Back to the Future

Patient chose her spinal surgeon nearly 15 years before she would need his services

When Maria “Lupe” Ayuso learned she needed spinal surgery to relieve the back pain she had endured for a decade, she didn’t have to research who she wanted to perform the intricate operation. 

She knew it would be the same neurosurgeon who undertook two successful back surgeries for her mother nearly 15 years earlier — Alfred Shen, MD, a Board Certified Neurosurgeon with Eisenhower Neuroscience Institute. 

“He was so personable and attentive,” she recalls. “And my mother’s surgeries went very well.” (Her mother agrees.) Ayuso told Dr. Shen in 2005, “If I ever injure my back and need an operation, you are the only one I want to do my surgery.” 

A decade before that prophetic sentence, Ayuso, an experienced medical admissions clerk, accompanied her sister to her job at Eisenhower Health. Ayuso left with a new position of her own in the Admitting Department. She later became office secretary to Lee Erlendson, MD, Board Certified in Anesthesiology and Pain Management. 

The first signs of pain
In 2008, Ayuso began experiencing pain in her lower back but brushed it off. An active walker, she typically logged up to seven miles a day. She also enjoyed lifting weights at her local gym. Somehow, during that time, she injured her back.

“I still don’t know how it happened,” says Ayuso. She only knows the pain kept getting worse. Under Dr. Erlendson’s watchful eye, she tried anti-inflammatories and pain medications, including steroid injections. 

That helped for a while, but she gained weight on the steroids and she stopped taking them as frequently. She learned to live with the pain — until she couldn’t. Only lying down brought some relief. “My back wouldn’t let me do what I wanted to anymore,” she says. “I couldn’t move.”

The back pain affected Ayuso’s home life and work life. “I don’t want to be 50 percent of myself when I work,” Ayuso says. “I want to give all of myself.” 

A common problem area
Two MRI scans revealed a potential problem spot at her L5-S1 spinal segment, the lumbosacral junction, which is the transition point between the lumbar spine and sacral spine. “It is one of the most common areas in the lower back people have disk problems,” says Dr. Shen. 

Then, Ayuso developed jabbing pain in her sciatic nerve. The sciatic nerve starts in the lower back and runs down each leg. Occasionally, her right leg and toes went numb. On the left side, she experienced constant numbness of the calf and toes. Ayuso, a big believer that “life goes full circle,” remembered her pledge to Dr. Shen. She made the call.

“These word-of-mouth referrals — whether from someone’s family member, friends, another patient or a colleague — are the ones I appreciate the most,” explains Dr. Shen.

He listened carefully as Ayuso outlined her symptoms and experiences with back pain. Her experience working alongside a pain management specialist helped her describe factors that would aggravate or relieve some of her pain issues. “Everything she told me was important to helping me sort out where her pain was coming from,” says Dr. Shen.  

Dr. Shen reviewed Ayuso’s MRI scans for clues. Each explained a potential source for her problems — a protruding disk and degenerative disk changes — but no other mysteries. Dr. Shen ordered an electromyogram (EMG) to help detect neuromuscular abnormalities. It told him Ayuso’s sciatic nerve on the right side was irritated, while the left had chronic changes, zeroing in on the leg numbness.

A final imaging test called a discogram enabled Dr. Shen to confirm that no neighboring disks were involved. 

Ayuso was ready for surgery. But first, she had to overcome an issue with her insurance company, which had denied coverage. In her job, Ayuso routinely helps patients get approvals for insurance. Now she had to be her own advocate. 

“Working with patients and being a patient yourself is an eye-opener,” she says. She wrote to the California Insurance Commissioner, sending proof of the need for the surgery. Soon she received the go-ahead. 

The day for surgery arrives
In December 2019, Dr. Shen performed a posterior interbody fusion to remove Ayuso’s problematic disk, then fuse together the unstable vertebrae so they could heal into a single, solid bone.

In a posterior procedure, Dr. Shen approaches the lumbosacral segment through an incision in the lower back. “I usually prefer this approach because it gives me more direct access to the nerve and underlying disk, and involves only one incision, which aids in healing,” he says.

Ayuso went home from the hospital just before Christmas. Dr. Shen prescribed walking, adding a few steps every day. By week four of recovery, he suggested she try one mile. She went three. By spring 2020, about three months post-surgery, Ayuso was up to six to 10 miles daily. 

Ayuso couldn’t be happier with the choice of surgeon she made years ago. “There are a lot of excellent doctors,” she says. “But if you want a great surgeon who is also caring, respectful, and an excellent listener, go see Dr. Shen.”

For more information, call Eisenhower Neuroscience Institute at 760.837.8020, or visit EisenhowerHealth.org/Neuro.