We've got your back
Jared West is a firefighter in Mashpee who builds houses on the side. But the Sandwich resident had to give up saving homes and creating new ones a few years ago after twisting awkwardly on an emergency call while trying to hoist up a heavy-set man who had fallen out of bed.
“I felt something pop,” recalled West, 44, who found himself hobbled by stabbing pain in his lower back and buttocks that left him unable to work.
West was eventually referred to Achilles Papavasiliou, MD, FAANS, a neurological surgeon at Cape Cod Hospital. Dr. Papavasiliou determined that West had aggravated a problem called spinal stenosis. This condition occurs when the spinal canal - the channel that runs vertically through the spine and houses the bundle of nerves called the spinal cord—narrows.
“As we age, the cushion-like discs between each vertebra begin to weaken and bulge, and the ligaments in the spine thicken to maintain alignment,” Dr. Papavasiliou said. “All those changes constrict the spinal canal and put pressure on the nerves.”
West has spinal stenosis, but was asymptomatic until he tried to lift the large man, which dramatically worsened the condition.
The solution to West’s back woes was one of the most common forms of back surgery, a procedure known as a laminectomy. The goal of this operation is to relieve pressure on nerves that are being compressed. That’s accomplished by removing a small piece of a bone from the spine called the lamina, which opens up space in the spinal canal and gives nerves more room. Surgeons may also remove any bony growths or disc fragments in the spine that may be impinging nerves.
At one time, all laminectomies were performed as open surgery, meaning they required an incision in the back measuring at least a few inches long. Muscle had to be cut to access the spine. But the minimally invasive techniques that Dr. Papavasiliou and other neurological surgeons at Cape Cod Hospital employ when performing laminectomies and other spinal procedures spare patients much of the trauma traditional surgery entails.
The key tool in minimally invasive spinal surgery is a metal cylinder called a tubular retractor, explained Dr. Papavasiliou. A surgeon makes a small incision in the skin, through which he or she inserts a tubular retractor into the patient’s body, where it moves muscle and other soft tissue out of the way without any cutting required. The surgeon docks the cylinder on the spine; though it’s less than an inch in diameter, that’s enough space for the surgeon to peer through with a microscope and manipulate surgical instruments as they take out bone and other tissue that are compressing nerves.
Neurosurgeons at Cape Cod Hospital have performed several thousand minimally invasive laminectomies over the past 15 years or so.
Back to An Active Life
“Patients tend to do very well,” said Dr. Papavasiliou, noting that his observation is supported by the Spine Patient Outcomes Research Trial (SPORT), a study he was a part of while doing his spine fellowship at Dartmouth.
SPORT was a nationwide study that found that patients with spinal stenosis who opt for surgery had less pain and better functioning over the long term than others who choose nonsurgical treatments. SPORT also found that patients with another common condition, degenerative spondylolisthesis—which causes pain as the spine becomes misaligned—fared better over the years if they chose surgery instead of conservative treatments. Finally, the trial found that surgery to repair a herniated disc prompted speedier relief from pain than other treatments.
Jared West is a testament to the benefits of minimally invasive surgery: He was jogging within a month of his laminectomy, back to work in three months and today regularly participates in a grueling competition known as the Spartan Race, which requires participants to climb walls, lug sandbags, wade through mud and overcome other obstacles.
But even if you simply want to be able to get back to golf or be able to play with the grand kids, the neurosurgeons at Cape Cod Hospital can help. “We have a lot of ways to treat back pain these days,” said Dr. Papavasiliou. “We can tailor the procedure to the patient’s problem.”