Case Studies in Orthopedic Care: Spine Surgery

Patient history

At 20, this University of Nevada Reno student clearly had a promising career ahead of her as a competitive swimmer. Until, that is, a mishap in the pool one day sunk her athletic aspirations and plunged her lower back into the deep end of pain. Fortunately, the injury – which occurred during a swim meet in 2004 – produced no paralysis or other neurologic impairments. Still, the resultant pain greatly degraded the quality of her life, preventing enjoyment of even so much as a leisurely dip in the water. The physicians who saw her over the course of the next year attempted to treat her with conservative care and chronic-pain management strategies that included physical therapy, epidural injections, anti-inflammatory medications, muscle relaxants and prescription narcotics – all to no avail. A last-resort intervention held out to the patient was spine fusion surgery. This was problematic, though: Owing to the patient’s young age, the outcome of arthrodesis was likely to be far less than optimal.

Case description

The patient was referred to Tahoe Fracture & Orthopedic Medical Clinic, where a then-relatively new, FDA-approved alternative to spine fusion surgery was being offered. During her first visit to the clinic, a detailed medical history was taken. Disc herniation at L5-S1 was suspected – a suspicion confirmed by plain X-ray, MRI and discography studies.

Treatment plan

The patient was found to be an appropriate candidate for disc arthroplasty, the alternative to conventional arthrodesis. The procedure began with a small incision in the lower portion of her abdomen. An anterior approach was used; fluoroscopy provided real-time imaging guidance throughout the two-hour procedure. The damaged disc was completely removed and replaced with a cobalt-polyethylene implant. The device was a mobile bearing segment, similar to those employed in knee and hip replacements.

Outcome

No complications developed, either during or after the procedure. The patient was released 48 hours later and sent home wearing a corset-type lumbar brace to promote comfort and provide wound site protection in the first week after hospital discharge. As expected, a very early return to function was observed. Approximately six weeks postoperatively, the patient was able to participate in recreational swimming – and to do so pain-free.

Discussion

According to the literature, arthrodesis – which continues to be a standard of care – is typically most appropriate for patients over the age of 40. Disc arthroplasty (or, total disc replacement) is an arthrodesis alternative appropriate for patients younger than 40. The goals of disc arthroplasty are to provide long-term pain relief, protect neural elements and prevent posterior facet arthropathy as well as adjacent segment disease by preserving spinal motion.

Following fusion surgery, return to normal function typically takes three months. By contrast, following total disc replacement surgery, return to function occurs as early as six weeks. Incision site and affected muscle heal in about two to four weeks, at which point it is usually appropriate to begin physical therapy for purposes of strengthening the abdominal and core muscles plus increasing range of motion.

Spine surgeons at Tahoe Fracture & Orthopedic Medical Clinic were among the very first in Nevada to obtain certification in disc arthroplasty following the procedure’s FDA approval, demonstrating yet again their keenness for cutting-edge technologies and techniques – but only those with proven science behind them.

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At Tahoe Fracture & Orthopedic Medical Clinic, we take the time to get to know each patient so that we can develop a customized treatment plan that’s tailored to his or her specific needs, lifestyle, and goals.

I truly wish I could give them more than just 5 stars!

"I couldn’t have asked for better care for my son than from the staff at Tahoe Fracture and Orthopedic. From the receptionist all the way up to the surgeon, we were treated with the utmost respect, kindness, patience, and care. They were not only quick to get him in for an examination, but were amazingly quick to fit him into the schedule to have his injury treated asap!! Thanks to them, my son is now on the road to recovery. I truly wish I could give them more than just five stars!"

Christa D. / Carson City, Nevada
Thanks Doc!

"Dr. Mike Fry is a wonderful doctor and caring person. When I saw him for the first time, he held my hand and said, “I’m going to make you well”, and he did! I had back surgery 2.5 years ago and still doing great. Thanks Doc!"

L.M.
We were deeply impressed with the entire experience.

"We were deeply impressed with the entire experience. Candace should be commended for her work ethic. Also my experience with the x-ray tech was outstanding. I would not change anything."

Dr. Fry and the entire staff were excellent.

"My entire experience was just as good as I had planned…a great day! Dr. Fry and the entire staff were excellent. Thanks a lot!"

I cannot express how much of a difference this has made in my life.

"Dr. Jones and his staff through the surgical procedures and other methods they have performed over the years have enhanced my daily living experience dramatically. I am leading a more productive life without the daily pain I dealt with in the past. I cannot express how much of a difference this has made in my life."