Saving the Spine: Restoring Structure For Maximum Result
Back pain had been a constant in Jennifer Ford's life for years. "I always did sports," she said. The list was long - soccer, softball, tennis, track and basketball. She was good enough to be recruited by UCLA as a soccer player. Once there, she added lacrosse to her list of sports. She met her husband, Dustin, while leading cycling tours in France.
A decade later—after working in public relations, teaching second grade and having two children—Ford, 33, began to feel more than her usual pain. It was especially bad when she ran, pushing her kids in a double-jogger. "I was taking ibuprofen three times a day," she said. But that wasn't working. She was in such agony she went to see an orthopedist, an old family friend. He did X-rays and then an MRI.
He called and the Fords went to his office. "I knew it was bad when I looked at his face," she said. He told her she had a tumor in her back and, he said, she shouldn't lift anything, not even her purse. "That was very scary," Ford said.
The physical therapist said, 'Okay, let's go.' I was shocked. I was also excited, just to be able to walk.
The doctor he recommended was Eugene Carragee, MD, at Stanford Hospital & Clinics. Carragee, Vice Chairman of the Department of Orthopaedics & Sports Medicine, is also the director of the Hospital's Orthopaedic Spine Center. Carragee is the editor-in-chief of the North American Spine Society's Spine Journal and a physician who has worked with U.S. troops overseas as a lieutenant colonel in the U.S. Army Reserve.
Eugene Carragee, MD works with his physician assistant, Zoya Benjamin, to review patient test results.
Reading to her kids is an activity Jennifer Ford can do while she recuperates, this afternoon in Taylor's room.
Ford called on a Thursday and was scheduled to be seen the following Monday. But her condition continued to worsen over the next two days until she could barely walk. Her very concerned husband tracked down Carragee at the Hospital on Saturday. "I'm here," Carragee said. "Come see me. I think it's best you come in sooner."
Carragee ordered CT and MRI images of her back. When he looked at those, he immediately admitted her to the Hospital. On Ford's spine was a bone cist and a benign tumor the size of a lemon, Carragee said. It had grown so large it had compressed her spinal cord, impairing signals to her legs. "It looked like it had eroded into the bone," he said. "We set her up to try to remove as much of the tumor as we could and preserve function in her legs."
It took four hours. The growth clung densely to her spine's dura, a protective membrane that surrounds the spinal cord. "We had to peel it off," Carragee said. "It was nerve wracking."
Complex superstructure, comprehensive care
Removing the kind of tumor Ford had is not an everyday occurrence. But it is the kind of demanding surgery the Orthopaedic Spine Center is well equipped to do, Carragee said. The Hospital's orthopaedic physicians are responsible for several breakthroughs in spinal care, from techniques to improve recovery time from herniated disc repair to a higher precision of the diagnosis of spinal problems. The Center is also at the forefront of minimally-invasive surgery to the spine, using microdisection and microsurgery. Recently, the Center relocated to the new Stanford Medicine Outpatient Center in Redwood City. Available there are state-of-the-art operating rooms, equipment and imaging.
The spine is the superstructure that supports our bodies. Yet its complexities are challenging when age, injury or illness alter its components. Back pain affects one in three Americans, according to the National Association Spine Society. While some of that pain is temporary, many people endure problems for years. And the impact of aging can only be forestalled, not eliminated.
Regardless of the cause, finding a combination of proper exercise, physical therapy, medications or surgery to restore function is much easier than in years past. Physicians are far more able to figure out what's going wrong.
Stanford's Orthopaedic Spine Center has been recognized as one of the best in the country, with physicians specializing in treatment of a wide range of conditions, including scoliosis, disc herniation, degenerative spine disease, spinal infections, spinal reconstruction, and spinal deformities. The Center also works collaboratively with the Hospital's Pain Management Center and Neurosurgery Spine Clinic to offer patients a multi-department approach to spine care.
Stanford physicians have also been recognized worldwide for their work in developing techniques to evaluate how each patient might benefit from disc surgery to relieve lower back pain. They have also inaugurated improvements in the readability of diagnostic images. Compared to his early days of practice in the 1980s, Carragee is far more confident of the diagnosis and outcome when he operates. "It used to be that we did explorations," he said. "We just don't do that now. If you use all the available imaging methods, the number of times where you go in and don't find what you think you're going to find is less than 5 percent."
I'm lucky. I'm a walking miracle. After you go through something like this, you want to cherish every moment.
Sometimes the surgical challenge can't be predicted. Ford's vertebrae was so damaged by the tumor that Carragee had to remove it almost completely. He added a titanium rod to Ford's spine and inserted bone grafting on either side. Two days later, however, Ford needed a second surgery to close a microscopic hole in the dura where the tumor had thinned it to extreme fragility.
How to Keep Your Spine Healthy
• Practice good posture - Standing up straight and sitting properly prevents stress on the spine.
• Sleeping position matters - Sleeping on your side or back is best.
• Use your knees - Bending over with legs straight and hoisting up weight is responsible for many, many back injuries.
• Maintain appropriate weight - Extra weight is another strain on the spine.
• Exercise regularly - Include aerobic and weight-bearing activities. As you age, think about changing your choices to low-impact activities.
• Strengthen your core muscles - A strong core helps support the spine.
• Stretch your body - Flexibility is important. If you have already injured your back, or have suffered from long-term back pain, consult your doctor about which stretching exercises will work best for you.
• A healthy diet - Eating fruits, vegetables and whole grains is recommended.
• If your back hurts, see your doctor.
For More Information
• The Stanford Health Library: Stanford Shopping Center, 650-725-8400; Stanford Hospital, 650-725-8100; Stanford Comprehensive Cancer Center, 875 Blake Wilbur Dr., 650-736-7157. Website: healthlibrary.stanford.edu
• The Stanford Hospital & Clinics Orthopaedic Spine Center, 650-725-5905.
Cooperation for optimal results
Carragee called Laurence Shuer, MD, a Stanford neurosurgeon, to join him in the operating room. "Our high degree of cooperation is a real benefit to the patient," Carragee said. "We can call on the great depth of resources we have right here in oncology, neurosurgery and other fields. That's the way it should work especially in cases like this."
Shuer patched the hole with one tiny stitch and covered it with glue made with a substance that is part of the body's own coagulation process. That fibrin glue is a huge advance from techniques once considered standard. "In the old days we would have used muscle taken off her back or a connective tissue from her thigh," Carragee said.
Ford had to lie flat on her bed for 24 hours. By the second day, she was up on her feet. "The physical therapist said, ‘Okay, let's go.' I was shocked. I was also excited, just to be able to walk."
Ford went home a couple of days later. But she's still seeing Carragee and goes for check-ups at the Orthopaedic Clinic's new location in the Stanford Medicine Outpatient Center in Redwood City.
She must be very careful with her healing spine and won't be able to pick up her children for months. Despite that restriction, she said, "I'm lucky. I'm a walking miracle. It just shows how fragile life is. We forget, but this has made me reflect. After you go through something like this, you want to cherish every moment."
About Stanford Health Care
Stanford Health Care, located in Palo Alto, California with multiple facilities throughout the region, is internationally renowned for leading edge and coordinated care in cancer, neurosciences, cardiovascular medicine, surgery, organ transplant, medicine specialties and primary care. Stanford Health Care is part of Stanford Medicine, which includes Lucile Packard Children's Hospital Stanford and the Stanford University School of Medicine. Throughout its history, Stanford has been at the forefront of discovery and innovation, as researchers and clinicians work together to improve health, alleviate suffering, and translate medical breakthroughs into better ways to deliver patient care. Stanford Health Care: Healing humanity through science and compassion, one patient at a time. For more information, visit: StanfordHospital.org.