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Revolutionizing the spinal fusion

BY ERIKA ROSE
TIME CORRESPONDENT | Sunday, August 9, 2009

Despite having a spinal fusion in June, 55-year-old Jim Szentesy of Valparaiso was dancing at his daughter's wedding this weekend.

To anyone who knows what this particular surgery entails, attending the wedding at all might sound like a stretch so soon after the notoriously traumatic operation. In fact, when Szentesy's neurosurgeon at St. Mary Medical Center in Hobart, Dr. Hytham Rifai, first recommended a fusion to relieve his pain, typically a last resort measure for those suffering severe degenerative disc disease, he was devastated, having known others who'd relayed horror stories of a miserable recovery.

"The reputation of a fusion is bad and rightly so," Rifai explains. He says there are generally two methods of permanently fusing two vertebrae together to stop the motion that is causing pain. One is to access the vertebrae through the abdomen, moving the bowel and vessels aside to gain access to the diseased disc. Or by way of the back, in which muscles are stripped, bone is removed and joints are destroyed in order for doctors to access the disc space. Using a bone graft and sometimes supplemental hardware to fill the decimated disc space, the two vertebrae grow together over time.

Both methods involve much trauma to the body and significant risk.

But thanks to exciting new technology, Rifai was able to present Szentesy with minimally invasive option that he is confident will catch on fast as demand for it increases, eventually forcing doctors to abandon the old methods and revolutionizing the way this typically traumatic surgery is done.

The new method is called AxiaLIF which stands for axial lumbar interbody fusion. Using a novel new way of accessing the disc while keeping normal anatomy intact, the doctor can remove the degenerated disc, implant a small rod to stabilize the spine and open the disc space and replace it with bone growth material through two 1-inch incisions as opposed to the lengthy incision required in the past.

"The end result is basically the same," Rifai says, "but we are doing it through a different route and different tools."

It's a difference that translates into minimum blood loss and disturbance to the body for the patient as well as a dramatically shorter hospital stay and quicker recovery.

Rifai says improvements in operating room technology have enabled minimally invasive spine surgery which involves looking at anatomy through an x-ray view rather than the naked eye.

"We have to adopt a new way of looking at the spine," he says.

Julie Steele had the operation in April at Methodist Hospital. The 46-year-old legal secretary and Merrillville native was the first patient to have a fusion done in this way in Northwest Indiana and Rifai's first such operation.

She had been living with unbearable pain and could barely walk. Unfortunately, the lumbar discectomy she had four years ago did not last and her pain was so great the last resort spinal fusion was becoming an obvious reality.

Being presented with the minimally invasive option meant no living in fear about a traumatic recovery.

"It was a very simple procedure. I wasn't afraid to have it done," Steele says.

"This was much less invasive. ... Otherwise, the procedure I would have had to have probably would involve abdominal surgery. That to me was a lot more scary."

Despite having two vertebrae fused together, Steele says her mobility isn't hindered at all. An avid exerciser before the surgery, she has been given the go-ahead to begin slowly building up her strength and eventually resuming her normal activities. She even performed a couple of test abdominal crunches.

"I was so excited when I found out I could do it," she says.

Rifai says that even though the fusion is a last resort measure, it is commonly done, especially in a geographical area that is thick with labor workers.

Still, he warns against jumping into this option even though it is less invasive.

"I don't want to give the public the message that this should be done right away," Rifai says. "People should have tried everything else before they attempt this surgery. A lot of people benefit just from therapy or medicine or injections before they commit themselves to surgery."

Rifai performs the procedure at The Methodist Hospitals, St. Mary Medical Center in Hobart, St. Margaret South in Dyer, Porter Hospital in Valparaiso and St. Anthony Medical Center in Crown Point.

Neurological surgeons Dr. Marc Levin and Dr. Yevegniy Khavkin perform the procedure at Community Hospital in Munster.

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