Minimally invasive procedure relieves chronic back pain for retired school teacher

Carole Riggs, a retired teacher and school principal, points to her work during one Christmas vacation - bending, twisting and sitting on the floor to create games and teaching aids - as the primary culprit behind many years of back pain.

Burak M. Ozgur, M.D., the neurosurgeon at Cedars-Sinai Medical Center who performed the minimally invasive procedures that relieved the pain, attributes the problem to adult degenerative scoliosis affecting the disks and structures between five vertebrae (thoracic 12 to lumbar 5) in Riggs' lower back. The operations took place in Oct. 2008, and Riggs, 71, has celebrated a year without back pain for the first time in about three decades.

Riggs and her husband, Charles, recently moved to Los Angeles from Springfield, Va., where they lived when the once-tolerable pain became severe. They were at a conference in San Diego in early 2008 when she discussed the pain with her son, Richard V. Riggs, M.D., medical director and chairman of the Department of Physical Medicine and Rehabilitation at Cedars-Sinai Medical Center. He suggested she consult Ozgur, a specialist in minimally invasive spine surgery in the Department of Neurosurgery, who recommended the minimally invasive, two-stage operation to correct her spine.

"At the time, it was all too new to me to just say, yeah, let's go with it. So I said, 'Let me wait and see.' Well, it didn't get any better. It just got worse," said Riggs, who has a doctorate in education and has taught at all levels up to graduate school.

She sought a second opinion from a local surgeon in Virginia who recommended a more conventional surgical approach that would have required months of painful recuperation. She also received injections of pain medications - which did not help - and eventually decided that the minimally invasive neurosurgical approach was her best option.

"For adult degenerative scoliosis, in which the spine is twisted and curved, minimally invasive procedures enable us to straighten the spine in a more natural way than traditional surgery allows," Ozgur said. "The traditional approach requires a large incision and the placement of screws that are used as handles to force the spine straight, typically causing significant pain and blood loss.

"In certain patients, like Carole Riggs, spinal correction can be accomplished without using force. If we re-expand the collapsed disks at each level, one by one, the spine will straighten up. It's like pumping up tires on a car. The ligaments will become taut and the spine will correct itself in a more natural way."

In the first operation, Ozgur inserted specially designed tools through small incisions in the side to remove the five damaged disks and insert "cages" that contain bone graft materials and a protein that accelerates the fusion process. This lateral approach allows surgeons to reach the intervertebral disks with less risk to organs, nerves and blood vessels of the abdomen or the major muscle groups in the back.

In the second procedure, two days later, he placed titanium screws and custom-shaped titanium rods along the spine to provide strength and stability. Instead of opening a large area of the back, the minimally invasive approach uses small, muscle-sparing incisions and an imaging guidance system to place the screws into the bones of the spine and slide the rods into position.

"Specialized tools make it possible to insert even long rods and screws without making large incisions, avoiding the muscle injury, blood loss, and months of recuperation associated with traditional spine surgery," Ozgur said.

Riggs was out of bed and walking the second day after surgery, and she, her husband and family members were celebrating the couple's 50th anniversary in Hawaii during the holidays a little more than two months later.

When October arrived this year, she marked the first anniversary of the procedures that brought an end to her ongoing pain. "I told my husband how well I was feeling. It's just unbelievable compared to what I experienced before surgery," said Riggs, who is planning another week in Hawaii during this holiday season.

"It's going to be fun," she said. "I was doing well last year but I certainly feel more like myself now with the surgery a year behind me."