Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
5 July 2007

X-STOP SURGERY FOR BACK PAIN

            The patient was a 69-year-old individual with an above average concept of how to maintain health and fitness.  He walked 4 miles a day as measured by the pedometer that he wore on his belt.  That pedometer could actually measure how far he walked each day.  If he hadn’t walked four miles by the end of the day, he would go out and walk around the block or other such activity until the four miles were there. 

            But the years have not been kind to his back and walking was becoming increasingly difficult because of back pain that radiated down his right leg.  The further he walked, the worse the pain got.  By April, the problem had reached the point that he was no longer comfortable walking to work in the morning, a distance of only ¾ of a mile.  If he stopped and rested along the way, the pain would go away in 3-5 minutes and he could continue.  But even with that, the pain kept getting worse. 

            This clinical syndrome (story) is called claudication.  It means pain that comes from the activity of walking.  It comes in two forms.  One form is secondary to bad circulation but the individual above had good circulation to his feet and that didn’t seem to be the problem.  The other form of claudication is called neurogenic and it comes from pinching nerves as the nerves exit from the spinal cord.  Neurogenic claudication is dealt with by rest or a back brace or exercises and when all that doesn’t work, finally back surgery. 

            In order to consider back surgery, there needs to be a special type of examination called an MRI (magnetic resonance imaging) scan done.  This type of imaging technique can see soft tissues and nerves.  This is different than x-rays that can only see bones but are very poor for looking at soft tissues.  An MRI scan was done and showed that the spinal cord was being pinched at several levels.  While the MRI scan could show where the spinal cord was being pinched, it couldn’t show which level was responsible for the pain.

            To find the area that was responsible for the pain, neurosurgeon Dr. Gon Sanchez, Sr. was consulted and reviewed the MRI scan.  Initially it appeared that perhaps the area that was hurting was coming from the 5^th lumbar vertebra /1st sacral vertebra area.  An injection of pain medication was applied to this area but really had no major affect on stopping the pain problem.  Next, injections were done at slightly higher levels in the lumbar spine at L3-4, and L4-5 lumbar vertebrae.  When this was done, the pain immediately stopped.  The procedure then was to figure out the right surgery to correct the pain problem.

            It turns out that vertebra stick out in a person’s back.  If you put your hand in the middle of your back at the waist and feel the middle of your back, there are hard bony lumps.  These are the posterior processes off of each vertebra.  As a person ages, there is a tendency for these to sink closer together and as the vertebra come closer together they pinch the nerves that are in between.  One step to correct this was called a laminectomy whereby the bony structures that were pinching the nerve were simply removed.  The recovery from this surgery takes a long time and it weakens the spine. 

            A new procedure developed in the past several years is called X-Stop surgery.  By this step, a very simple operation is done putting a metal device between the posterior processes of the vertebra.  This prevents them from sinking together and pinching the nerve.  After analyzing the MRI scan and the injections that were done into this gentleman’s back, Dr. Sanchez felt that placing an X-Stop between L3-4 and L4-5 could stop the neurologic claudication this person was having.

            The morning of surgery the patient went to the Same Day Surgery Center at about 10:00 am in the morning. Some very wonderful nurses at St. Mary’s Hospital asked all the questions that needed to be asked, started an IV and explained the procedure that was coming up.  Rita Wendt, the nurse anesthetist who was to manage the anesthesia came in and discussed what was about to be done.  She was very reassuring.  The patient went off to the operating room at that point and woke up a few hours later, pain free.  Yes, there was some soreness from the surgery that was done but the neurologic pain that came from pinching the nerve in his back was gone.  That afternoon was spent lying around in bed and about 6:00 pm, Dr. Sanchez returned to check on the results of the surgery.  Things seemed to be going well and the patient was allowed to return home.  Instructions were no heavy lifting for a month, and don’t bend backwards on purpose.  Obey all of “mother’s rules” and check back in a week or so.  The next day, the patient walked about a mile, and over the next three weeks averaged three miles a day without the back pain that he had before.  Fortunately, the possible complications of infections, blood clots, etc. etc. etc. didn’t happen.  Granted, not everyone will recover quite so quickly; the better your condition before surgery, the easier the recovery will be.

            I know that there are horror stories of back surgery and it is treated as a last resort.  But years ago, gallbladder surgery took a week in the hospital with a tube down the person’s nose and a lot of misery.  Now gallbladder surgery is done in one day and the person goes home to have bacon and eggs the next morning if they want.  Back surgery with an X-Stop is a similar advance in the modern surgical techniques.  Dr. Sanchez, Sr. and his son orthopedic surgeon Dr. Gon H. Sanchez have excellent results in over 90 patients.  The staff at St. Mary’s Hospital was excellent, comforting and caring.  I can attest to the excellence of surgical intervention by Dr’s. Sanchez at St. Mary’s Hospital in Pierre because the above patient was me.  In three weeks time, I am back to work full time and my pain problem is gone.