Ending a Lifetime of Back Pain

When Cathy Gregory was 12, she did something most kids do without thinking. She lined her back up against the gym wall and slid down to sit. Unfortunately, her leather soled shoes slipped on the floor and she landed hard. Cathy remembers, “I saw stars it was so painful. I couldn’t walk right for days after.”

Her mom took her to an orthopaedic doctor who thought she was exaggerating the pain.  For two years, he recommended back braces, casts and bed rest. Cathy was in and out of hospitals until finally, a myelogram, a diagnostic test using injected dye, showed she had two large herniated discs, a problem that had only grown worse during the two years of ineffective treatments. 

At age 14, Cathy had a multi-level laminectomy – a surgical procedure that removed portions of the bones in her spine and part of the discs. It took a long time to heal. “I was excused from gym for three years in high school. I couldn’t do anything.”

 Despite the surgery, Cathy, now 58, had chronic back pain for years. But she learned to live with it. She exercised nearly every day and liked to garden. She went to a chiropractor when the pain got bad, but as she says, “I waited too many years to find an orthopaedic doctor.” But when the pain started in her left hip and leg, Cathy couldn’t wait any longer. “It was excruciating when I laid down in bed. Pain just radiated down my left leg. My husband and I purchased three different mattresses thinking that because I could tolerate the pain during the day it must be the mattress, right? For about two to three years, I hardly slept at all.” When pain finally affected Cathy’s daily life and sense of independence – she couldn’t bend or lift anymore and her husband was carrying the laundry - she was ready to do something about it.

 “We have two boys who played soccer and had made many trips to IBJI for injuries. Both boys broke wrists, there was a foot injury, and miscellaneous things over the years. (Glenbrook North High School sends all their injured athletes to IBJI.) My experience with IBJI doctors had always been good.”

 Cathy made an appointment with IBJI Glenview spine specialist, Mark Mikhael, MD. She liked him right away. “He was a good listener, sympathetic, understanding, gentle. I felt like he cared about me. I also liked the convenience of IBJI and that if I needed surgery, I wouldn’t have to go downtown – we’d be right at Evanston Hospital.”

 But Dr. Mikhael’s confidence and knowledge “cinched it” for her. Looking at the MRI images he’d just received for her, Dr. Mikhael pointed out and clearly explained to her the problems he saw –and what he could do.  Says Dr. Mikhael, “I felt that Cathy would likely need surgical correction for true relief in symptoms, but we discussed the alternatives and felt it best to exhaust all non-operative approaches first.”

 Dr. Mikhael referred her to Kiran Chekka, MD, an IBJI pain management specialist, and also prescribed physical therapy. The first injection in spring of 2012 helped for a few months. The second, that summer, relieved the pain in her leg and lower back on her left side, but the pain had migrated to her right side.

 Cathy and her husband met with Dr. Mikhael to discuss surgery. “We had tried PT, oral analgesics and injections, but Cathy’s quality of life was diminishing. She felt she had suffered enough.” To address Cathy’s progressive spinal instability and malalignment, Dr. Mikhael recommended a multilevel fusion procedure. He would remove some of the discs and replace them with plastic spacers, then realign the spine with screws and rods to provide stability.

 Says Cathy, “I asked as many questions as I could, then I researched. I spoke with two other surgeons at Rush and Northwestern but after meeting with all of them, I felt most comfortable with Dr. Mikhael’s expertise and personality.” Cathy knew this was a complicated operation and was afraid, but as she says, “Dr. Mikhael was so confident that I felt confident.”

 Surgery was scheduled for October, so Cathy could enjoy the summer with her three college-aged children. She received one more pain injection and continued using Cymbalta. Dr. Mikhael performed the spinal reconstruction and multi-level fusion at Evanston Hospital on October 23, 2103.

 Says Dr. Mikhael, “We do spinal reconstruction daily, but her case was more complex than we typically see. The surgeon who treated her when she was 14 had aggressively removed large parts of her spine – so much so that her spine didn’t follow normal anatomy at all! It was misaligned and falling apart on itself slowly. The distortion of her anatomy put pressure on the nerves which caused Cathy’s extreme pain. The surgery was a great success. We were able to completely realign Cathy’s spine.”

Cathy’s recovery has been a success as well. While most people take a year to recover, Cathy is feeling great just six months out. “I was in the hospital for several days and got physical therapy right away. They wanted me to ‘get up and walk’ and before long, I was walking down a hallway and climbing stairs. The greatest thing was I had no radiating pain!”

Cathy continued physical therapy for a few months to recondition her muscles and help them readjust to their new positioning. Although she couldn’t lift anything for a month after surgery and wasn’t supposed to bend or twist, within a couple weeks she was active. The fusion eliminates motion at a couple levels so she may have some lower back stiffness, but she has no long-term activity restrictions. Cathy can exercise, run and garden – live life again - the way she wants.

Says Cathy, “Chronic pain kept me from leading the life I wanted. Now, I work out at the Y in a low impact aerobics class and do strength training. I do everything I want. At the end of the day, I’m a little tired but I feel wonderful.”

 “I am so happy Cathy can do her favorite activities again without pain,” says Dr. Mikhael. “I counsel people to wait on this surgery, to exhaust all their options until they’re waving the white flag. Cathy reached a tipping point where the pain and payoff made sense. Some people jump to surgery a little prematurely. We’re here to help patients determine when it’s the right time for them.”

Dr. Mikhael talks about IBJI and how teams collaborate to achieve great outcomes. “My colleagues and I work closely with one another. A patient’s back or neck problem might turn out to be a shoulder or hip problem, so we refer to and consult with each other all the time. It’s seamless and comprehensive care – pain management, MRI, PT – all are integrated. At a hospital you get referred around, wait a week for an appointment and it’s not convenient. Here, you walk down the hall for the high quality care you need.”

Cathy’s believes she got the best care from Dr. Mikhael and IBJI. “I would invite Dr. Mikhael for Thanksgiving dinner! If my kids needed surgery, I wouldn’t send them anywhere else.”

Mark Mikhael, MD specializes in the surgical treatment of cervical (neck) and lumbar (mid/lower back) spine disorders, such as disc herniations (causing sciatica or radiculopathy) and spondylosis (stenosis and arthritis). His interests include minimally invasive spine surgery, microsurgery of the spine, nerve compression, and spinal reconstruction (stabilization and fusion). He practices at IBJI Glenview/Wilmette at 847-998-5680.