Case Studies

Back pain had become a steady companion to the 48-year-old female from Illinois – she first began experiencing it 15 years ago. But even though it was a constant in her life, the 4-foot 10-inch, 200-pound factory laborer never made peace with that pain. When it became so intense that it began compromising her ability to work, she turned to a well-known surgeon for help. Sadly, his only advice was that she lose weight. The woman then came to us for a second opinion.

Our evaluation of the woman included electrodiagnostic testing and MRI studies. Although her neurologic  examination was normal, we immediately noticed a prominent rib-hump deformity, pelvic asymmetry and a shoulder-hip imbalance. Further, she was found to have radiculopathy originating in thoracolumbar region and extending to her thighs, buttocks and calves.

Spinal stenosis and a 55-degree kyphoscoliosis, part of which was idiopathic and part of which was degenerative.

The patient had previously undergone conservative treatment, which included bracing, physical therapy, chiropractic adjustment, medication and local corticosteroid injections, none of which provided longterm relief. Accordingly, we recommended a staged anterior-posterior instrumented decompression and reconstruction of her spine from T5 to S1, performed on an inpatient basis.

In Phase One, our surgical approach was through her chest and abdomen from T12 to the pelvis. Following decompression, cadaver bone was grafted in (recombinant DNA protein was used to stimulate formation of new bone). Time at the operating table was four hours, 30 minutes.

In Phase Two, we took a posterior approach beginning at T5 and extending again to the pelvis. During the seven-hour procedure, metal screws and rods were placed at the back of her spine to stabilize it. We also decompressed her lumbar back (to address the stenosis and leg pain) and performed laminectomies.

The two phases were conducted four days apart in order to ensure full restoration of lung function between surgeries. The patient was hospitalized a total of eight days and then discharged home. No physical therapy or protective bracing were ordered. Pain was controlled by oral narcotics; she was also prescribed muscle relaxants.

Three weeks after surgery, the woman was back at her job, but with restrictions (chiefly, she was prohibited from lifting more than 25 pounds of weight until postoperative Week 12). Incisional pain at a minor level remained for several weeks; however, the deep bore mechanical pain in her back and legs was gone immediately after the surgery. Follow-up occurred with the patient bimonthly for one year. Our final examination showed she was continuing to enjoy freedom from pain and had regained full functionality. Today, she is productive at her job and is able to engage in all her normal activities of daily living.

This case was a success because the right diagnosis was made, which permitted selection of the surgical course most advantageous given the patient’s physiologic and psychologic makeup.