Zeeland resident Nancy Hoekstra, 50, suffered from neck pain for years. Her doctors prescribed pain relievers and steroids to alleviate the pain, but instead it worsened and radiated across her shoulders and down her left arm. Then, her hand became numb. In March, the pain got so bad she went to the emergency room.
“I knew it was severe enough that I needed more extensive treatment,” said Hoekstra, who is a surgical nurse at Holland Hospital.
Hoekstra was referred to David W. Lowry, MD, a neurosurgeon at the Brain + Spine Center in Holland. A MRI scan revealed that the cause of Hoekstra’s pain and other symptoms was a herniated disc between two of her cervical (neck) vertebrae. This is a condition in which the inner core of the disc bulges out through a tear in the disc, impinging on nerves of the spinal cord.
Cervical artificial disc
Since nonsurgical techniques had failed to relieve her pain, Dr. Lowry discussed surgery options with Hoekstra. Traditionally, the “gold standard” for disc disease has been spinal fusion – or removing the damaged disc and fusing the adjacent two vertebrae together, thus stabilizing the segment and providing pain relief. Possible disadvantages are loss of motion in the neck and increased wear and tear on the discs next to the rigidly fused vertebrae.
Fortunately, Hoekstra was also a candidate for a new procedure called cervical artificial disc replacement, which involves removing the damaged disc and replacing it with an artificial one that the neurosurgeon affixes to the two adjacent vertebrae. Dr. Lowry explained that the stainless steel disc’s unique “ball and trough” design provides relief for patients while offering a significant advantage over a spinal fusion: it allows them to retain neck flexibility.
Hoekstra had the artificial disc surgery at Holland Hospital in May. To access the cervical vertebrae, Dr. Lowry made a small incision in the front of her neck. The procedure took about an hour and was performed under general anesthesia; Hoekstra went home the next day.
“Wow” is Hoekstra’s first response when asked about results. “The pain was gone right after surgery. I had some neck discomfort at first, but compared to the pain I had before, it was a significant improvement.”
About 200,000 cervical spinal fusions are performed each year in the U.S.; the artificial disc provides a new option for many. “It’s anticipated that over the next four years, one-third of patients who have a fusion today will be able to have an artificial disc,” Dr. Lowry noted.
Balloon kyphoplasty for painful spinal fractures
The Brain + Spine Center also offers advances in treatment for another spinal problem common in older adults: vertebral compression fractures, or spinal fractures. Half of women and one-quarter of men over 50 are at risk for spinal fracture due to increasingly fragile bones from osteoporosis.
The condition occurs when one of the bones of the spinal column weakens and collapses, causing debilitating pain. Over time, fractures can occur in multiple vertebrae, shortening the spine and causing it to bend over to form a “dowager’s hump.” This hunchback posture, called kyphosis, may then compress the lungs and abdomen and cause other complications.
“The old treatment was to put the patient in a brace and on bed rest, which can result in weaker muscles and further bone loss,” said M. Adam Kremer, MD, a neurosurgeon with the Brain + Spine Center. “Ideally, we wanted a procedure that would be safe, effective in addressing the pain and deformity, and would allow patients to mobilize as soon as possible.”
Drs. Kremer and Lowry now perform that procedure – called balloon kyphoplasty – on hundreds of patients with recent spinal fractures. It involves inserting a hollow instrument into the fractured vertebra and guiding a small balloon through the instrument. The balloon is carefully inflated to raise the collapsed vertebra to its normal position, then deflated and removed. The void it leaves is filled with bone cement to stabilize the vertebra – permanently. The minimally invasive procedure takes about 20 minutes under general anesthesia and requires only a 1 cm incision.
“The effect is immediate,” said Dr. Kremer. “The pain is gone and the spinal curvature is corrected. Patients are able to go home without restrictions and return to normal activities. Their osteoporosis – if that’s the cause of their bone degeneration – must still be addressed, but it’s easier to restore bone mass if physically active.
Surgery is a last resort
As boomers age and more people are living longer, they increasingly turn to neurosurgeons for help in remaining active into their golden years. The two treatments described here are prime examples of what neurosurgeons do, noted Dr. Lowry, who has practiced at Holland Hospital since 2000.
“A common misperception about neurosurgery is that it’s brain surgery, period. We actually do surgery on the brain, spine, spinal cord and the entire nervous system, which includes the nerves that travel through all parts of the body,” he said.
While Drs. Lowry and Kremer certainly perform brain surgery and treat brain tumors, blood clots and head trauma, the most common problems that bring patients to the Brain + Spine Center are disc herniations, bone spurs and fractures, and thickened ligaments or joints due to arthritis.
“The majority of surgery we do – about 90 percent – is actually on the spine, with a focus on minimally invasive procedures,” Dr. Lowry said. “We typically will use a microscope when we do surgery to keep the incision as small as possible.”
Dr. Kremer, who joined the Holland practice earlier this year, has treated more than 3,000 patients with spinal problems since 2004. He pointed out that the neurological surgeons see patients five days a week, and are on call 24/7 for emergencies. “We’re accessible to offer personalized, top-of-the-line care when patients need us,” he said, “and we’re going to bend over backwards to help them – for routine or complicated problems.”
Contrary to what the term “neurosurgery” implies, surgery is considered a last resort. “We try to avoid surgery for people who don’t need it,” Dr. Lowry explained. “But when it becomes clear that having surgery is in their best interest, we don’t put them through unnecessary delays.”
Hoekstra said she was glad she had that option close to home. Today, she is back at work with no restrictions. Better yet, she is able to do “those simple, daily activities of living without pain,” like hold her youngest grandson and tend her garden. Her cervical disc replacement is expected to last a lifetime. “To know that we have this available to us in the Holland area is wonderful news,” she said.