Spinal Fusion Surgery Gets Mom 'Back in the Game'
Pam Bourns, a woman in her early 40s with three young children, had been suffering lower back pain for years. The Santa Rosa resident never seriously considered back surgery, though, until the spring of 2011 when the pain became so severe that she wasn't even able to throw a baseball with her kids.
"I thought back surgery was only for people in their 70s," Pam explains. "I had been experiencing lower back pain for more than 15 years. Everything seemed to aggravate the pain - gardening, carrying babies, you name it. I tried to manage it by taking hot baths, doing physical therapy and visiting chiropractors. I also was taking anti-inflammatory medications nearly every day, but I was worried about the bad side effects of taking so much medication.
"Then I saw a chiropractor who took X-rays and told me I had a serious condition called spondylolisthesis," she continues. "After that, I realized I needed to see a medical doctor who specializes in spinal conditions."
Pam's regular doctor in Santa Rosa referred her to a specialist there. The specialist, who did not perform surgical procedures, suggested she see his colleague, neurosurgeon Eldan Eichbaum, MD, for a second opinion.
"At the time, Dr. Eichbaum was living and practicing medicine in Santa Rosa," Pam says. "Before deciding on surgery, he had me try other treatments, including a epidural nerve-root block to relieve the pain. Then last summer, Dr. Eichbaum moved to Fremont to practice at Washington Hospital, and I continued to see him there. I really trusted him, and I didn't want to change doctors - especially if I was going to need surgery."
Dr. Eichbaum notes that Pam did, indeed, have spondylolisthesis.
"One of her vertebra - the fifth bone in the lower back, called L5 - had slipped down in front of the first bone in the sacrum (pelvis) area of the spine, called S1, and that resulted in instability of the spine," he explains.
"Pam is fairly young to have this condition," he adds, "and it is probable that she had a mild abnormality at birth that grew progressively worse as the spine aged. In addition, she also had spinal stenosis - a narrowing of spaces in the spine that causes pressure on the spinal cord and nerves - because the disc between the vertebrae had deteriorated."
Having exhausted other conservative treatment options, Dr. Eichbaum and Pam agreed that spinal fusion surgery provided her best hope for regaining a better quality of life. The surgery was scheduled for November 5, 2012 at Washington Hospital.
"Pam's surgery involved both anterior and posterior fusions," Dr. Eichbaum says. "I performed the anterior portion of the surgery with the assistance of a vascular surgeon, to ensure the safety of her blood vessels."
Dr. Eichbaum describes some of the various steps of the complicated surgery:
* An anterior (frontal) incision was made through the abdomen, just below the navel. The collapsed disc was removed and a donut-shaped piece of grafting material was placed into the disc space between L5-S1.
* The surgery also expanded the small openings where nerve roots exit the spinal canal to relieve the pressure caused by stenosis. Then they placed a screw through the S1 vertebra to buttress the graft so it wouldn't slip out.
* After turning the patient over and making a posterior (back) incision, Dr. Eichbaum performed procedures at L5-S1, to remove bone that was narrowing the spinal canal and compressing the nerves.
* He then performed a posterior/lateral fusion, placing grafts of bone from her laminectomy to connect one vertebra to the other at the bony structures called "transverse processes" on each side of the two vertebrae.
"Doing the surgery from both the front and back results in a sturdier fusion of the vertebrae," says Dr. Eichbaum. "We also put in screws connected by a rod to hold everything in place and promote the fusion, which takes about 1-1/2 years to fully take hold."
After her surgery, Pam was restricted from some activities such as bending, twisting and lifting for a while, but she started walking right away.
"I really expected to spend a month or more with a lot of pain and using a walker to get around," she says. "But I really wasn't in much pain after surgery, and I used a walker only in the hospital and to get out to the car when I got to go home five days after the surgery. Then I only used a cane for about a month, and I started physical therapy about three months after surgery."
Today, six months after her surgery, Pam is back to most of her normal activities.
"I can do things now that I hadn't been able to do for a long time - planting a garden, going to my kids' games, walking 12 or 13 laps around the track at my kids' school - I could only walk 2 or 3 laps before surgery - all without ending up in pain," she notes. "Plus, I don't take pills for pain anymore. We're hoping to visit Arches, Zion and other national parks in Utah this summer and do some hiking there with the kids. I don't do any 'daredevil' stuff, but Dr. Eichbaum says I should be able to go skiing on the bunny slopes with my kids next winter. That's my goal.
"The surgery has helped me feel like I'm in my 40s, not my 70s," she adds. "I would follow Dr. Eichbaum anywhere."
To learn more about Washington Hospital's Minimally Invasive Spine Program, visit www.whhs.com/neuroscience/spine.