GETTYSBURG MEDICAL NEWS
The Clinical View
By P. E. Hoffsten, M.D.
2 January 2008

WHY TWO BACK SURGERIES?

            A physician on call in a clinic or in an emergency room will on average see 20 to 30 patients per day.  No fewer than 10 percent of these walk-in patients will come in because of a backache.  For anyone who has ever had a backache, there is really not a whole lot of things more miserable and yet the solutions on how to deal with a backache boil down to relatively few.  The physician that sees you will tell you not to do the things that make your back hurt.  They will tell you to rest, put a heating pad on your back, take a pain pill, let some time go by, lose some weight, and hope.  Some people find comfort with a back brace.  Whether this advice works obviously depends upon what it is that is causing the backache.  When all of the above conservative measures are no help, the person may be advised to consider surgical intervention.  It is almost universal at that point that the hands go up in the air and the person says, “No!  No surgery!” 

            There is no question that there has been a substantial number of ill advised and ineffective back surgeries.  But like everything else in medicine, we are getting better and there are situations where surgery is the only real solution to the problem. Recently I have had personal experience with three cases that all came out with a remarkably good result.

            Speaking for myself, I have abused my back with football, basketball, wrestling, and lifting things I wasn’t really designed to lift.  Not that I was ever very good at athletics, but I had fun.  My first experience with the severe low back pain occurred 20 years ago and was related to “facet joint arthritis.”  Facet joints can be thought of as a hook and catch system that holds your back in the erect position.  These joints take tremendous pressure when a person bends over and lifts something up, mothers lifting babies out of a crib, or anyone who reaches down to the floor and lifts something with their back is wearing the facet joints.  After years of this type of activity, the cartilage over the facet joint wears away and one winds up with bone on bone in the low back.  This is a very painful condition.  Commonly the person goes through the rest, heat, pain pill, and don’t do that again advice.  Unusually, these joints are treated surgically by fusing them so they no longer move relative to each other.  The disadvantage of this surgery is that it places added stress on the joints above and below the ones that are fused and one has to be unusually careful about not straining their back further.

            My facet joints got better 20 years ago after I quit playing racquetball and my back was pretty good for a while.  But then an aching problem began when I would be walking.  At first it only came on after I had walked two to three miles at which point I would have to stop and rest for 15 to 20 minutes and then I could go again for a while.  It was apparent that there was a fatigue problem that was new and different.  So I got an MRI scan done of my back and it showed that there was spinal stenosis present.  This means that the canal through which the spinal cord runs had become arthritic and too tight to hold the spinal cord.  My spinal cord was being pinched.  The further I walked, the more inflamed it became and the more it hurt.

            This was the time for “X-stop” surgery.  Last June, I had two X-stops placed between L3-L4 and L4-L5 with quite remarkable results.  The summer was wonderful, thus the reason for surgery number one.

            But then delusion number one intruded in a most unpleasant way.  I believed that there might be only one thing wrong.  Sixty year olds rarely have just one thing wrong.  Now I had developed a new pain on the right side of my low back and radiating down the back of the right leg all the way to the ankle.  I again had x-rays done of my back and an MRI scan.  Dr. Gon Sanchez, Sr., pointed out a number of different places where my pain might originate.  The X-stops had fixed the spinal stenosis, but now it had appeared that there was a nerve root exiting the spine that was being pinched by arthritic overgrowth.  There followed several “Marcaine” injections into the areas that might be the source of the pain.  The first two injections really didn’t stop any pain at all and then a third one was right on.  I got up off the table after that Marcaine injection and went out and walked a mile and a half with no pain at all, whereas I had not been able to walk a block and a half without having to stop prior to that. 

            So Dr. Sanchez said we needed to “ream out” that hole that was too small and pinching the L5-S1 nerve on my right side.  I knew I had to do something and this was his professional advice.  And so on December 11^th, he did the foraminectomy.  Three days later, I walked to work for the first time in four months without a twinge of pain.  Life is good again. 

            The week before, he had done a similar type of surgery to remove a ruptured disk on a very active young man who was completely disabled by the back pain of this ruptured disk.  We met in the lobby this last week both very happy people completely fixed.

            And I continue to marvel at the number of people with very puzzled looks on their faces when I tell them my back surgery was done right here in Pierre.  Invariably they ask, “Really, you didn’t go out of town?”  The easy answer is why would I go someplace to get second best when Dr. Sanchez and his son are clearly the most conservative and competent back surgeons around.  Central South Dakota is indeed blessed with an outstanding medical community.