Spinal Surgery to Relieve Leg Pain

"This surgery - it changes your outlook, which changes your life."- Ron Young
RON YOUNG HAD PUT OFF BACK SURGERY for as long as he could. “I’d been managing back pain since the early eighties,” the active 76-year-old Rancho Mirage resident says. “And I’d tried it all — exercise, pain medications, multiple back braces, and physical therapy. They helped me cope, but it didn’t get any better.

“My primary care physician had referred me to a good pain management doctor who helped me a lot with [epidural] injections,” he continues, “but I finally realized that I needed surgery.” That realization occurred about a year and a half ago. “I was on a cruise and took an on-shore tour,” he recalls. “I had such a heavy sensation in my legs and felt I had no strength, so the first thing I did was find a place to sit. That happened with every tour during the cruise. When I got home, I figured it was time to look into a surgical option.”

He first saw Board Certified Neurologist Samir Macwan, MD, who did a thorough workup to determine the cause of the heaviness in his legs and, by this time, numbness had developed in Young’s legs. Dr. Macwan then referred Young to Alfred Shen, MD, who is Board Certified in Neurological Surgery at the Eisenhower Neuroscience Instititue.

"With experience, you gain a sense of how much bone can be removed without the risk of destabilizing the spine and creating the need for a more complicated surgery."- Alfred Shen, MD
“Mr. Young had been having progressive numbness of his legs and feet since 2017,” Dr. Shen says. “The unusual thing was that it was ascending, starting in his feet and going upwards. This is a hallmark of peripheral neuropathy, damage to nerves outside the spine and brain, and Dr. Macwan did an electromyography test that confirmed the peripheral neuropathy issue.

“But the other major issue Mr. Young had was his progressive inability to walk very far,” he continues. “He attributed it to the numbness, but peripheral neuropathy doesn’t necessarily preclude you from walking long distances. Yet by the time I saw him, he could walk only about three blocks on a good day, or one block on a bad day before he had to stop. An avid hiker and walker, he used to be able to go miles without stopping.

“When we met, he described that he was experiencing a sensation of heaviness in his legs,” Dr. Shen says. “The more he walked, the heavier his legs felt. He also was experiencing a deep ache in his legs with prolonged walking, but no shooting pains down his legs like most back patients. This was definitely different from what we normally see.”

As part of his workup, Dr. Shen ordered an MRI of Young’s lumbar spine. It revealed stenosis (a narrowing of the spinal canal), and spondylolisthesis (a spinal disorder in which a vertebra slips forward relative to the bone below it; this misalignment can also cause stenosis).

After trying one more round of conservative treatment that included physical therapy and an epidural injection — which didn’t relieve Young’s symptoms — it was time to talk about surgery.

“I liked that Dr. Shen didn’t push for surgery right away,” Young says. “And when the time came, he went over exactly what he thought could be done.”

“We recommended a procedure called laminectomy,” Dr. Shen explains, referring to surgery in which the lamina — the back part of a vertebra that covers the spinal canal — is removed. Also called decompression surgery, laminectomy enlarges the spinal canal to relieve pressure on the spinal cord or nerves. “The idea was to give the spinal nerves more room and allow for better circulation in those areas.”

There was also the possibility that Dr. Shen would have to fuse the vertebrae in Young’s lumbar spine that were malaligned or affected by spondylolisthesis. While X-rays affirmed that this portion of his spine was stable, the laminectomy could cause his spine to become unstable if too much bone was removed.

“With experience, you gain a sense of how much bone can be removed without the risk of destabilizing the spine and creating the need for a more complicated surgery that included fusion,” says Dr. Shen. “But until you get in there, you can’t know for sure, so we had to discuss this risk with Mr. Young.”

“I understood that I wouldn’t know until I woke up whether Dr. Shen had to do a fusion,” says Young. “But if in his judgment I needed it, he’d go ahead so I wouldn’t be facing a second procedure down the line.”

“I also had to discuss the fact that while surgery to decompress the nerves would help relieve the leg heaviness and help him walk farther, the numbness from peripheral neuropathy would likely not improve,” Dr. Shen says. “His was one of those cases where there was more than one neurological diagnosis, one of which could be helped with surgery, and one not. It was important to establish this before surgery so he had realistic expectations.”

Young has been very happy with the outcome.

“When I took my first steps after surgery, I knew what Dr. Shen did had been successful and it was helping me,” he says. “That heaviness and pain were greatly alleviated. The nurses and therapists walking me couldn’t believe I was doing so well.”

Young recalls how Dr. Shen told him that when he “shaved” back the lamina on his affected lumbar vertebrae, he could actually see the spinal cord sack re-expand as the pressure was relieved. And Young did not require spinal fusion.

After his surgery, Young was once again able to join his family on vacation and play with his grandkids.
Within two weeks, Young was able to walk a half-mile; two months later he could go a mile without stopping. But the real “proof in the pudding” came when he traveled to the New Jersey shore in early summer for an 18-day visit — something he never would have attempted before surgery.

“My return flight was delayed on the runway due to a storm, I missed my connecting flight and had to spend the night in Dallas, and then stand in line to get re-ticketed,” he relates. “I never could have endured that before.

“But now I have confidence in what I can do, and I’m planning another trip East in the fall to see my son in Massachusetts,” he says. “This surgery — it changes your outlook, which changes your life.”

To contact Eisenhower Neuroscience Institute, call 760.837.8020.