Active Life Begins (Again) At 40 After Minimally Invasive Spine Surgery Replaces Two Disks

Main Category: Neurology / Neuroscience
Also Included In: Bones / Orthopaedics
Article Date: 23 Jan 2008 - 1:00 PDT

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Kelly Weber's tennis racket hasn't been retired, after all.

A car accident five years ago destroyed two disks between three bones in Weber's spine, bringing her active lifestyle to a sudden stop. But minimally invasive spine surgery performed at Cedars-Sinai Medical Center is giving the Greeley, Colo., resident a chance to return to the tennis court and ski slopes without the pain that made even sitting in a car a difficult task.

"I couldn't extend my right leg because I'd have pain going down it. So I'd have to keep the steering wheel really close and my leg bent, and sometimes I couldn't even drive because of the pain," said the 40-year-old mother of two.

According to Weber, who used to play on a United States Tennis Association (USTA) league and is a water aerobics and water therapy instructor, after the accident, she was unable to even hug her then 3- and 5-year-old daughters in a normal way. "I'd have to sit down and then have them sit on my lap," she remembers.

After the crash, Weber underwent a surgical procedure called lumbar laminectomy in which pieces of damaged disk material were removed to take pressure off a pinched nerve root exiting the spinal column. Disks act as firm cushions between the vertebrae.

Surgical fusion of the area - lumbar vertebrae 3, 4 and 5 - was discussed, but knowing that this would require a long period of recuperation and limited mobility, Weber wanted to wait until technology provided a less-invasive option for multiple-disk replacement.

While waiting, Weber sought pain relief and healing through medical treatment and a variety of complementary approaches, including massage therapy, acupuncture, chiropractic, water therapy, and Bikram yoga. If nothing else, she reasoned, she would be in good physical condition when it was time to try surgery. Selective nerve root blocks, in which an anesthetic and a steroid were injected into the inflamed area, provided some short-term relief but no long-term solutions.

Last May, Weber learned of a minimally invasive operation to replace two or more adjacent disks. She researched the work of neurosurgeon Burak Ozgur, M.D., a minimally invasive spine surgery specialist who is one of the top surgeons experienced in the technique. Weber arranged a Nov. 2 consultation with Ozgur, who had joined Cedars-Sinai's Department of Neurosurgery in October. Surgery was performed Nov. 14.

Ozgur said the procedure, which was completed in about three and a half hours, is performed in two steps. "First, we approach from the side, exactly 90 degrees from the spine, and access the two disk spaces. We remove the disks and put in 'cages' that contain bone graft materials and a protein that enhances and speeds up the fusion process. Then from the back, we insert screws and rods to stabilize the spine."

Using a scope and special instruments, the entire operation is performed through four incisions, each measuring about an inch and a half. These are closed with melt-away stitches and glue, resulting in very small scars. More importantly, the procedure spares the muscle injury and significant blood loss that is common with traditional back surgery, along with the long, painful months of recuperation.

Weber was discharged from the hospital after three days and stayed with family in the Los Angeles area. Her mother returned with her to Greeley on Nov. 23, staying about three weeks for support.

"I cannot believe how good I felt right afterward. I went Christmas shopping. My mom had to make me slow down," said Weber, noting that without constant pain she has more energy and feels "full of life." Although she has to pace herself for a while, she expects to gradually resume her normal routine.

"I think this procedure is revolutionizing spinal fusions because it's changing how people are recovering," Ozgur said. "Compared to invasive surgery, the end result looks the same as far as the construct, but the recovery is much improved. And it can be an option for other indications, such as adult degenerative scoliosis, which is usually more complicated and involving more levels. I've done five- and six-level cases with this type of approach."

The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP).

Cedars-Sinai Medical Center