Faye Bunker – Degenerative Disc Disease, with Cervical Spondylotic Myeloradiculopathy and Low Back Pain

Posted on November 6 2014 by Spine & Scoliosis Specialists

Faye Bunker

Faye Bunker
Greensboro, NC

Degenerative Disc Disease, with Cervical Spondylotic Myeloradiculopathy and Low Back Pain

“I’m totally pain-free for the first time in 10 years.”

Osteoarthritis and degenerative disc disease run in Faye Bunker’s family. Her sister and her younger brother, as well as her late, older brother, all have had multiple back surgeries.

So Faye was not surprised when she began having pain in her lower back and then her knees when she was in her 50s. In 2003, she had both knees replaced. Within a couple years, her back pain had grown worse and she also was having neck pain. She heard popping noises when she turned her neck. Soon, pain began radiating down her left arm.

“I couldn’t lift anything,” she says. “When I was making a gallon of tea, I couldn’t lift it to the shelf in the refrigerator.”

The orthopaedist who had performed her knee replacements referred her to Max W. Cohen, MD, FAAOS, a fellowship-trained spine specialist, for evaluation.

Diagnosis

Dr. Cohen found that Faye had cervical spondylotic myeloradiculopathy (degenerative disc disease with bone spurs and pinched nerves) in her neck. The disc between her C5 and C6 vertebrae was degenerating, and the space between those vertebrae in her neck was narrowing, leading to pinched nerves. He also found degenerating discs in her lower spine, which were causing her chronic lower back pain.

Faye tried conservative treatments, including physical therapy, pain medications and injections, for the pain in her arm and neck but it did not respond. In 2007, Dr. Cohen performed an anterior cervical discectomy and fusion (ACDF), removing the bone spurs and disc that had degenerated and fusing together the surrounding C-5 and C6 vertebrae using bone grafts, a plate and screws.

“I had almost instant relief,” she says.

Then a year later, the pain began again. Imaging studies showed degeneration in an adjacent disc.

“That sometimes happens in patients with degenerative disc disease,” says Dr. Cohen. “All the discs are in a constant state of wear, and we can’t really get ahead of it. We can only fix the main problem we see at that time.”

Faye had a second surgery in 2008 to extend the fusion to C4. That eliminated her neck pain, but she continued to live with constant back pain.

“The back pain was a ‘10′ and it never went away,” she says.

Even though Faye’s back pain was a longstanding complaint, Dr. Cohen had advised doing her neck surgery before even considering back surgery because using a walker – part of the recovery phase of back surgery – would have been difficult with her neck problem. As her back pain grew worse, Faye returned several times to see Dr. Cohen, who advised continuing with conservative, nonsurgical treatments.

Like many doctors, he encourages patients who have degenerative disc disease with chronic lower back pain to exhaust all other treatments before resorting to surgery.

By 2009, Faye’s back pain had become unbearable. Imaging studies showed that the discs between L4 and L5 and L5 and S1 had degenerated.

“I really couldn’t do anything without pain,” she says.

The final straw may have been when she had to give up playing the organ at her church, something she had done for more than 40 years.

“My husband had to help me around, and to get up to my organ, it was two steps,” she says. “I tried everything to make it, but I couldn’t.”

Surgery

Faye Bunker

Faye returned to Dr. Cohen’s office and asked again about back surgery. Even though she had decided surgery was the answer to her pain, she was a little frightened because her siblings had not fared well.

“My sister had seven back surgeries and none of them worked,” Faye says. “She had one where she went about three months without pain but then she went right back to having pain. My younger brother has had back surgery and it didn’t work – it’s worse now. And I have another brother that has since passed, and he had back surgery, and it didn’t work. So I had a big fear of that, but my pain was so bad, I was willing to take a chance.”

Ultimately, it was her trust in Dr. Cohen that overrode her concerns.

“I had all the confidence in the world in him because of the job he did with my neck,” she says.

In June 2009, Dr. Cohen performed a L4-L5 and L5-L6 transforaminal lumbar interbody fusion with titanium screws in her lower spine. The degenerated discs were removed and a plastic cage was inserted to support the vertebrae. In order to avoid taking bone graft from her hip, synthetic bone grafts were used, along with the cage and screws, to fuse the vertebrae together.

Recovery

Faye Bunker

The initial recovery period in the hospital after her back surgery was difficult, Faye says.

“For the first few days, you think you have made a mistake,” she says. “You sit there thinking, ‘What have I done?’ You can’t move anything.”

After she was discharged, she was able to use techniques she had been taught in the hospital to lie down and sit up.

“Every day, things got better,” she says.

After several days of physical therapy in her home, Faye says, “I was able to walk with a walker, and then I walked around with a cane for a couple more weeks.”

One of the keys to her recovery was following post-operative instructions to the letter, she says. “I did exactly what the doctor said to do and exactly what the therapist said to do.”

Four months after her surgery, she drove to the beach by herself – following Dr. Cohen’s instructions to stop every hour as she drove.

“It’s been steadily uphill since then as far as getting better,” she says. ” I didn’t have any complications at all and I lay all that to Dr. Cohen. He discusses everything, the pros and cons, and what you have got to do afterwards, and that helps you understand it.”

She believes his advanced training as a spine specialist gives him an edge in helping patients.

“You hear people say, ‘Go to a neurologist if you’ve got back problems instead of an orthopaedic,'” she says. “But I knew Dr. Cohen is a spine specialist and I thought, ‘Well, he should know more about those vertebrae than anybody else.’ And as it turned out, he does.”

Today, Faye says, “I’m totally pain-free for the first time in 10 years.” She once again exercises, does housework, enjoys playing with her great-grandchildren and is back playing the organ three times a week at church. She praises Dr. Cohen for his positive attitude (“He’s got a good personality about him – I just love him”) and his focus on helping patients.

“I ended up at the right place, at the right time, with the right man,” she says with a laugh. “My husband wouldn’t be jealous at all that I said that, because he has his wife back.

Stephanie Demetrelis – Idiopathic adolescent scoliosis

Posted on November 6 2014 by Spine & Scoliosis Specialists

successstory_stephanieStephanie Demetrelis
Archdale, NC

Idiopathic adolescent scoliosis

“Now I can do what I want and not have to worry about being in pain all the time.”

When Stephanie Demetrelis was 13, she bent over a coffee table at her home – and in that one second, her life changed.

My mom was like,”Oh my goodness, what’s wrong with your back?” Stephanie recalls.

One shoulder blade looked higher than the other, making her appear to have a hump on her back.

Diagnosis

successstory_stephanie_standingStephanie’s mother, Sandra, took her to an orthopaedist, who referred Stephanie to a scoliosis specialist, Max W. Cohen, MD, founder of Spine & Scoliosis Specialists in Greensboro. Dr. Cohen, a fellowship-trained specialist, diagnosed idiopathic adolescent scoliosis, noting a double curve measuring 40 degrees during his initial evaluation in 2003.

Because Stephanie’s curve was so severe and she was already through most of her growth spurt, she was not a good candidate for a brace – which sometimes can stop further progression during the growth spurt. Instead, Dr. Cohen asked her to return for check-ups at regular intervals to track changes.

“About a year after that, I started having problems with my back,” Stephanie says.

She had been a basketball player when she was younger, but gave that up her freshman year of high school due to pain.

In high school, she took up golf and soon made her school’s golf team. Even as she grew more skilled in that sport, Stephanie was enduring regular pain, and her curvature grew worse – progressing to 46 degrees by 2006.

“If I bent over, you could see this huge hump,” she says. People would say,”Oh, your back.”

Typically, doctors consider surgery when the curvature is 45 or 50 degrees, or if the patient has pain or decompensation (where the head moves out of alignment with the spine). Stephanie and her parents, Sandra and Gary Demetrelis of Archdale, NC, remained hesitant about surgery.

After Stephanie graduated from Vandalia Christian School in 2008, she received a golf scholarship to attend Catawba College in Salisbury, NC. College brought long golf workouts and intensive study sessions, and her discomfort grew worse. The tipping point came in October 2008, when pain caused her to withdraw from a tournament after the first round.

“I was hurting so bad,” she says. I went back to Dr. Cohen and I was like,”I have to get the surgery; I have to get it because I can’t even live a normal life.” Everything I did was so painful.

After returning to Catawba to complete the semester, she had difficulty sitting in class or working on the computer for long periods.

“I remember my last exam, right before Christmas break,” she says. “The exam lasted three hours. It was on the computer, and I was hurting so bad I thought I was going to have to tell the teacher I couldn’t finish. I knew then: I have made the right decision to have surgery.”

Surgery was scheduled for just after the Christmas break and she planned to take the next semester off to recuperate.

“I wasn’t really that scared about it,” Stephanie says. “I felt like Dr. Cohen really knew this was going to help me. I trusted him completely.”

Surgery

before-after_stephanieDuring the surgery on January 6, 2009, Dr. Cohen used a state-of-the-art technique to straighten Stephanie’s curved spine – utilizing screws, hooks, titanium rods and a Dacron band called a universal clamp. Stephanie was the first scoliosis patient in the U.S. to benefit from the clamp, which Dr. Cohen helped develop for U.S. use with Abbott Spine. Bone grafts were then laid over her spine to create a “scaffolding” for the vertebra to grow together in the new straightened position.

“We’re actually tricking the body into thinking it has a fracture that needs to heal,” says Dr. Cohen.

Key to the success of the procedure is the “hardware” used to straighten the spine.
It holds the vertebra in place while the bone grafts grow together.

Recovery

successstory_stephanie-golfStephanie spent a week in the hospital, feeling pretty “miserable,” she says, and another month recovering at home before she began feeling a lot better. Gradually, Dr. Cohen allowed more activity, and in July 2009, Stephanie began practicing golf again.

“I wanted to play so bad,” she recalls. “I just could not wait to get back out there.”

Stephanie was elated when, two weeks after she began practicing again, she won the girls’ High Point Junior Golf Championships in her age division.

In fall 2009, she returned to college and the golf team at Catawba College. By spring of 2010, she was finding the rigors of four-hour practices, long tournaments and college too much and decided not to continue in competitive golf.

“I still play but for fun now,” she says.

successstory_stephanie-computerIn fall 2010, she transferred to the University of North Carolina at Greensboro to major in travel and tourism. She is amazed that she can sit in class or work at a computer for hours without pain.

“I used to not be able to study or sit at a computer for long,” she says. “Now I don’t hurt at all when I’m in class or working on the computer. I’m not in any pain.”

Her advice for other young scoliosis patients who are in pain and considering surgery?

“If you have scoliosis and you’re in pain, you need to get the surgery,” she says. “I definitely recommend it.”

 

 

 

The Parts of Your Spine and How They Work

Posted on November 4 2014 by Spine & Scoliosis Specialists

The spine is one of the most important parts of your body. Without it, you could not keep yourself upright or even stand up. Your spine gives your body structure and support. It allows you to move and bend. The spine also protects your spinal cord. The spinal cord is the column of nerves that connects your brain with the rest of your body, allowing you to control your movements. Without a spinal cord, you could not move any part of your body, and your organs could not function. That is why keeping your spine healthy is vital if you want to live an active life.

Vertebrae, Ligaments, Tendons, and Nerves

Your spine is made up of 24 small bones. Each bone is called a vertebra (ver-ta-bruh). These are the building blocks of the spinal column. Together, all the bones that make up the spine are called vertebrae (vert-a-bray).

The vertebrae protect and support the spinal cord, and bear most of the weight put on your spine. Each vertebra is made up of a large bone called the body, and laminae (lam-in-ay) which extend from the body and form a ring to enclose and protect the spinal cord. The laminae includes the spinous (spine-us) process, which is the bone you feel when you run your hand down someone’s back, two transverse (trans-verse) processes where the back muscles connect to the vertebrae, and the pedicle (ped-i-cuhl) that connects the two sides of the lamina.

Between each vertebra is a soft, gel-like cushion called a disc. The disc helps absorb pressure and keeps the bones from rubbing against each other. Each vertebra is held to the others by groups of ligaments. Ligaments connect bones to bones. There are also tendons in the spine which connect muscles to the vertebrae. Like other parts of the body such as the knee or elbow, the spinal column also has joints. Spinal column joints are called facet (fuh-set) joints. Facet joints link the vertebrae together and give them the flexibility to move against each other.

When the vertebrae stack on top of each other, the holes line up to form a long hollow tube that runs the length of the spine. The spinal cord runs through this long hollow tube. The spinal cord itself is a large bundle of millions of nerves that carry messages from your brain to the rest of your body, and from every part of your body back to your brain. The spine branches off into thirty-one pairs of nerve roots. These roots exit the spine on both sides through spaces called neural foramina (noor-al for-a-min-ah) between each vertebra.

Segments of the Spine

The spine itself has three main segments: the cervical (ser-vi-cal) spine, the thoracic (thor-a-sic) spine, and the lumbar (lum-bar) spine. The cervical spine is the upper part of the spine known as the neck. It is made up of seven vertebrae. The thoracic spine is the center part of the spine. It is made up of 12 vertebrae. The lumbar spine is the lower portion of the spine. It is usually made up of five vertebrae, however, some people may have six lumbar vertebrae. Having six vertebrae does not seem to cause a problem.

Below the lumbar spine is the sacrum (sack-rum). The sacrum is actually a group of specialized vertebrae that connects the spine to the pelvis. Before birth, these vertebrae grow together (or fuse) creating one large “specialized” bone that forms the base of your spine and center of your pelvis. The nerves that leave the spine in the sacral region control bowel and bladder functions and give sensation (feeling) to the crotch area.

There are two sacroiliac (sack-row-ill-e-ack) (SI) joints in your pelvis that connect the sacrum to the ilium (ill-e-um) (the large pelvic bone). The SI joints connect your spine to the pelvis, and thus, to the entire lower half of your skeleton.

Like any other joints in your body, there is cartilage on both sides of the SI joint surfaces. But, unlike most other joints, the SI joints are covered by two different kinds of cartilage. The surfaces of the joint where movement occurs have both hyaline (high-a-leen) (which is glassy and slick) and fibrocartilage (figh-bro-cart-il-age) (which is spongy) surfaces that rub against each other. The joints also have many large ridges (bumps) and depressions (dips) in the surface that fit together like a puzzle.

The SI joints are also unique because they are not designed for much motion. It is common for the SI joint to become stiff and actually “lock” as people age. The SI joint only moves about two to four millimeters when bearing your body’s weight and bending forward. This small amount of motion in the joint is described as a “gliding” type of motion. Due to the small amount of movement and the complexity, finding out about the SI joints’ motion is very difficult during a physical exam.

The SI joints are said to be viscoelastic (vis-ko-e-las-tick). This means that the major movement of the joint comes from giving or stretching. This motion is quite different than the hinge motion of the knee or the ball and socket motion of the hip. The SI joints absorb shock for the spine by stretching in various directions. The SI joints may also provide a “self-locking” mechanism that helps you to walk. The joints lock on one side as weight is transferred from one leg to the other.

Tips to Relieve Stress and Tension

Posted on November 4 2014 by Spine & Scoliosis Specialists

Whether you are at work or at home, it is common to feel stress and tension. Today, people are often called on to do more with fewer resources. They are faced with more responsibility and more deadlines to get their tasks done. The health of your neck may be at risk with these mounting pressures. But scientists have helped us learn that we have a defense against these mounting pressures — the “Three R’s” for easing tension and reducing neck pain at home and work:

  • Rest — Take frequent breaks during the work hour, and choose alternate activities such as deep breathing, walking, napping, or exercising to get your mind ready for a new job task.
  • Relaxation — Take a load off. Lie back. Turn down the lights, and listen to your favorite tape or CD. Breath slowly and deeply, allowing your abdomen to rise and fall rhythmically. Using visual imagery can also aid in relaxation. Try to visualize each muscle relaxing one after another.
  • Recovery — Repeated and prolonged activities can take their toll if your body does not get a chance to recover. Recovery helps repair sore, aching tissues along the way, keeping them healthy.

Here are some additional tips you can use to avoid tension at work and keep your back and neck healthy:

  • Be Relaxed — Try to keep your muscles relaxed. To stay relaxed, look relaxed.
  • Pace Yourself — Keep an even keel. Avoid sudden changes in your workload. Try to avoid last minute “panics” to meet deadlines.
  • Take a Break — Take a thirty second “microbreak” every twenty to thirty minutes to do some deep breathing and a few exercises. Take a few minutes each hour to do some exercises, get a drink, or go bug a coworker. Use your lunch break to take a nap or a walk.
  • Change Positions — Avoid holding your neck, trunk, or limbs still for a long time. Plan ways to get the job done using different positions. Sit for a bit, then stand for a bit. Or simply readjust your approach to the task.
  • Rotate Duties — Rotating or sharing your tasks can be fun by offering a new work setting while giving your body a chance to recover.
  • Avoid Caffeine and Tobacco — Caffeine (in coffee, tea, soda, chocolate, and tobacco) can increase stress, reduce blood flow, and increase your awareness of back and neck pain.

Tips for Safer Lifting

Posted on November 4 2014 by Spine & Scoliosis Specialists

Many back injuries occur during lifting. To help protect your back and avoid painful injury, follow these safer lifting tips:

  • First, plan and prepare for the lift. It only takes a moment to ensure your safety, but the pain of a back injury can be long lasting!
  • Ensure that you have a safe and clear path.
  • Before beginning, think through the lift.
  • Get a good footing with a wide base of support by placing your feet a minimum of shoulder width apart. This lowers your center of gravity and increases your stability.
  • Keep the load close! Keeping the load you are lifting close to your body can reduce stress on your spine and back muscles. Think of how a lever and fulcrum work. Your back muscles, spine, and arms are the parts that form this lever system. The force needed to lift an object is lower if the load is nearer the fulcrum point. If the load is too far away from your body, the muscles of your spine have to work harder to help with the lift. This puts too much stress on the muscles of your spine and can cause injury.
  • Maintain the neutral spine position! By moving the pelvic wheel around its axis, your upper body hinges forward while your spine stays in neutral. Keep the neutral spine position at all times!
  • Remember to lift with the large muscles of your legs!
  • Do not twist and bend your lower back at the same time! This is one the most damaging movements to the spine. To avoid twisting, pivot your feet to complete the lift.
  • Get help if necessary! If the load is too bulky or heavy, do not hesitate to get help or use a hand truck! Do not be too tough or too busy to get help. Will power does not take the place of a reasonably safe lift.

Tips for Maintaining a Healthy Spine

Posted on November 4 2014 by Spine & Scoliosis Specialists
  • Pay Attention to your Body: If something you are doing causes your back to hurt, stop and rest or stop altogether. Whether it is a particular exercise, prolonged sitting, bending, or twisting, listen to your body’s signals. Pain is a warning. Discuss the activity with your doctor or physical therapist before proceeding.
  • Sit and Sleep Comfortably: Be sure that your back and neck are properly supported when you sit or sleep. When you sit, make sure your lower back is supported. Talk to your health care provider about choosing an appropriate mattress and pillow. You can upset the alignment of your spine if a mattress is too soft, or a pillow too high.
  • Lose Weight: If your weight is causing excessive pressure to your spine, weight loss can reduce your discomfort.
  • Lift Properly: Do not lift heavy loads by placing the pressure on your lower back. Use your legs to lift, and always bend your knees so your arms are at the same level as the heavy object you plan to lift. This simple technique will save your back unnecessary wear and tear.
  • Avoid Osteoporosis: Talk with your physician about combating the effects of osteoporosis – bone thinning. Possible treatments include weight-bearing exercise, adequate calcium and vitamin D, and hormone replacement therapies.

Tips for Maintaining a Healthy Posture

Posted on November 4 2014 by Spine & Scoliosis Specialists

Posture at work, rest, and play affects the health of your back and neck. Posture is a result of proper body mechanics — which occurs when your spine goes from the healthy neutral position into action.

STEP 1: Understand the Neutral Back Position

  • A healthy spine has three natural curves:
  • The neck, or cervical spine, curves slightly inward
  • The mid back, or thoracic spine, is curved outward
  • The low back, or lumbar spine, curves inward

 These natural curves are the result of the muscles, ligaments, and tendons that attach to the vertebrae of the spine working together in harmony. Without these supporting structures, the spine would collapse. They support the spine just as guide wires support the mast of a ship.

In your spine, the guide wire system is made up mainly of the abdominal and back muscles. The abdominal muscles provide support by attaching to the ribs, pelvis, and indirectly to the lumbar spine.

The muscles of the back are arranged in layers, with each layer playing an important role in balancing the spine. By using these muscles together, you can change the curves of your spine, like when you bend over to pick something up.

Neutral alignment keeps the muscles, ligaments, and tendons that attach to your spine working together in harmony. This is important to help cushion your spine from too much stress and strain. Learning how to maintain a neutral spine position can help you avoid problems with your spine, and help you move safely during activities like sitting, walking, and lifting.

Controlling the tilt of your pelvis is one way to help balance your spine. As certain muscles of the back and abdomen contract, the pelvis rotates. As the pelvis rotates forward, the lumbar curve increases. As the pelvis rotates backward, the curve of the low back straightens. Rotation of the pelvis is like a wheel centered at the hip joint. The muscles of the upper thighs also attach to the pelvis and contraction of these muscles can be used to change the curve of the spine.

The abdominal muscles work alone or with the hamstring muscles to rotate your pelvis backward. This causes the slight inward curve of the low back to straighten. If these muscles cause the curve of the low back to straighten too much, this may produce an unhealthy slouching posture.

In the other direction, the hip flexor and back extensor muscles rotate the pelvis forward. This increases the curve of your lower back. If this curve is increased too much, another unhealthy posture may result.

A balance of strength and flexibility is the key to maintaining the neutral spine position. This balance ensures the best muscle function. Like a car, an imbalance may lead to wear and tear, eventually damaging the various parts of the car.

Muscle imbalances that affect the spine have many causes. One common cause of muscle imbalance is weak abdominal muscles. As the abdominal muscles sag, the hip flexors become tight, causing an increase in the curve of the low back. Another common problem results from tight hamstrings. As the hamstring muscles become tight, the pelvis is rotated backwards. This produces an abnormal slouching posture.

STEP 2: Put Safe Posture Into Practice

Sitting
Healthy sitting posture is based on the neutral spine position. Positioning your hips and knees at 90 degrees can help you keep a neutral sitting posture. This position is balanced between the extremes of lumbar movement. Remember to choose a properly designed chair to help support your lumbar spine. The neutral spine position is also important when getting up from a chair. Holding your spine safely in neutral, the pelvic wheel turns forward, placing the “nose over the toes.” With the feet placed shoulder width apart, stand upright. Use the buttock and thigh muscles to push yourself up. Do not twist or bend too far over at the waist, or you will put too much strain on your lumbar spine.

Walking
Proper body mechanics are also important while walking. Try to maintain the neutral spine position while walking. In the neutral position, your legs and arms swing naturally during forward motion. Conditions that alter the normal way of walking, and cause a limp, can severely stress the spine. While walking, always try to maintain your spine in the neutral position.

Lifting
Lifting is one of the most dangerous activities for your spine. The neutral spine position MUST be used to reduce the risk of injury. With your spine in the neutral position, movement occurs as the pelvic wheel turns. The hip is the axis of pelvic rotation, not the back! Notice how the back loses the neutral position when the pelvis does not rotate forward. This posture focuses the force on your back muscles during a lift. Lifting in a neutral position allows the larger and more powerful leg muscles to do the lifting. When lifting, first find the neutral position. Bend at the hips by rotating the pelvic wheel at the hip joint axis. Keep the safe posture, hold the object securely, and use your large leg muscles to generate power. Tighten your abdominal muscles during the lift to create a stabilizing corset around your trunk.

 

Rick Chaney (aka Jots the clown) – Cervical and lumbar degenerative disc disease

Posted on November 4 2014 by Spine & Scoliosis Specialists

Jots the ClownRick Chaney (aka Jots the clown)
Kernersville, NC

Cervical and lumbar degenerative disc disease, with spinal stenosis, pinched nerves, radiculopathy and cervicogenic headaches

“If Dr. Cohen hadn’t done my surgery, I’d probably be lying in bed on disability.”

When Rick Chaney was 12, he lived a boy’s dream life – traveling with the circus alongside his father, Earl Chaney, a clown in the Ringling Bros. and Barnum & Bailey’s Greatest Show on Earth. The grease paint left a permanent mark. By age 15, Rick was performing as his own clown persona, Jots.

Over the years since then, from his days in Las Vegas to his current life in Kernersville, NC, Rick has always been a part-time or a full-time clown. Early on, he was Ronald McDonald for a year, following in his father’s footsteps. Later, he clowned part-time while working as a construction manager after moving to North Carolina to raise his children.

Today, he’s back clowning full-time through his company, Circus Daze – but only after enduring two car accidents, months of pain and two major spine surgeries. He credits Max W. Cohen, MD, FAAOS, founding physician of Spine & Scoliosis Specialists, with putting a big clown smile back on his face.

Diagnosis

Rick’s spine problems began in 2003, when his car was rear-ended by a truck, which then pushed his vehicle into a second truck. Rick began having severe back pain and sciatica. He sought help from Dr. Cohen, a fellowship-trained spine specialist in Greensboro. Not only was the doctor knowledgeable, but he also has an upbeat attitude that was inspiring, Rick says.

“He always has a smile on his face,” says Rick. “When I met him, he just seemed positive about everything that was going to happen, so it made me have a positive outlook on everything.”

Dr. Cohen diagnosed Rick with spondylotic myeloradiculopathy. In layman’s terms, he had degeneration of the disc in the L4-L5 area, with bone spurs and pinched nerves, aggravated by injury. His symptoms included back pain and sciatica (radiculopathy), or pain down the leg.

Dr. Cohen notes that it’s not uncommon for a patient in his 30s or 40s to have degeneration of the discs without realizing it. Then, when the patient is in an accident, as Rick was, the problem manifests itself in pain.

“If he was younger, he may have just been sore for a week or two, but being that the disc had already had some deterioration, it became painful and it wouldn’t get better,” Dr. Cohen says.

Rick underwent a variety of treatments before opting for surgery more than a year after his injury.
“We exhausted every other method of trying to take away the pain: shots, massage therapy, all the works,” Rick says. “And finally it was just, we gotta do this (surgery).

Rick recovered and felt stronger than before. Then, in 2007, Rick was in the wrong place at the wrong time again.

“I was in my friend’s car, and a lady fell asleep at the wheel of a car,” he says. “She hit us head-on and totaled both cars. I was lucky to be alive.”

He suffered a broken ankle, torn knee ligaments and a neck injury. Because he and his friend were on a work assignment at the time, the injury was handled as a Workers Compensation claim and Rick was not able to select his own doctor. His ankle and knee healed, but his neck pain grew worse and he had incapacitating migraines.

“The migraine would start at the left side of my head and go right up the top, right up to the front,” he says. “It was like it was crushing right down on a nerve, and it wouldn’t stop. It was horrible. I would have to go to bed and turn out the lights.”

In addition, he had excruciating neck pain that traveled down his left shoulder, radiating from the C-5-6-7 area of his upper spine. That meant he had almost no range of motion in his neck. He tried virtually every treatment, from physical therapy to injections. None helped.

His diagnosis was the same as with his neck years earlier– spondylotic myeloradiculopathy – but this time the degenerating discs were in his neck area at C4-C5-C6. He grew despondent as his doctors told him there was little more to be done and that the chance of success with an operation was minimal.

“All along, I had been asking to see Dr. Cohen,” Rick says. “I finally just insisted, ‘Send me to Dr. Cohen.’ The doctor I was seeing said ‘OK, I’ll send you to Dr. Cohen. He’s young and he’s got new, innovative ideas.’”

Rick got an appointment with Dr. Cohen, “and he just brightened my whole life up, instantly,” Rick says. “That doom and gloom was gone. We went from ‘there’s about an 80% chance surgery won’t work’ to ‘there’s an 80% chance this is gonna work.’”

Surgery

Rick’s back surgery in 2005 was among the first minimally invasive posterior lumbar fusions performed in the U.S. At the time, Dr. Cohen traveled around the U.S. training other surgeons to perform what was then a new procedure. In Rick’s case, Dr. Cohen removed the disc and bone spurs to relieve pressure on the nerves and then fused the spine from L4 to L5. Instead of the long incision made in a traditional fusion, Dr. Cohen made a number of small incisions. “It allows for a quicker recovery and less damage to the muscles than the traditional technique,” Dr. Cohen says.

(See “Surgeon’s Perspective” here for more details.)

In Rick’s second surgery in 2008, Dr. Cohen performed an anterior cervical discectomy fusion, again removing bone spurs and ruptured discs, then fusing the spine from C4 to C6 using bone grafts held in place by a cervical plate attached with titanium screws.

The advantage of that technique over older surgical procedures is that the patient does not have to wear a neck brace and avoid moving his neck for many months. With the plate and screws holding the fusion in place, the patient can begin moving his neck almost immediately.

Recovery

After his first spine surgery a few days before Christmas in 2005, Rick says it was hard to get out of bed at first, but hospital staff helped him begin moving.

“I got home Christmas Eve to be home with my children,” he says. “They did therapy at the house for several weeks. I started off on a walker, and progressed pretty quickly to walking down the stairs, to walking around the block, to walking a mile, and so forth, until I was much better. It was a very successful surgery. As a matter of fact, I thought I was stronger after the surgery. I felt great.”

Recovery from his neck surgery in October 2008 was even easier than from his back surgery, Rick says.

“I was in the hospital probably less than 24 hours this time and then I went home and started the healing process,” he says.

He says the most amazing part of his recovery was the immediate disappearance of his headaches. Though they had felt like migraines, they were what are called cervicogenic headaches, caused by pressure in his neck.

“When I saw Dr. Cohen a week or 10 days after the surgery, I said, ‘I’m in a lot of pain still, but you know what? I haven’t had a headache yet.’”

Key to his recovery, he says, was following post-operative instructions, which included wearing an external bone stimulator around his neck that provided electromagnetic stimulation to promote bone growth in the area of the fusion.

“I did all the things that the doctor told me,” Rick says. “That’s the most important part: He told me what to do, and I did it.”

Today, Rick rarely has a headache and his neck pain is gone.

“It’s been a couple years of healing, but my neck is strong as ever,” he says.

Jots the Clown

He and his wife Monica opened their own clowning company, Circus Daze (www.circusdaze.com), in 2010. They have performed at corporate events for American Express and other companies, as well as at retirement homes and children’s birthday parties.

For a man who had terrible neck pain only a few years ago, it’s an amazing recovery.

“I feel like I’m in pretty darn good shape for a 49- year-old – bouncing around like a youngster right now,” Rick says. “I walk on stilts, I juggle, and I balance an eight-foot cane on my chin.”

Monica, who performs with him as Sonshyne the clown, watches in awe. “Every time I see him do that,” she says, “I remember when he couldn’t even move his neck at all.”

Knowledge is Power: How to Keep Your Back Healthy

Posted on October 15 2014 by Spine & Scoliosis Specialists

Date Published: October/November 2014
Author: Max W. Cohen, MD, FAAOSmax_cohen

Do you ever feel a twinge when you move a certain way and worry that a back problem is developing? Or perhaps you already suffer from lower back pain at times?

Many factors and conditions can affect the health of your spine. But almost all conditions, even those with a genetic component, can be influenced by things you do – or don’t do – in your daily life. Some of the most important influences are your posture, your weight, your bone density and whether you smoke.

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