The latter scenario is what happened to Marina Avila, 75, last March.
“After cleaning out some linen closets, I started feeling a little pain in my lower back,” the Rancho Mirage resident relates. “I lay down for a little while to relax, thinking it would go away, but it was still there when I got up.”
Her discomfort continued through the evening, but she went to bed assuming it would resolve by morning. When she woke up in the middle of the night to use the bathroom, however, it had gotten worse. Much worse.
“I got out of bed and took a few steps and the pain was excruciating,” Mrs. Avila says. She managed to use the toilet, but on her way back to bed, the pain was so severe that she fainted and fell to the floor.
“When I came to, my husband tried to help me, but I couldn’t get up or even crawl to bed,” she continues. “I told him to cover me with a blanket and let me sleep on the floor.” [MORE]
In the morning, she was able to get on her feet and back into bed where she stayed for a couple of days. The pain persisted, worsening when she stood or tried to walk. She also had numbness in her right leg. Her daughter, an ICU nurse at Eisenhower Health, insisted that Avila go to the hospital to find out what was wrong.
She was admitted to the emergency department (ED), underwent an MRI scan, and Board Certified Neurosurgeon Alfred Shen, MD, was asked to consult with her.
“The MR imaging done in the ED showed a large disc herniation at L4-5, between the two lowest vertebrae of the lumbar spine,” Dr. Shen explains. Also called a slipped or ruptured disc, a herniated disc occurs when the gel-like pads between vertebrae slip out of position. While some herniated discs cause no symptoms, others can compress or irritate nearby nerves and cause pain, numbness or weakness.
“This certainly explained Mrs. Avila’s symptoms,” Dr. Shen notes.
“Based on my examination and the imaging, my recommendation was to first treat her conservatively with intravenous steroids to reduce the inflammation, and some oral and intravenous analgesics for the pain,” he continues. He also had a physical therapist work with her to teach her how to mobilize in and out of bed without too much twisting.
Within 24 to 36 hours of initiating the steroids, Mrs. Avila’s pain began to lessen and she was able to move with the aid of a walker.
“Since her pain was improving and she was able to ambulate, we gave her the option of going home to recuperate or going to rehabilitation, then coming back to see me in the office in a few weeks,” Dr. Shen relates. “The caveat was if she experienced any changes or weakness, she should come back sooner versus later. I was comfortable knowing her daughter would be looking after her.”
Surgery was still an option, too, but as Dr. Shen notes, “This was around the time when the pandemic first hit and we were still figuring out protocols about who should go to the operating room.”
Mrs. Avila opted to try inpatient rehabilitation and underwent 18 days of physical and occupational therapy.
“A couple of days after I arrived, they stopped all visitors due to the pandemic,” she recalls. “I was counting the days until discharge.”
Dr. Shen saw Mrs. Avila in April, about two weeks after her discharge from rehabilitation. “She was able to walk about 200 feet with a walker, and still had sciatic pain that was a two out 10 at rest, and a six out of 10 with ambulation,” he says. “At this point, she’d been in pain for about a month. I recommended surgery, knowing it would take a week or so to get it scheduled.”
Mrs. Avila agreed. As part of performing due diligence, however, her son-in-law sought a second opinion from Volker K. H. Sonntag, MD, a pioneer in spinal neurosurgery and emeritus professor of neurosurgery at the renowned Barrow Neurological Institute in Phoenix.
After reviewing Mrs. Avila’s case, Dr. Sonntag not only agreed that surgery was indicated, but that she’d be “in good hands” with Dr. Shen. Turns out, Dr. Sonntag had been one of Dr. Shen’s mentors during his residency training at the Barrow Neurological Institute in 1998.
“I performed an L4 laminectomy [removal of the vertebral arch to ease pressure on the spinal cord or nerve roots and to access the disc] and an L4-5 discectomy [removal of abnormal disc material that’s pressing on the nerve roots],” Dr. Shen relates. “While this is usually fairly routine surgery, due to the size of Mrs. Avila’s herniation, it was more challenging. It wasn’t just a bulge but an almost complete blow-out, and the sac of nerves that traverses that area was pretty severely compressed.”
Using a surgical microscope, Dr. Shen had to tease out fragments of disc material that were pushing on the nerves. Once this painstaking process was complete, he could see the outer covering of the spinal nerves (thecal sac) relax as compression eased. After completing the discectomy, he irrigated the area with antibiotic solution and closed the incision.
“Therapists were able to get Mrs. Avila up walking the same day, and you could see in her face that the pain was pretty much gone,” Dr. Shen says. She went home the next day.
Today, Mrs. Avila says that she’s “over 90 percent” better, with just a little bit of residual numbness and tingling in her right heel.
“I thank the Lord every day that I can walk around and move without the pain,” she says.
“Mrs. Avila’s experience emphasizes the importance of proper body mechanics,” says Dr. Shen. “That means bending at the knees, not the waist, and to avoid heavy lifting.”
“I never thought about bending properly before,” Mrs. Avila admits. “Now, when I see people at a store bending from the waist, I think, ‘oh, gosh, they’re not doing it correctly!’”
“I learned my lesson,” she adds.
For more information about Eisenhower Neuroscience Institute,
call 760.837.8020 or visit EisenhowerHealth.org/Neuro.