Laser back surgery the answer for one patient
By Betty Cianci

This is part one of a two part series. Part I details Mrs. Cianci's need for back surgery and her decision to have it done by laser. This will be followed by Part II next week, detailing her actual experience.

Walking through Philadelphia's International Airport some months ago, I was startled when a U.S. Airway's employee driving a motorized cart stopped and called out, "Are you okay?"  I looked at the woman dumbfounded.  I told her I was "fine."  She looked at me again and said, "Are you sure?"  I nodded my head and darted into the nearest women's restroom.

Studying my reflection in the mirror, I wondered why the employee thought I looked on the verge of collapse.  I had to admit there were times I felt unsteady but attributed it to sinus.  I would call my internist for an appointment.

Several days later in the internist's office, I described the airport incident.  My doctor asked me to walk back and forth across his office.  He agreed with the airline employee, my gait was not normal.  He asked about other symptoms.  I mentioned neck pain and back pressure.  He wrote orders for MRIs of the brain and spine and also made an appointment for me to see a neurosurgeon. 

My brain scan was normal but the MRIs of my lower back showed severe spinal stenosis with a narrowing of the spaces in my spinal column causing compression to the spinal cord and nerve roots. My neurosurgeon said I needed "decompression surgery."  The operation was not life threatening but if not performed within a reasonable time, I could risk partial paralysis with loss of bladder and bowel control.

The neurosurgeon laid out the surgical procedures: hospitalization for three days, rehab facility for two weeks of physical therapy, and 12 weeks of home recuperation.  He noted the surgery would be painful and the results not necessarily apparent.  However, the spinal deterioration would stop.

Back home, I researched "spinal stenosis, its causes and treatment" on my computer.  Several medical websites mentioned laser surgery as less invasive.  I talked with a friend who had suffered from a similar condition and recently underwent conventional open-back surgery.  He told me his surgical procedure was lengthy and he suffered a heart attack while under anesthesia.  Bypass surgery was needed and performed within a few days.  His recovery from the heart surgery went well but his stenosis recovery had been hindered.  He is now in constant pain and uses a walker.  After hearing of his experience, I continued my research.

Most laser surgeries in the United States are performed in ambulatory facilities located around the country and staffed by surgeons who have undergone extensive training in the field.  Many spinal institutes offer "potential patients" a free initial study of their MRI results.  A medical staff member reviews reports and notifies individuals if their condition can be surgically handled at their facility.  Before any surgeries are performed patients must bring MRI films, EKGs, and other requested reports to the facility for final determination.

The downside to this surgery is that insurance, including Medicare, will cover surgical charges except for an approximate $10,000 operating room fee.  Medicare only covers this fee when surgery is performed in a hospital they authorize.  The public can check on the performance and experience of particular surgeons and facilities by going into a website called, http//www.healthgrades.com   According to my internist, this site is highly respected.

Laser surgery is performed under local anesthesia.  The doctor makes a small incision near the site of the problem area and a drinking straw-sized tube is inserted into the spine.  Afterwards, a series of larger tubes are inserted, one on top of the other, gradually expanding the incision without tearing or damaging the muscle.  After the process is completed, a small translucent "working tube" is left in place and all other tubes are removed.  At that time, the surgeon inserts a fiber optic camera with acute magnification into the tube.  A laser and other specially designed instruments are then used to correct the injury.  In many cases, patients are able to walk out within a few hours of arrival and stay within the vicinity of their clinic for approximately a week.  Most institutes recommend condos or hotels nearby offering discounts to patients.

My decision made, I selected a spinal institute in Tampa, Florida.  I was to bring MRI films, EKG and blood test reports along with all my medications in original containers.  The institute emphasized that if these procedures were not followed, surgery would be delayed.

My husband Sal and I flew from Salisbury to Tampa where we had rented a condo on Tampa Bay.  The amenities included a continental breakfast and van transportation to and from the airport and the institute.

Next week Mrs. Cianci relates in detail her surgical and post-op experiences.