Spine Care: Feature Articles

New Promise for Difficult Back Pain
Waterbury Hospital surgeons using innovative procedures for disks and spinal compression

Glenn Taylor, MD, is using an anterior - or frontal - approach to "fuse" degenerated or worn ,lumbar disks, after non-operative treatment has failed to relieve symptoms. Meanwhile, Charles Raftery, MD is bringing relief to compressed vertebrae in the upper back with specialized balloon devices that restore posture and relieve disability.

The watch words here are smaller incisions, less trauma to the body and shorter recovery times. Here’s how the procedures work:

Surgery minus the long recovery
When Dr. Taylor met Luzaria Therrien, “Everything I did hurt. I was suffering and really irritable,” said the 30-year-old Watertown resident. “Even though you’re hurting, you’re still supposed to do everything you’re expected to do. It’s really, really hard,” Therrien said.

“Wear and tear degeneration of a lumbar disk can cause disabling and chronic pain,” explained Dr. Taylor. “While there are some risk factors, such as obesity, cigarette smoking, physically demanding occupations, as well as a genetic predisposition to disk breakdown, everybody and anybody can be affected.”

Small incision gets from belly to back
During an “anterior lumbar interbody fusion” procedure, Dr. Taylor operates through a small abdominal incision. After removing the diseased disk, he inserts a bone graft, cut and machined to a specific size and shape, between two vertebra in the lower back. An anterior locking plate, made of titanium, is then screwed to the vertebrae to hold the graft into place. Over time, the graft fuses the vertebra, which alleviates the pain.

“What makes this operation different from the traditional anterior lumbar interbody fusion is that we do not need to turn the patient over to apply screws into the vertebrae from behind to stabilize the graft,” said Dr. Taylor. “The plate secures the vertebrae, prevents motion and allows us to do the entire operation through one incision.”

The operation is less invasive for the patient and there is less operative time, less blood loss, faster rehabilitation and a better overall outcome, noted Dr. Taylor. “I had my surgery June 11, and I already feel better than I have in two years,” noted Therrien, a former cheerleader at Wilby High School in Waterbury. “I can’t overdo it, but by exercising in the pool and using the treadmill, I’m moving closer to full recovery.”

“Dowager’s hump” not just for Quasimoto
Remember a stooped over Charles Laughton as Quasimoto in The Hunchback of Notre Dame? Charles Raftery, MD, performs a minimally-invasive procedure for patients who experience back pain due to compressed vertebrae, the collapse of the bone tissue of the vertebral body. Osteoporosis is the most common reason for compressed vertebrae, causing more than 700,000 compression factures a year in the U.S., according to the National Osteoporosis Foundation.

Osteoporosis may lead to spinal compression fractures, causing a stooped posture. In many cases, a prominence mostly seen in the elderly, referred to as a "Dowager’s Hump," develops due to multiple compressed vertebra. The hump causes the chest and abdomen to compress, making normal activities such as walking, eating and sleeping painfully difficult.

Creating a space between the vertebra
A procedure known as “kyphoplasty” involves inserting a balloon, or an inflatable bone tamp, into each of the patient’s compressed vertebra. The balloon is then inflated to put each vertebra back into its normal position. “When the balloon is taken out, it leaves a pocket into which cement is inserted under low pressure,” said Dr. Raftery. “With the balloon and the low pressure insertion of the cement, the bone can be safely stabilized and, in many cases, safely restored to an improved position.”

This procedure can be performed on vertebrae from the middle of the upper back (thoracic) all the way down to the lower back (lumbar). The goal of surgical treatment of spinal osteoporotic fractures is less pain and improved function, according to Dr. Raftery. “There are some instances in which rest and pain medication are still necessary,” he said. “Our goal is to reduce the pain to help people get back to a more normal lifestyle. In the vast majority of cases, that’s the outcome.”