Orthopaedic Surgery at Stanford Restores Spine Altered By Scoliosis
Just like most of us, Jerry Stark took his physical strength for granted until the first time it didn't respond the way it always had—and delivered word of its new status with a sharply-sent message of pain.
Stark had spent most of his working life as a house painter in Santa Rosa, crawling up ladders, over roofs, through attics. Often he was carrying full five-gallon cans of paint at the same time. It was hard physical work, but Stark didn’t think twice about it. "When you're doing physical things all the time, you just keep doing them," he said. "You never think you won't be able to. It's just what you do."
He figures it might have been about 20 years ago that he lifted something "and I lifted it wrong," he said. "I dropped to my knees in pain and couldn't get up." After a few minutes, the pain was gone and he returned to work as if nothing had happened, he said. But many more years as a painter would exact a heavy toll. By the time he saw Ivan Cheng, MD, an orthopaedic surgeon at Stanford Hospital & Clinics, he had endured nearly 30 years of increasing disability from a spine that had degenerated into a twisted, bent version of its once-straight self and with it any semblance of a normal life.
"When they asked me at Stanford what my pain level was—they go by numbers 1 through 10—I started with an 11," Stark said. His spine was curving into an extreme S shape and sloping forward, too. Very little about Stark's life was normal, especially since he needed so much medication for his pain that he felt drowsy most of the time. Work was out of the question. And small inconveniences symbolized his deterioration—the day arrived when Stark was so bent over he could no longer see his face in his bathroom mirror.
I kept thinking, 'You can exist this way. It's not going to get worse.' Then you look in the mirror and it is worse. And you know you have to do something about it.
Back pain is a health complaint so common that the National Institutes of Health estimate it may have visited as many as 85 percent of adults in the United States at least once in a lifetime. The causes are many. Some of us may injure our backs with one bad lift of a heavy box. Age-related changes to the spine's system of bones and cartilage bring their own type of pain.
Stark's scoliosis, like that diagnosed in 6 million others in the United States, had no definitive cause, although genetics and biology may play some part. The abnormal curvature of the spine can appear at any time of life. With age, however, comes the natural degeneration of discs, the pads of cartilage that cushion the spine's stack of bony vertebrae. Bone on bone grinding becomes one cause for pain; pinched spinal nerves can send pain signals down through the legs.
For many, medication and other non-surgical treatments can alleviate the discomfort caused by scoliosis’ misalignment. For others, including Stark, the changes caused by the condition may require surgery. Until recently, such surgery was very risky and could mean months of hospitalization toward an end result that was not always positive. Stark, fearful, tried to ignore what was happening to his body. "I kept thinking, 'You can exist this way. It's not going to get worse.' Then you look in the mirror, and it is worse. And you know you have to do something about it."
With these minimally invasive techniques, where we can achieve the same amount of correction, we can minimize the amount of blood loss and the amount of anesthesia - really enhances recovery.
"Twenty years ago, there probably would have been a lot of reluctance to operate on Mr. Stark," said Cheng. "Surgery for these types of spinal problems often took multiple procedures, staged over days, with massive blood loss and patients might lay in bed for six months at a time."
New techniques—and hope
What Cheng and other orthopaedic surgeons now have available are new, minimally invasive ways to enter the body and new implants endowed with technology that makes them more reliable. Stark and his former wife, Pam, who volunteered to be part of his post-surgical support team, along with his grown children, began to interview surgeons. At one facility, they waited four hours to see a surgeon; they liked him but were put off when, after presenting him with some questions, he directed them to his assistant. They decided they'd seek a second opinion at Stanford. "I think the longest we waited was 10 minutes," said Pam Stark. "He pulled everything up on a computer and explained everything. He didn’t hold back. And he said, 'Anytime you need to call me, you can call me.' When we left there, I told Jerry, 'He's the guy.'"
At 68, with significant spine issues, Stark did present a challenge, even for an experienced surgeon like Cheng, but Cheng was impressed with Stark's spirit. "Because of his deformity, he could barely walk, even with a walker, but he was still a vibrant individual. You could see that he was very motivated to accomplish a lot more in his life, that he really wanted to get something done that would allow him to move on with his life."
- Know how to lift safely. Never bend over an object at the waist; lower your body by bending at the knees. Keep the object close to the body.
- Good posture also helps to reduce strain on the spine. When sitting, tip weight forward on the pelvis instead of leaning back; draw chin back instead of jutting jaw forward.
- Exercise in ways that strengthen your back muscles, warming up slowly before beginning. Developing core muscles also supports a strong back.
- A supportive mattress and pillow you sleep on can be beneficial to spine health.
- Think about what kind of shoes you wear—and how you carry a purse or shoulder bag. Wearing high heels and carrying a heavy bag on the same shoulder can contribute to stress on the spine.
- Alternate between sitting and standing during the day.
- Maintain a healthy weight.
I'm so glad I did it. It's like a new life—and I feel good when I look in the mirror now.
- Physiotherapy, including massage, whirlpool baths, ultrasound
- Chiropractic care
- Posture adjustment
- Surgery, including fusion, decompression, microdiscectomy
In Mr. Stark's first surgery, Cheng avoided the traditional large incision approach along the spine and, instead, made just three small incisions along the side of his torso. Through these incisions, in a relatively short three-hour process, he was able to remove Stark's damaged discs and replace them with synthetic spacers. "With these minimally invasive techniques, where we can achieve the same amount of correction, minimize the amount of blood loss and the amount of anesthesia—that really enhances recovery," Cheng said.
In a second procedure five days later, Cheng did use a large incision along Stark's spine to place titanium screws and rods to complete the straightening and stabilization. Again, the procedure was relatively short—about five hours.
An active life restored
Cheng had estimated that it might take Stark up to a year to regain normal function, but at seven months out, it's hard to tell that anything was ever wrong with Stark. He's been completely disciplined about his physical therapy and has found delight in returning, with full vigor, to a full life, right down to details like jeans. Before his surgery, the curvature in his spine was so extreme he couldn't fasten a belt around his waist and could only wear sweat pants. Once he was upright again, one of the first purchases he made was a new pair of Levis. He also takes some pride in showing off the before and after X-rays of his spine. "This one shows the extreme curvature of the spine," he explains. "Everything was moving." Then he holds up the after image. "This is when Dr. Cheng was finished. Here's the new Jerry Stark."
He has a few kinks in his mobility yet to work out. "I'm still in pain at different times, doing different things," he said, "but I'm so glad I did it. It's like a new life—and I feel good when I look in the mirror now."
0:02 This is a good one right here to start with. It shows an extreme view of how much I was
0:10 Mr. Stark had a degenerative scoliosis, which means that he had an abnormal curvature of
0:15 his spine when you look at his spine from the front view. And, he was stuck in this
0:19 position and he couldn't stand up straight at all.
0:22 I was in serious back pain.
0:26 Each year it would get progressively worse. He got tired to the point to where he was
0:31 on so much pain medication he didn't have a quality of life.
0:36 A lot of changes occur in the spine that are very common as we get a little bit older.
0:41 The discs start degenerating, some of this degeneration and collapse can occur asymmetrically,
0:46 so the cushioning between the bones is no longer there. Plus, all the arthritis there
0:52 to begin with, and all these things were combining, to cause him a lot of problems.
0:57 It got so bad that I felt I had to do something about it. I have a pain doctor that recommended
1:03 Dr. Ivan Chang at Stanford. We went to see him and, he was right on from the beginning.
1:12 This is a type of complex deformity that probably, the majority of surgeons, either are not willing,
1:19 or are not trained, to treat. It certainly is in the higher end of challenge in terms
1:23 of spine surgery.
1:24 Dr. Chang came in. He pulled everything up on the computer. He explained everything,
1:30 He didn't hold back.
1:32 Dr. Chang made you feel like, "Let's go take care of it. Everything will be all right."
1:37 We booked the operation and I thought it was going to be actually, a one-year recovery.
1:44 I mean, look at him. Seven months. I mean after a month he was up. He was so well taken
1:53 care of.
1:55 There are multiple advances in spine surgery that make major undertakings like this much
1:59 more tolerable for patients. We have better implants these days that can really achieve
2:05 greater correction of these spinal deformities with less work. Plus these minimally invasive
2:11 techniques, while we can achieve the same amount of correction, we minimize the amount
2:15 of blood loss, minimize the amount of anesthesia, and I think, it really, enhances their recovery
2:21 rate. We were able to get Mr. Stark up in, in, the day after surgery.
2:24 When Dr. Chang was finished, here's the new Jerry Stark.
2:30 And now you can see, not only the extent of the surgery, including all the instrumentation
2:34 and all the metal, but you can see overall, how better aligned he is now.
2:38 You know, we can look at all the x-rays we want, but looking at him clinically, he's
2:42 walking independently, and he is one of the happiest patients I can imagine.
2:47 It feels so good. It's like a new life. And, I feel good when I look in the mirror now.