Ready to ride

Lea Douglass, 66, had suffered from back and leg pain for 20 years.
 
“I’m a hairstylist and I stand for hours every day,” she says. “That’s what the doctors said caused the problem.”
 
The problem was spondylolisthesis, a condition in which a vertebra in her lumbar (lower) spine had shifted over the bone below it. With that came stenosis, a narrowing of the spinal canal that put pressure on the nerves, causing leg pain.
 
Surprisingly, Douglass could still ride her horse — a passion of hers.
 
“When I sat and my legs were bent at the hip, it relieved the pressure on that part of my spine, so riding was one of the more comfortable positions for me,” she explains.
 
The pain from standing at work, however, became increasingly intolerable. She tried cortisone injections, working up to 18 shots in one year. She underwent a minimally invasive procedure called rhizotomy, in which targeted sensory nerves innervating the joints in the spine are heated or burned to help relieve back pain. She was even the first local patient to participate in a clinical trial in which she wore a device designed to block pain signals to the brain.

But nothing worked. And by spring 2014, Douglass was wearing  a fentanyl patch and taking eight narcotic pills a day to manage the pain. It was not how she wanted to live her life.
 
Then, one of her longtime clients, a cardiac nurse, recommended Alfred Shen, MD, Board Certified in Neurological Surgery.
 
“I met with him twice and I liked his manner and his plan for treatment,” she says of Dr. Shen. “He’s very kind, and he took time to explain everything. And his staff is wonderful.”
 

“Mrs. Douglass had done the right thing by trying conservative measures first, and she did all she could possibly do over the years to manage the pain,” Dr. Shen says. “But she was wise enough to seek out a surgical option after the injections weren’t working.
 
“In reviewing all her radiographic studies, she had a very isolated problem at a single-level, with clear-cut misalignment and stenosis. More importantly, her symptoms were related to this single issue, and so the decision to  recommend surgery was fairly clear cut,” he adds.
 
On April 24, 2014, Dr. Shen performed an L4 lumbar decompressive laminectomy, L4-5 interbody fusion with instrumentation, and reduction of L4-5 spondylolisthesis.
 
“We freed up the pinched nerves, brought her vertebra back into alignment and fused it with instrumentation and her own bone in a normal position,” he explains.
 
Douglass was up walking the morning after her surgery, and stayed in the hospital for just two nights.
 
“I never had physical therapy,” she says. “Dr. Shen just told me to walk, so I worked up to three to four-and-a-half miles a day. About two weeks after surgery, I was completely off pain medication. And while they told me I’d be out of work for three months, I was back in six weeks,” she adds, crediting her “strong bones.” She also resumed riding her horse last fall when the summer heat subsided.
 
“The key to Lea’s success was being able to identify the source of her pain,” notes Dr. Shen. “Patients and physicians often get caught up in treating the pain and overlook the underlying cause or source of the pain. Once the potential pain generator(s) are identified, then one can recommend a treatment plan, which may include conservative measures. When one recommends surgery, it must be based on clear indications, which means that the source of the patient’s pain has been objectively identified and conservative measures have failed. Lea’s recovery has been fantastic. She, however, must also be credited with her own success as she has been an active participant in her spine care throughout this process.”
 
“I feel just fine,” Douglass notes. “I rode yesterday, did a bunch of gardening, and today I’m off to Los Angeles to see my children and grandchildren. My back just isn’t a problem anymore.
 
“I couldn’t be happier,” she adds.