• Spine Surgery

Spine Surgery

Getting the Sparkle Back in Her Eyes

Loriann Thayer spine surgery patientLoriann Thayer, 58, of Webster will never forget the agonizing pain that took over her life last summer. Thanks to a herniated disc pressing on her sciatic nerve, the intense aching extended from her right buttock down to her foot, affecting her 24/7.

“I couldn’t stand straight in the same spot long enough to rinse a cup,” she says. “It was strangulating numbness and then pain. It felt like someone was strangling my leg. I’d try to make myself go out and do something, but it was so excruciating. I couldn’t sit or put weight on the opposite leg. For the most part, I would lean against the counter or lay on my left side. I slept maybe an hour or hour-and-a-half per night. This pain was the worst thing I’ve ever been through.”

Lorianne was out of work for eight weeks while she tried different options and followed the steps outlined by her insurance provider. Finally, last October, Dr. Ziev Moses, a neurosurgeon at UMass Memorial Surgery at Milford, performed a minimally invasive tubular microdiscectomy that solved her problem and finally ended the ordeal. “I felt fantastic after the surgery,” Loriann recalls. “The terrible pain was gone.”

According to Dr. Moses, Lorianne had a disc herniation in her lower spine, one of the most common areas, and it was impinging on the sciatic nerve. Spinal discs are essentially elastic rings with soft material inside that serve as cushions between the vertebral bones. If the elastic ring becomes weakened, the soft tissue inside can herniate outside of the ring and potentially compress the passing nerves.

Although he occasionally sees cases where a patient lifted something heavy and heard a snap or pop, Dr. Moses says that most disc herniations—including Lorianne’s—occurred due to normal wear and tear from aging. “The spine is made up of bones and soft tissue, and the discs are the shock absorbers between the bones,” notes Dr. Moses. “Just as we get grey hair and wrinkles, we develop disc degeneration over time. The vast majority of people in their forties and older who undergo an MRI will see some kind of disc degeneration including protrusions. Not all herniations need to be treated with surgery. It’s just when it is significant enough to impinge on the nerve that you develop symptoms like numbness, tingling, buttock pain, muscle tightness, and weakness.”

Usually a disc herniation will cause leg symptoms. Lorianne had S1 impingement, which goes all the way down to the bottom of the foot. Since other treatments to ease her pain had failed, she was a candidate for the tubular microdiscectomy surgery. Dr. Moses explains that the operation consists of removing the herniated or protruding portion compressing the nerve.

Because the spinal nerves, vertebrae, and discs are located deep inside the body, any approach to gain access to the spinal area requires moving the muscle tissue out of the way, Dr. Moses continues. This technique involves progressive dilation of the soft tissues, as opposed to cutting directly through the muscles. By using tubes to keep the muscles out of the way, he works through a 2-centimeter incision without having to widely expose the area.

“You have to have some kind of space, so you need a series of dilations to go through the muscle and make way onto the bone,” Dr. Moses says. “The muscle gets pushed out around the bone, creating a window in that area. This technology avoids the need to dissect the muscle off the bone. Once we have a window, we drill a small part of the bone, remove the ligament over the nerve, gently move over the nerve, and remove the disc herniation.”

A microscope focused down a tube is used for magnification and illumination. After the procedure is complete, the dilated tissues will come back together. Dr. Moses says the surgery takes about an hour, and in Lorianne’s case, she had a 7-millimeter herniation. “Overall it’s a very safe technique,” notes Dr. Moses, who trained with one of the leaders in this technology in Chicago. “In the past, it’s something that required a bigger surgery, but with the new advances and these minimally invasive technologies, it’s become just a day surgery.”

Lorianne’s problems started in April and she assumed it was sciatica, which she had experienced in the past on the opposite side. Gradually, the pain worsened and she would have to stretch and take baby steps after car rides to get more comfortable. Then in mid-August, it grew disabling to the point that she had to stop working.

She had two appointments with her primary care doctor who prescribed a muscle relaxer and physical therapy. When nothing helped and an MRI revealed three herniated discs, the next step was seeing a neurosurgeon.

According to Dr. Moses, most cases of back pain resolve without operative measures. He suggests giving it about four to six weeks of exploring different treatments such as medications to help with inflammation or physical therapy to improve core muscle strength and to offload the pressure on the spine. “You could also get a steroid injection where a pain specialist places a needle in the spine and injects a steroid near the nerve,” he says. “My philosophy is to be conservative. I like to get to know the patient, know what their preferences are, get a good handle on what the symptoms are, and make sure anything I offer will help. It’s really important to understand where the pain symptoms are. If a patient has a disc protrusion but it’s not corresponding with symptoms then we’ll keep looking further. Hopefully, the symptoms will start improving and not developing. Weakness, bowel or bladder problems, and worsening pain can be signs a herniation is getting worse. ”

Loriann met Dr. Moses at the end of September and could barely walk into the office. To her relief, she found him proactive about moving the process forward. He got her in very quickly to a pain management doctor to see if injections would work and told her if they didn’t help, he would schedule her for surgery since she had explored so many other avenues. They gave it a week for the injections to kick in; however, the pain was still unbearable. “From the minute I met Dr. Moses, I felt completely confident,” she says. “He was entirely focused on me 100 percent. He listened and went over the MRI in lots of detail. He asked if I had any questions, and I didn’t feel rushed. When my husband went to the second meeting, Dr. Moses went over the MRI all over again with him. ”

Loriann underwent day surgery at Milford Regional a couple of weeks after her initial appointment. Because only one of her three herniated discs was impinging on a nerve, the other two did not need surgery. According to Dr. Moses, patients can expect to be up and walking the same day, but should avoid strenuous activity for at least two weeks. “They’re given a supply of pain medication for soreness, but most find they don’t need it after the first day or two,” he says. “We tell them no bending, twisting or lifting to avoid reherniation. Some people go to work the same week while for others who have a more active job, it can be two to four weeks.”

Loriann took pain relievers for a few days and then an occasional ibuprofen when her back would tighten. She started work three weeks after the surgery, but before that, she dropped in for a short visit. “I brought my coworkers some Halloween snacks and they said I was walking like a normal person,” Loriann says. “The surgery was a great experience—the surgical team was very kind and supportive. The next day, I could walk with no pain. I drove a mile to the store to see if I could walk in as it was something I hadn’t been able to do. I picked up two things. I felt so good that I could have done a full load of groceries, but I didn’t want to overdo it.”

Patients schedule follow-up appointments for two weeks and six weeks post-surgery, and then can space it out further. Dr. Moses sometimes recommends physical therapy around the six-week mark as it could benefit patients who became deconditioned during a long bout of back pain. Loriann says she feels grateful that she no longer has to cope with the debilitating pain.

“Dr. Moses is attentive, extremely intelligent, thorough and compassionate, and his knowledge base and ability to let the patient know exactly what’s happening and what will be done is a perfect marriage to the fact that he is very proactive,” Loriann notes. “I couldn’t be happier with the care I received, and so was my husband. The day after the surgery, he said my eyes were sparkling and I was smiling, and that he finally had his wife back.”

Learn more about Ziev Moses, MD

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