The Rabbi has Moves.
Learn a little about foraminal lumbar disc herniations and my patient's recovery after a spinal decompression surgery.
Rabbi Goren came to see me when I was in practice in Queens, NYC. He had been on a vacation playing golf with his son, when he was stricken by lower extremity pain (sciatica) that became incapacitating. I initially didn’t know he was a Rabbi (he didn’t advertise it), but was struck by his sense of humor, gravitas and his warm personality. He was such an intriguing human being. It turned out not only was he a Rabbi but had emigrated with his family from Chile and somehow was also a black belt in Taekwondo. He also happened to be a Curb your Enthusiasm fanatic; a TV show I also enjoy.
What was causing the Rabbi’s pain? It turned out the Rabbi was suffering from a foraminal disc herniation that was pinching his L3 nerve root (the nerve that exits the spine between the L3 and L4 lumbar vertebrae) and the L4 nerve root as it passed by the disc. A disc herniation occurs when part of the jelly like substance of an intervertebral disc herniates into the spinal canal. This can impinge on nerves as they exit the spinal column resulting in pain that runs down the leg known as sciatica. This pain can be associated with numbness and weakness of the leg (also known as radiculopathy).
A foraminal disc herniation is a unique type of disc herniation that impinges on the nerve in the tube where it exits the spine (the neural foramen). Treating this type of disc herniation requires a different surgical approach compared to a central disc herniation. Unfortunately, the Rabbi had both a central and foraminal component.
Rabbi Goren was in such pain that he could hardly stand or walk like he once could. Wanting to avoid surgery, I sent him for an epidural steroid injection— an injection of steroid and numbing medication near the compressed nerve—and it did give him some temporary relief. However, he continued to limp, enduring severe pain and discomfort trying to perform services for his congregation. After a while, he asked me if surgery could help. In his case, I believed it would.
I performed a micro decompression of the L3-4 segment through the foramina known as an extraforaminal approach. In addition to this I also performed a central decompression to ensure both the L3 and L4 nerve roots were fully decompressed. This dual approach was necessary because the disc herniation was compressing more than one nerve. I used a minimally invasive technique where the surgery was performed through a small tube limiting muscle damage and speeding recovery.
His pain was relieved by the procedure, and he has returned to full activity, but what I remember the most about the Rabbi was by how he carried himself through what would otherwise be a scary situation. When we had to cancel his surgery because of the COVID pandemic, his only thoughts were for us, the healthcare workers. When I told him I was leaving my practice in NYC, to move to California he only supported me. We keep in touch to this day, and he recently shared with me his experience about his surgery:
“Two years ago, I couldn't walk. The back pain was intense and immense. I tried everything, shots, PT pain medication, but nothing helped. Reluctantly, and only because my wife and three friends, who happen to be surgeons, forced me to "talk to a surgeon". Little did I know that by looking for a back surgeon from The Hospital for Special Surgery in Manhattan, I would find someone like Dr. Katsuura.
I knew that any surgeon from HSS in Manhattan would be exceptional in his/hers surgical skills. I went to Dr. Katsuura because he took my insurance but only after I saw his impeccable medical credentials.
My wife and my son went with me to our first appointment. On my first appointment, he was with us for at least 45 minutes, not only checking me medically but taking the time to know a lot about me as a person. His kindness, respect, and concern were evident! I wasn't another patient with lumbar stenosis, it was "me" that had the problem.
I clearly remember his words, ever so humble, "Rabbi I think I can help you but only when you are ready not to be in this pain." Surgery was scheduled, then postponed because of Covid restrictions. Then surgery happened.
I strongly believe that Dr. Katsuura's personality, kindness, and humbleness were part of my incredible recovery. His concern for my well-being before surgery was more than most Drs. will do. Even more amazing was his concern for my well-being after surgery. I don't mean only the day after the procedure. Weeks and months after my last visit he was reaching out to see how I was doing. That you don't learn in medical school. That care reflects who you are as a human being. Dr. Katsuura is a truly kind soul with incredible surgical skills.
Look at these two videos, before surgery I went to Disney land, and had to rent an electric wheelchair to go around with my granddaughter. Two years later I am jumping at Dave's and Buster's and dancing at a wedding with the bride.
If Dr. Katsuura could only improve my golf game, that would be a true miracle. For now, I will keep using my back surgery as an excuse for my poor golf game.
With infinite gratitude.”
-Rabbi Uri Goren
Summary Points:
-Doctors should see patients not just by their maladies, but as people with lives, concerns, and fears. Rabbi Goren’s story reminds me to always focus on the person. His warm personality made him not only an amazing patient, but someone whose example I try to follow.
-Foraminal stenosis can be treated successfully with an extraforaminal decompression, but it may need to be combined with a central decompression if the lateral recess is stenotic.