LEFT: Dr. Cameron Brown, MD, an Orthopedist with Associated Litchfield County Orthopedics, performed The Charlotte Hungerford Hospital's first Transthoracic Microdiscetomy surgery. RIGHT: Physician Assistant Sarah Watson with Associated Litchfield County Orthopedics, assisted with The Charlotte Hungerford Hospital's first Transthoracic Microdiscetomy surgery.
(Torrington, CT) On January 11, 2010, for the first time ever at Charlotte Hungerford Hospital, two surgeons performed a transthoracic microdiscectomy. This recently invented microspine surgery cuts patient recovery time from weeks to days; reduces the risk of complications; eliminates the need for blood transfusions; and means that Dale Meeker is rid of 20+ years of chronic back pain.
“I feel so much better it’s amazing. I’m really happy,” the 53-year-old from Bantam, Connecticut says. In 1984, Dale had spine surgery at another hospital that didn’t go well. The experience caused her to fear hospitals and doctors to such a degree that she chose to live in chronic pain for decades rather than consider another surgery.
Wrong Number Was Fate
Dale’s chronic pain worsened after she injured her back at work on July 31 of last year. She thought she’d just pulled a muscle. When the pain continued to get worse, Dale found a spine surgeon in the Yellow Pages. But she dialed the wrong number. She reached Dr. Cameron Brown’s office at Associated Litchfield County Orthopedics by mistake. Or maybe not. Dale now says the wrong number was fate.
Tests revealed a herniated disc in the middle portion or thoracic section of her spine. After medication and rest didn’t relieve Dale’s pain, Dr. Brown raised the possibility of transthoracic microdiscectomy surgery at Charlotte Hungerford Hospital. Dr. Brown describes this relatively new surgery as a major advancement over the more conventional thoracic spine surgeries in use since the 1970s.
”In the old days, we used a large incision and the patient needed months and months of rehab,” Dr. Brown says. “These days we do the surgery with a microscope. We use a small incision; we sneak in between the ribs and go around the lob of the lung; then underneath the aorta — a blood vessel as big as a garden hose.”
A herniated disc in the thoracic spine, like Dale’s, can be extremely serious. In some cases, the first sign of the herniated disc is paralysis below the waist. Fortunately, herniated discs in the middle of the spine are not nearly as common as they are in the lumbar or lower spine.
An Urgent Need To Operate
In Dale’s case, events in late December and early January led to an urgent need to operate. One night last December, Dale woke up in a wet bed. She began experiencing a constant urge to urinate. Her legs felt heavy or dead. She thought she had a urinary tract infection. After conducting several exams the hospital ruled that diagnosis out.
Wednesday night, January 6, Dale again woke up in a wet bed. That morning in her kitchen she lost continence again. Incontinence combined with extreme heaviness in Dale’s legs convinced CHH staff to conduct further tests resulting in the decision to perform urgent surgery that Monday. More Than 100 Advanced Spine Surgeries
Dr. Brown has performed more than 100 transthoracic microdiscectomies — always by himself. This time he utilized a general surgeon from Charlotte Hungerford Hospital and his Physician Assistant Sarah Watson. Using a team approach reduced the surgery time. Dale was out of surgery in less than 75 minutes. “In this surgery I was flying first class because of Sarah and the talents of the general surgery department at Charlotte,” Dr. Brown says.
Surgery Basics
To remove the herniated disc, the surgeons had to first remove a portion of Dale’s eighth rib. When a disc herniates it invades space the spinal cord needs, causing pressure on the cord and pain. The disc must be immobilized to prevent it from herniating again. That’s done by fusing the vertebra on either side of the bad disc. This feat was accomplished with the freed portion of the eighth rib. Because there’s very little motion in this portion of the spine, the patient never feels any loss of movement.
“When I woke up from surgery,” Dale says, “I didn’t have any more pain in my legs or numbness or heaviness. That was amazing because I’d had that pain for so long.”
“This is a minimally invasive procedure with rapid healing. Dale didn’t need any blood transfusions, the risks are much smaller and there’s virtually no risk of paralysis,” says Dr. Brown. More conventional thoracic surgery requires two or three blood transfusions and at least two weeks in the hospital, including intensive care for the first week.
When contrasting this new surgery with earlier, more invasive spinal surgery options, Dr. Brown draws an analogy with the advancements in heart surgery.
Minimizing Risk To The Heart And Lungs
“Years ago, cardiac surgeons had to completely open the rib cage,” he explains. “Today they operate on the heart through a hole no bigger than a parfait glass. The micro surgery performed is like operating in the bottom of the parfait glass. You have a tunnel and the problem you’re fixing is at the bottom of that tunnel. It’s a method that saves us from endangering the heart, lungs and the great blood vessels.”
Not everyone with severe middle back pain is a good candidate for this surgery. Good candidates may be people with an acute loss of lower extremity (hip to toe) function or bowel and bladder dysfunction if the problem is caused by a mass pressing on the spinal cord or a fractured vertebra.
Helping Her Best Friend
About six weeks after the operation, Dale returned to Dr. Brown’s office. This time her visit wasn’t for herself. Dale convinced her best friend to visit the office with her to see if Dr. Brown could help relieve the friend’s back pain.
“I hate doctors and I’m scared of hospitals but I have all the faith in the world in Dr. Brown,” Dale says. She adds that the quality of her life has improved greatly since the CHH operation.
Dale’s operation may have been the first transthoracic microdiscectomy at Charlotte Hungerford Hospital but it’s a harbinger of many more to come. Teaching, Relating & Crashing Make a Physician Better
Dale Meeker cites at least three attributes that greatly enhanced her experience with CHH and Dr. Brown. One of Dr. Brown’s first statements impressed her. The doctor told Dale he would teach her about her spine so she could make her own informed decisions about treatment. He taught and she learned so well that after one recent MRI Dale correctly diagnosed a problem with her back before the physicians reviewed the MRI.
Then there was Dr. Brown’s down to earth manner. Dale says he relates well with patients. “I feel very comfortable with him. He explains things in terms that I can understand and he’s very genuine. He seems like someone you’ve known forever.”
Dale thinks Dr. Brown’s great bedside manner was strengthened by a plane crash. On July 3, 2005 at 3 p.m. Dr. Brown crashed his single-engine, two seat plane in Vermont. The engine lost power after take off and Brown suffered major head, lung, leg and other injuries.
“He could have safely landed in a field, but he saw there were farmers working in that field. He chose to save the farmers’ lives by crashing into a tree instead. That tells you what type of person he is. He’s experienced pain, he’s experienced surgeries and he’s knows what patients go through.”
Cameron D. Brown, MD, was educated at Cambridge University, Cambridge, England, earned his medical degree at Georgetown University School of Medicine, Washington, DC, and was a Spinal Fellow at the prestigious Rothman Institute, Philadelphia, PA. Dr. Brown is board certified in orthopedic surgery and is a member of the American Academy of Orthopedic Surgeons, Scoliosis Research Society, and the Cervical Spine Research Society.
