Target: Spinal Stenosis

John White, 70, is an active guy. Retired from the military, police and federal court, and still running his own private investigator business, it’s not in his nature to be sedentary. But worsening back and leg pain had seriously curtailed his ability to maintain an active lifestyle. “I could get up and walk around, but I was limited in how far I could walk,” the Palm Desert resident relates. “I had to cut my exercise routine by about 80 percent.” The culprit was spinal stenosis, a narrowing of the open spaces within the spine, which can put pressure on the spinal cord and the nerves that travel through the spine to the arms and legs. White also had spondylolisthesis (instability of the spine), caused when one vertebra slips forward on another, also narrowing the spinal canal.

Conservative measures first

Under the care of Board Certified Orthopedic Surgeon David Tahernia, MD, at Eisenhower Desert Orthopedic Center, White first tried conservative measures to manage his pain.

“I took pain pills, I’d lie down in the middle of the day to rest my back, and I was icing it several times a day,” he relates. “I also tried an epidural injection, but it only gave me relief for a few days.

“I knew I needed surgery,” he continues. “Dr. Tahernia had shown me my MRI and I could clearly see the bulging disc pushing against the nerve. I have an engineering background, so I recognized a mechanical problem when I saw it. And it required a mechanical solution, so I was ready to cut to the chase and have surgery.”

Unfortunately, White had undergone the placement of three heart stents several months before his back and leg pain started. As part of his postoperative care, he was taking what he characterizes as “pretty heavy duty” blood thinners. As a result, his cardiac surgeon said that, due to the risk of bleeding, he shouldn’t undergo any invasive surgery for a year.

“So when the back and leg pain started, I put up with it for nine or ten months, trying the conservative treatments, but it wasn’t fun,” he says with great understatement.

New advances make outpatient back surgery possible
White finally was cleared to undergo surgery on June 21, 2016. It was an outpatient procedure that took only 45 minutes, and he was home a few hours later. With advances in technology and minimally invasive surgical techniques, outpatient surgery is becoming increasingly standard. In fact, an estimated 60 percent of surgeries, including orthopedic procedures, are performed on an outpatient basis today.

“Mr. White was a good candidate for this type of procedure,” Dr. Tahernia explains, noting that his patient had severe stenosis at the L3 and L4 level in his lumbar (lower) spine, and some moderate, but not severe, spinal instability.

“We did a bilateral decompressive laminoforaminotomy to relieve the pressure on the nerves,” he says. “Then we inserted what’s called a Coflex® Interlaminar Stabilization Device.”

The Coflex device is a titanium metal implant that helps keep the spine stable after surgical decompression. It’s strong yet flexible enough to support the spine and maintain motion without having to fuse the bones together with metal rods and screws — the traditional approach to spinal fusion that’s been in use for the past 20 years, and which immobilizes a segment of the spine.

While the Coflex device is not an option for every patient with stenosis, Dr. Tahernia is able to offer it to appropriately selected patients like White. And it is covered by Medicare.

“We use a small incision — about two inches — to insert the device, so there’s not a lot of soft-tissue trauma,” Dr. Tahernia says of the minimally invasive procedure. “There’s also less bleeding and a faster recovery. Most patients can go home the same day. “Mr. White’s other option would have been lumbar fusion, which is a bigger surgery with a longer recovery,” he adds. “It was nice to be able to offer this instead.”

White certainly agrees.

A faster recovery
“I had zero pain after surgery, even after the anesthesia wore off,” says White. “I was restricted in my activities for the first few months, especially when it came to twisting, bending and lifting. But I was back to driving within two weeks, sitting in a car seat with good back support, and being careful getting in and out.

“Dr. Tahernia also gave me fantastic instructions about exercising in the pool,” White continues, “and that was to walk, not swim, from one end to the other. I gradually increased the number of laps and, as my strength built up, I wore tennis shoes to create drag so it required more strength. I’ve worked up to 25 to 30 laps, and it’s made a tremendous difference.

“Today I feel as if I’m back to as if I never had a problem,” he adds, four months post-surgery. “I’m impressed. But I also followed his instructions to the letter.” Notably, White had confidence in Dr. Tahernia’s skills even before he needed spinal surgery.

“We used to live in Orange County,” he relates. “My wife had had 11 back and neck surgeries while we were there — four procedures for the same issue — and she continued to have problems. No one there seemed to be able to diagnose why she was still having pain after so many surgeries.

“So when we moved here to the valley seven years ago, we asked around for a good orthopedic surgeon, and Dr. Tahernia came highly recommended,” he continues. “My wife saw him, he did imaging tests and diagnosed the problem. Then he performed surgery, and her back pain and problems are gone.

“Based on her experience and now my own, I know he does a careful evaluation and really nails the problem,” White adds. “He provides A-plus care, clear instructions about what to do and not to do after surgery, and excellent follow-up.”

To learn more about Eisenhower Desert Orthopedic Center, call 760-773-4545.