A New Lease on Life
Possible through a combination of the most advanced, minimally invasive spine surgical techniques.
Caption: Letter “Dear Dr. Katsuura, Thank you from the bottom of my heart. You have given me a new life. I am 83. One year ago, Dr. (blank) brought us together and you did an L5 (actually L4), and L4 (actually L3) laminectomy. I now work hard on two acres, have NO spine pain, and can drive in a car for hours pain free. Prior to your treatment, I could do virtually nothing. I was depressed. Thank you.” Top right: a lateral X ray showing the kyphoplasty cement in the vertebrae. Bottom: an MRI scan showing the broken vertebrae at L4 and the spinal stenosis (pinched nerves).
A common clinical scenario I face is the combination of the acute lumbar compression fracture combined with lumbar spinal stenosis. Compression fractures occur because weakening of the bone caused by osteoporosis allows them to be crushed like soda cans. In this condition, any movement of the spine is excruciating. Spinal stenosis occurs when the spinal canal becomes narrowed and the nerves inside become pinched, resulting in searing leg and back pain. Stenosis is generally caused by bone spur formation and thickening of the ligaments around the spine, but when you have a lumbar compression fracture it can also kink the canal.
One of my patients, an 82-year-old man, presented with just this combination of back problems and was completely debilitated by it. He had severe low-back pain and severe sciatica (pain shooting down his leg). In patients with insufficiency fractures caused by osteoporosis, traditional spinal hardware (rods/screws/cages) that I might use to reconstruct a spine could be incredibly risky because the weak bone will not hold the implants. Furthermore, at the age of 82, the last thing you want to do is be laid up in bed with post-surgical pain waiting months to recover. Ideally, you can get back to enjoying your life!
In these instances, I love to combine two of my favorite treatments: the minimally invasive (MIS) lumbar decompression with vertebral cement augmentation kyphoplasty. This is not a traditionally used combination in old-school spine surgery, where a massive open-exposure with metal spine stabilizing implants is favored. Although I do use this type of approach when appropriate, in the elderly it’s a lot to go through. On the other hand, a MIS decompression can be done through an incision of about 1.5cm in length, or about the diameter of a quarter. Through a specialized retractor, I can access the spinal canal without cutting any muscles. From here, I am able to “roto-root” the clog in the spinal canal ensuring that the nerve roots are decompressed and not being pinched.
In a cement augmentation kyphoplasty, I inject cement into the broken vertebrae, using a needle through a small hole in the skin. The procedure takes about 10 minutes, and there is usually only minimal blood loss and no need for stitches. The pain relief can be instantaneous.
I always try to tailor my surgical treatments to meet my patient’s goals and get them back to life as fast as possible. I see one of my callings as keeping patients in their 70s, 80s, and even 90s going without subjecting them to extensive surgical procedures with prolonged recovery times. Sometimes, major surgery is required, but with modern techniques we can really target the source of pain with minimal “cutting.” The patient above was kind enough to send me a letter and agreed to share his story for my website, and I am excited to share it with you.