The most common condition of the spine is spinal stenosis. or compression of the small vertebral canal that contains the nerve roots and the spinal cord with the consequent pain, weakness, cramps and numbness. This blockage occurs because of arthritis and other degenerative conditions. It can cause pain, but not only that, but paralysis“for which he urgently needs surgery,” says Dr. Han Jo Kim, an American neurosurgeon specializing in this operation.
Kim visited Guayaquil this month to speak with professionals from the orthopedic community about the main techniques in spinal surgery, and shared with La Revista the options for those who cannot undergo this operation. Her specialty is spinal deformity and scoliosis surgery for adults and children. He is the director of the Spine Fellowship (medical community of the spine) and is part of the team at the Hospital for Specialized Surgery (HSS) on Long Island, New York, a center that has held first place in orthopedics in the United States for thirteen consecutive years. United States, according to the rating agency US News & World Report.
He comments that after the stenosis, it is common to see deformities such as scoliosis and kyphosis. The first is a lateral deviation, and the second is an exaggerated forward curvature of the back, related to osteoporosis, being a woman, and being older.
What are the signs of scoliosis? It depends on the type. There are two, idiopathic scoliosis, which is usually seen in children, and is usually not painful, but needs surgery to prevent it from progressing and starting to put pressure on the organs, affecting breathing and heart function.
Idiopathic scoliosis is the result of a combination of genetic and environmental factors. “Studies have been done that have shown that even if they are identical twins, it is not the norm that they both develop the disease. Genetic penetration is around 60-80%. So there are 40 to 20% of the causes that are related to environmental factors, “says Kim.
And there is also the degenerative scoliosis, in which there is significant wear and tear on the discs and joints in the spine. It occurs in older adults and causes spinal stenosis or compression. “In them there is a considerable level of pain in the back, in the leg and sciatic-type symptoms, and that is why they also need an operation,” says the doctor. Here the causes are a combination of aging and osteoporosis.
Both groups, by the way, have serious problems with posture. Many patients worry about their image, because they notice that they have a hump and feel misshapen, plus they can’t straighten up and feel like they’re always leaning forward.
“We also do a lot of revision surgery,” explains Kim. “This means that patients who have had surgeries before, and now have problems that stem from them, need an operation in which we review their status. Those are the three main types of patients I see and who are indicated for an operation.”
Who is a candidate for spinal surgery?
When it comes to patients with deformities such as scoliosis or kyphosis, they will be recommended for surgery if there is significant progression. “If I see a 14-year-old patient with a measurement of 50 or 40 degrees, but in a second review it has progressed to 60 degrees, I would say that he needs surgery”.
It is similar in adults with degenerative scoliosis, especially those over 60 years of age. “If they develop symptoms like leg or back pain that makes them unable to walk or stand for a short time, and seems to be getting worse, should have surgery”. A patient who used to walk up to 15 minutes and now can’t last more than 5 minutes without being paralyzed by pain, will be suggested an operation to relieve the stricture, even if there is no deformity.
“A lot of times you can’t do surgery until they’ve gone through physical therapy, by injections or by a non-invasive procedure. In these cases, the problem can be fixed temporarily. These interventions may delay surgery for a few years, but some will only see benefits for a few months, and then surgery is indicated.
Dr. Kim defines spine surgery as a process that begins with a deep reflection of what each individual patient needs. “You can’t put a circular piece in a square mold; for every different spinal problem there is a different treatment method and technology. You can’t give a single solution to everyone. It is a matter of precision and customization, he sums it up.
If someone is not a candidate for surgery, you can always try muscle training through physical therapy. “Or maybe incorporate other methods, like acupuncture or chiropractic; sometimes it can be fixed with significant weight loss or trying to get in good shape.”
Is chiropractic safe? Dr. Kim believes that for certain patients, chiropractic can be very safe and recommended. But you have to get your surgeon’s approval, because for some people this practice can be dangerous. “A few years ago I had a patient in emergency surgery because he had a stenosis in his neck, and during a chiropractic maneuver, he developed paralysis that lasted five hours, before we were able to get him into the operating room to reverse the problem.”
How to find a professional for spinal surgery? The most important thing when choosing, Kim says, is to make sure that surgeon is totally dedicated to spinal surgery. “The reason is that it is an area of complex anatomy and pathology. If you go to a surgeon who works on the hip and knee and occasionally does the spine, you will not see the same result. Whether it’s a neurosurgeon or an orthopedic surgeon, what matters is that that person is working on the spine full time”.
At HSS Long Island, for example, there is a high volume of these operations. Kim estimates that her department performs around 4,000 procedures a year, either using robotic or traditional surgery but with new instruments to make it safer and faster.
Compassionate care and extreme honesty
Dr. Kim’s philosophy is one of compassionate and personalized care. “Every patient has a set of problems and needs empathy. Know that there will be times when you can help the person and times when you can’t, and in those cases, it’s extremely important to be extremely honest. Say, ‘I can operate on you, but it’s probably not going to work.’
During the event in Guayaquil, one of the attendees asked how to make decisions about degenerative disc disease or arthritis in the spinal joints. “The answer is that if there is no instability or stenosis or significant compression on the nerves, I would not recommend surgery, because even if it is done without complications and appears successful, it is not going to cause improvement in the patient,” Kim states. . “Y when we operate, we must have a good dose of security that after the surgery that person will be better. That is the philosophy we need.”
And if you can’t operate, there are other non-surgical options to consider, such as radiofrequency ablations, injections, targeted physical therapy, acupuncture or chiropractic, and anti-inflammatory medicine.
In order to educate the community of spinal surgeons, Kim has written a cervical spine surgery manual (The Riew-Kim Manual for Cervical Spine Surgery), co-authored with Dr. K. Daniel Riew, to be published in 2023 and available for pre-order on Amazon.
“We try to explain the operation step by step, so that the results we have had can be replicated; each chapter covers one type of operation. Other experts have also provided us with their surgery tips and tricks; everyone has slightly different methods.” (YO)