Breakthrough Back Surgery—Fixing Faulty Spines

About 300 thousand spinal operations are performed each year in the U.S., but one in three of those surgeries will result in failure. When a procedure goes wrong, patients are often left with few options. Now, one doctor who is fixing spines and changing lives.

Sharion Wilton is happiest with a needle and thread in hand, but quilting was just too painful when Sharion injured her spine 15 years ago. It happened after she passed out and fell in her bathroom one night.

"I put my head through the wall," Sharion Wilton told Ivanhoe.

Excruciating neck pain and migraines followed.

"It felt like a hot poker in my back,"Sharion said.

She had a spinal fusion to fix the problem, but over time, the discs on either side of her spine disintegrated. Dr. Kenneth Light says her spine was fused in an awkward position.

"It made the discs above work twice as hard when the patient looked straight ahead," Kenneth I. Light, MD, Spine Surgeon in San Francisco, California, told Ivanhoe.

Dr. Light cut where it had been fused, straightened it, and replaced the faulty discs with two artificial implants.

"By cutting the fusion and putting the disc replacement in, it allowed the spine to straighten itself," Dr. Light explained.

Sharion was one of the first patients to have the surgery.

"I feel like a brand new woman, I do. I feel like I got my life back," Sharion said, and now pain isn't interfering with her quilting.

The disc replacements should last a lifetime. In rare cases, the implants can migrate into the bone, but Dr. Light says that risk is extremely unusual. Spinal implants have been used in Europe for over 30 years, but have only been used in the U.S. for about seven.

BACKGROUND: Spinal cord injuries are one of the most painful injuries of the body. Not only is it extremely dangerous to injure your neck or spine, but it can affect the movement of the rest of the body. Spinal cord injuries (SCI) are primarily common in adults, but children sometimes suffer from them too. Doctors diagnose a spinal cord injury by the level and type. This is determined by the location of injury on the spinal cord and the loss of feeling or numbness. Spinal cord injuries can aggravate discs and nerves in the back and cause them to over compensate for the injured nervous system. (Source: http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=1384)

CAUSE: Common causes of spinal cord injuries are typically due to physical accidents such as:

  • Car accidents
  • Sports injury
  • A fall from an extreme height
  • Stab or bullet wound
  • Severe twist of the middle body
  • Diving accident

(Source: http://www.nlm.nih.gov/medlineplus/ency/article/000029.htm)

SYMPTOMS: The severity of a spinal cord injury relates to the place of the injury on the spinal cord. "The completeness" is also a way to identify how severe a spinal injury is. There are two classifications of severity; complete and incomplete. A complete injury is if all sensory and motor function is obsolete below the spinal injury and an incomplete injury is if there is some motor and sensory activity beneath the spinal injury. Some symptoms include:

  • Paralysis (loss of movement) in arms or legs
  • Trouble walking
  • Headache, neck pain or stiff neck
  • Tingling or numbness in leg or arm
  • Head is in unusual position

(Source: http://www.nlm.nih.gov/medlineplus/ency/article/000029.htm and http://www.mayoclinic.com/health/spinal-cord-injury/DS00460/DSECTION=symptoms)

NEW TREATMENT: A failed back or neck surgery is a fear of all patients who are in need of back or spinal cord surgery and they have a reason to be. Every one out of three back surgeries will have to be re-attempted. Failed back surgery syndrome (FBSS) characterizes the case of those who have had an unsuccessful outcome with spine or back surgery. But now, there is a procedure for spine injuries that can straighten the spine and replace damaged discs in the back. Dr. Kenneth Light of San Francisco, California performs disc replacement surgeries that relieve any back pain and fix what previous doctors could not. This procedure also improves a patient's range of motion in the back and neck. With a quick recovery rate, more patients are looking more into this procedure than traditional surgery. (Source: Dr. Kenneth Light)

Kenneth I. Light, MD, Spine Surgeon in San Francisco, California, talks about a new breakthrough surgery for your back.

Almost everybody knows someone who seems to have back problems. How many of those go wrong?

Dr. Light:  There are about 250,000 laminectomies done every year and it's said in this country that of 1/3 of all spinal operations result in failure. So, that would be about a hundred thousand failures a year.

So, every day you're seeing someone who went to a doctor to get something fixed and now you have to fix that, correct?

Dr. Light: Pretty much.

What are the most common procedures that have the most mistakes?

Dr. Light:  You can categorize them as mistakes and then you can categorize them as the natural history of the problem that results in a less than optimal result. A mistake would be that the doctor operates on the wrong disc or the wrong level. Fortunately, that does not happen that often, but I would say it probably happens about one out of every 1,000 cases, maybe a little bit less. Then, there's a type of problem where the cause of the pain is obscure, meaning the cause of the pain isn't obvious and the doctor thinks the cause of the pain is one disc when in essence it might be a combination of discs. So, only a part of the problem is corrected. Then, there's the type of problem that happens where the doctor does the proper operation, but by virtue of the way that the operation is completed the problem returns. So, the most obvious and common situation is somebody that has a herniated disc in the lumbar spine. One of the most popular operations for that is called microdiscectomy. Microdiscectomy means that the doctor makes a very tiny opening in the back, the smallest possible opening that he can make. Then, there's a common belief that if you just go in and take out one tiny little piece of the disc that the problem is solved and because you've done so little that, that cures the problem. When in essence that isn't quite how it happens. It happens like that for maybe 60 or 70 percent of people. There's another 30 percent of patients  where the little piece of the disc that herniates and is removed is just the tip of the iceberg.  Just under the surface there's a large fragment of disc material that the next time the patient coughs or increases their intraabdominal pressure it's pushed out again in to the spinal cannel and compresses the nerve. That happens approximately one out of five cases. One out of five people who have microdiscectomy have recurrent herniation of the disc and that's an ongoing problem. There's another issue that comes out that happens, when you remove the disc the disc is part of the natural shock absorber of the spine. So, when you remove part of the disc you remove some of the shock absorbing qualities of the spine. There are a group of people maybe again one out of five that once the disc is removed they develop a condition called mechanical back pain or arthritic back pain because they've lost the normal cartilage in the spine. The disc space narrows the spine starts to shift in an irregular fashion and that in and of itself is a cause of back pain. So, another 1/5  of the patients who have microdiscectomies develop arthritic back pain as a result of it. So, those are two very common causes of failure in that situation.

Would you say that most of your patients who come here after having surgery and it did not work for one reason or another, do they come back within five years of that surgery or within five months?

Dr. Light: I would say that most people, if they know that they're going to have a failed operation usually it occurs sometime in the first year or two following the operation. There is another group of patients, another possible cause of failure and in this case we're going to discuss this is the cause of the problem in spinal surgery. One of the most common operations we do is a spinal fusion. What a spinal fusion really is, is the doctor takes a piece of bone and places it between the two vertebral bodies and the two vertebrae wind up fusing together or joining together as one vertebrae. So, what that really does is it solves the problem of the disc in that area. In other words, there's no more disc. If there's no more disc there's no more pinching of the nerve. If there's no movement of that disc space, then there's no more nerve irritation. So, what it does is it solves that problem. But what it does is first of all it makes the spine very straight and the spine is meant to have a curve in it.

Would you say to stay away from spinal fusions?

Dr. Light: If you can. There are certain problems where spinal fusions are absolutely necessary. If you have a condition known as spondylolisthesis where one vertebrae has slipped in relationship to the next that slippage or a malposition of the vertebrae pinches the nerves, in that situation the doctor has to put the vertebrae back and has to fuse it. Otherwise there's no way of holding it. If you have a condition such as scoliosis or curvature of the spine the only way to straighten the spine and keep it straight really is to fuse it. So, if you have one of those two things you have to have it fused. There are specific situations where it's unavoidable, but nowadays we have better things than spinal fusions. We have these things called disc replacements and they are clearly superior to spinal fusions. Hopefully everybody will be able to keep the movement in their spine with a disc replacement and avoid having a spinal fusion.

Have you ever done what you did with Sharion before and did you come up with this?

Dr. Light: I've done it one other time. I did it at the time that I did her operation. So, her story is very simple. She fell and hit her head and injured the C 5-6 disc. She went on and was treated conservatively and then eventually underwent spinal fusion. Then, gradually over the years the discs on either side of the spinal fusion disintegrated so to speak. She was left with terrible pain that originated on both sides of the fusion. In addition, the fusion itself was fused in an awkward position and what it did is it made the discs above have to work twice as hard when the patient looked straight ahead because the disc below, the C 5-6 disc, was fused in a flexed or kyphotic posture. So, every time she looked straight ahead she had to tip her head back and put stress on the disc above. So, she had a fusion that was not fused in an appropriate position and she had degeneration of either discs, discs on either side.

Is it painful?

Dr. Light: It was painful. She was miserable. She had to take pain medication on a regular basis; she had to stop performing her normal activities. She'd get numbness in her hands, weakness in her hands. She wasn't able to work, she was not very happy.




San Francisco, California