September 30, 2022 by John Fernandez
Complex Surgery Can Solve Debilitating Back Pain Safely
After years of debilitating back pain, Timothy McQuade could barely walk down his driveway to collect his mail. Now, however, he no longer worries about getting around. He’s planning a future filled with travel, thanks to life-changing spinal surgery.
Mr. McQuade underwent complex surgery at Boca Raton Regional Hospital’s Marcus Neuroscience Institute, part of Baptist Health South Florida. Timothy Miller, M.D., the Institute’s director of functional neurosurgery, teamed up with neurosurgeon Brian Snelling, M.D., for a six-hour procedure to fuse 10 of Mr. McQuade’s vertebra, realign his back, correct its curvature and decompress the nerves leading to his legs.
“This patient had a very complicated situation that really could only be addressed with a big surgery,” Dr. Miller says.
Three months post-surgery, Mr. McQuade completed his regimen of physical therapy and continues to build strength daily. He can’t remember the last time his back felt this good and he’s looking forward to new adventures.
“I want to see more of Florida. I want to see Kentucky. I want to see the Smoky Mountains,” says Mr. McQuade, a 66-year-old retiree who lives in Deerfield Beach. “I want to go swimming again. I’m not thinking of just getting to the end of my driveway anymore. Soon, I’ll be able to travel and see other parts of the world.”
A New Protocol
Mr. McQuade’s procedure was the first complex surgery at the Institute using a new protocol called Enhanced Recovery After Surgery (ERAS). The system takes a patient-centered, multidisciplinary and comprehensive approach to achieve the best possible results through extensive planning, testing, strategic pain management and careful follow-up.
Part of a growing national movement to reassess all routines related to surgery, the approach emphasizes evidence-based medicine — specific steps that have been proven through research to benefit patients. Nothing is taken for granted.
“It’s a comprehensive start-to-finish checklist that is followed from the time the surgery is booked,” Dr. Miller explains. For example, the system might call for pre-operative measuring of bone density, getting patients on calcium or vitamin D supplementation if they need it, and checking their levels of magnesium — all factors that could influence healing.
“We do a lot of things preoperatively to make sure patients are safe for surgery and optimized from a medical perspective,” Dr. Miller explains. “At the time of surgery, there additional things we do, such as giving pain medication preoperatively or using medication to help control bleeding. Post-operatively we have an advanced, evidence-based pain management regimen that is not heavy on narcotics, so patients are more alert, get out of bed sooner and can be ready for discharge earlier.”
The very deliberate approach leaves little to chance. “We are doing everything we can to optimize recovery,” Dr. Miller says. “In this case,the patient was extremely challenging and he had a long surgery, yet he was ready to leave the hospital a few days after surgery. That’s pretty impressive.”
Assessing the Situation
Mr. McQuade, a retired truck driver and athlete in his youth, can barely remember a time in his adult life when his back didn’t hurt. For decades, he sought temporary relief with conservative treatments such as epidural steroid injections, but the pain always returned. He moved to South Florida about four years ago hoping to enjoy his retirement, but things kept getting worse — and he was losing hope.
His deteriorating condition prompted him to seek care at Marcus Neuroscience Institute at the recommendation of his doctor. Detailed imaging revealed debilitating problems with the curvature of his spine, misalignment with his hips and posture, and severe degenerative disc disease, Dr. Miller says.
“He had some scoliosis going on, and he had something called positive sagittal balance where he is essentially hunched forward so his head was not centered over his hips properly. That’s very painful,” Dr. Miller says. “Another factor is he had severe stenosis — that is a narrowing around the nerve in the lumbar spine going down to the leg, causing a lot of pain.”
Advance planning for this surgery — and all spine surgery — was absolutely key. Spine surgery requires sophisticated measures of the patient’s spinal curves and angles and a very deliberate plan for how to insert the appropriate hardware to address each individual’s problem based on their anatomy, Dr. Miller explains. “We can’t just throw in screws and rods, and hope for the best. We have to correct those parameters,” he explains. “That might involve things like drilling off bone to correct the curvature of the spine, inserting bone grafts, and bending the rods we are putting in to correct the patient’s anatomy.”
Dr. Miller and Dr. Snelling performed Mr. McQuade’s surgery using the Institute’s sophisticated 3-D intraoperative navigation system, which provides real-time pictures during the procedure and aids in the precise placement of hardware. “Dr. Snelling and I do these cases together quite often, so you get two neurosurgeons instead of one, which makes things go much faster,” Dr. Miller says. Reconstructive plastic surgeon Anthony Dardano D.O. also participated to help put the muscles back in place and carefully close the incision, which extended from the mid-back to the sacrum, the base of the spine that connects to the pelvis.
The Road Ahead
Marcus Neuroscience Institute is well-equipped to take on such a complicated case. The facility, which is undergoing expansion, has earned the Gold Seal of Approval® for Spinal Surgery Certification from The Joint Commission, the nation’s premier independent accreditation organization. It also recently acquired advanced technology to perform robotic-assisted spine surgery.
Not all cases require surgery, however. “We offer a full spectrum of care,” Dr. Miller notes. “We try to utilize all conservative treatment options first. Surgery is reserved for when it is absolutely necessary.”
Mr. McQuade is very grateful for the care he received. “I feel so much better now,” he says. Accustomed to spending time on the road for work, he’s excited now to tour around for fun with his wife, especially after so many years of virtual immobility. “They’ve given me a second opportunity at life. It’s like a new chapter for me.”