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Doctors Try New Surgery to Ease Back Pain

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Harry Wolf's back pain was so bad earlier this year, his family feared it would kill the 88-year-old retired oil worker.

They worried he was in such agony that the man who, until recently, had been a lively and energetic grandfather and great-grandfather would eventually just give up on living.

I couldn't sit, I couldn't stand and I was getting only an hour or two of sleep a night,'' the San Antonio man recalls.I had no appetite. I lost 20 pounds.''

Two months after undergoing a new type of back surgery called minimally invasive microdiscectomy, however, Wolf says he feels super'' and hasno pain whatsoever.'' Indeed, he and his wife, Virginia, recently spent three hours doing yard work outside their Northeast side home.

I couldn't have done that before,'' he says.I don't think I'd be alive today if I didn't have the surgery.''

Eight out of 10 adults suffer a low-back problem at some point in their life. And back pain is one of the most common reasons for missed work and visits to the doctor. For many, the pain can be traced to problems with the spinal discs, the jelly-filled sacs that cushion the vertebrae like bubble wrap cushions fine china.

If - because of age, injury, even a particularly powerful sneeze - a disc becomes herniated or ruptures, it can ``pinch,'' or put pressure against the spinal column. This can trigger often-excruciating pain, numbness and muscle weakness.

For most people with back pain, surgery is the option of last resort. And with good reason. In conventional surgery, the doctor first makes an open incision 2-3 inches long down the center of the patient's back. If the patient is obese, the incision must be even longer. The surgeon next strips away layers of muscle and cartilage to expose the problem disc. Even if the surgery is successful and the pressure on the spine is relieved, recovery can be long and arduous.

Until very recently, back surgery patients could expect to be hospitalized for a week or more, remaining completely immobilized to allow the area to heal. While that has since been reduced to only a day or two, recovery can still be delayed.

The problem is that for every day of bed rest, muscle strength declines 3 to 7 percent,'' explains Dr. Lawrence Frank, an expert in minimally invasive microdiscectomy and a neurosurgeon at the Chicago Institute of Neurosurgery and Neuroresearch.Since these patients are often older, many still need physical therapy to help get them back on their feet.''

Instead of surgery, then, chronic back pain is usually first treated non-invasively.

Like knee arthroscopy or laproscopic gall bladder removal, minimally invasive microdiscectomy is part of the microsurgery revolution that allows surgeons to perform complex procedures through tiny incisions while using precision instruments. Other minimally invasive procedures are also available for other spinal problems.

Microdiscectomy has recently begun to be done on neck problems (more compact, less room for error, nerves are less forgiving, more eloquent), while another procedure allows spinal fusion using screws and rods put into place through small incisions.

Compared to conventional surgery, the benefits of these minimally invasive procedures include less trauma to the body, minimal pain and shorter recovery times.

Because the technique is still relatively new, data on patient outcomes remain sketchy. But preliminary findings indicate success rates similar to those of conventional surgery: 70 percent of patients are pain-free shortly after undergoing the surgery, 20 percent feel better but still have some discomfort and 10 percent are still in pain six months later. About 5 percent of patients need to have a second procedure, usually because spinal fragments continue to leak out of the disc.

Not everyone is sold on the procedure, however. Gerard A. Malanga, director of sports, spine and orthopedic rehabilitation at Kessler Institute for Rehabilitation in West Orange, N.J., says there is a danger of doctors and patients becoming overly enamored with cutting.

Sometimes less isn't necessarily more,'' he explains.It'd be a shame if non-operative treatments were abandoned in favor of surgery. Aggressive physical therapy, stretching, exercise. These all have long track records of efficacy.''

Lawrence Frank concurs somewhat, saying there are times when the smaller operating area can present barriers.

If the site starts bleeding it can be harder to find the source of the blood,'' he says.In that case, you have to open the patient up and convert to the open surgery.''


(The San Antonio Express-News web site is at

c.2003 San Antonio Express-News

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