
During the first two weeks after minimally invasive spine surgery, John took it easy. He walked every day and even tried the stationary bike and treadmill a little. Soon he resumed a few of the exercises his CCSI physical therapist taught him. At first, John frequently took medication prescribed for pain. However, by the end of two weeks, his need for pain pills had significantly tapered off.
After surgery, John noticed immediate relief of his leg pain. Although his back muscles burned at first, soon his back only felt very tight and sore -- not painful. He felt best when he kept moving.
Now, he coaches his kids’ baseball team and loves it. John got his life back. Could this be you?