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New & Notables
BEATING BACK PAIN
New procedure offers relief on outpatient basis
Author: Deborah Mann Lake - Special to the Houston Chronicle
When a less-invasive procedure replaced open back surgery in the early '80s as the treatment of choice to correct herniated disks, an estimated 2.5 million Americans who suffer from disk disorders breathed a collective sigh of relief.
The procedure, a laminectomy, is done with magnification and can be performed through a smaller incision than the traditional diskectomy -- meaning less pain and a shorter recovery for patients.
Now with even stronger magnification tools, more and more doctors are using a procedure that is less invasive than laminectomy. Called microdiskectomy, it can even be done on an outpatient basis.
"In microdiskectomy, we're able to remove part of the extruded (herniated) disk by using a magnifying loupe to see it. It reduces the amount of soft-tissue trauma and the length of stay and rehabilitation," said Dr. Richard Francis, assistant professor in the Department of Orthopedic Surgery at the University of Texas Medical School at Houston.
The procedure, done under general anesthesia, requires a cut of only 1 to 1 1/2 inches. Using the magnifier, surgeons carefully remove a small piece of bone and gently move the nerves out of the way to get to the disk.
Compression on those nerves causes pain, particularly in the legs. In severe cases, it can cause weakness in the legs and incontinence.
"A disk is like stuffing that leaks out," Francis explained. "It has the consistency of crab meat, and it's just that material that we're interested in getting out to relieve the pressure on the nerve. The hole the material came through will seal itself off."
Dr. David Baskin, professor of neurosurgery and anesthesiology at Baylor College of Medicine, said a team of surgeons, nurses and anesthesiologists actually began doing the procedure a decade ago at Methodist Hospital but only on young, healthy patients with relatively simple herniated disks.
Now it can be done on almost any patient, he said.
"This has really revolutionized the care of patients with disk disorders. It can be done in any situation where you have a herniated disk with isolated pressure," Baskin said. "The only difference is that if you have a patient with other medical conditions, such as diabetes, then that patient may be held overnight for observation."
Baskin said that because there is less tissue trauma, patients have less pain, which can generally be controlled with oral medications. He also said the use of coagulating forceps to seal blood vessels controls bleeding and also allows for a quicker recovery.
In cases where a great deal of bone must be removed and the spine might become unstable, surgeons may still need to fuse the spine, he said. Fusion usually requires more invasive surgery, including a longer incision and recovery time.
In 5 percent to 10 percent of cases, a back procedure such as laminectomy or microdiskectomy must be repeated soon after the first surgery, Francis said.
"But the vast majority, 90 to 95 percent, have relief from their leg pain from that herniated disk. The problem is, because that disk is abnormal to begin with, it can degenerate further and later cause back pain," Francis said. The time for the degeneration to recur varies from patient to patient depending on the disk.
Katy resident Kerry Divin, 35, lived with the pain of a herniated disk in his lower back for six years before reinjuring it moving furniture.
"It was like someone had a knife in my back and was turning it back and forth," he said. "But I wasn't ready to have surgery yet."
But after his back began to spasm, Divin wound up in an emergency room, where he discovered the disk had more severely ruptured. After spending a week in the local hospital, he was referred to Dr. Richard Francis.
"He could tell by grabbing my toes and telling me to do certain things which disk was damaged and how bad," Divin said. "I had no strength in my big toe."
Divin, a project manager for an industrial electrical company, was released from the hospital the day after his surgery.
"The next day the pain was gone," he said. "I was sore, but I didn't have any more sharp pain. It was the best I've felt in six years. I wanted to go back to work right away."
Divin went through four weeks of physical therapy after his microdiskectomy and was able to go back to work a month after the procedure. The recovery period for open surgery can take several months.
Francis emphasizes that not all disk problems require surgical intervention and that medication and therapy should be tried first.
"People who are overweight and don't exercise have a higher incidence of disk disorders and need to make lifestyle changes," he said.
Only by making these lifestyle changes, Francis added, can back surgery patients experience optimum recovery.
RESOURCES
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