Pain In The Neck

Wayne Memorial is first east of 95 to use new pain-relieving surgery
As reported by Ron Hasson, News-Argus Staff Writer
Tuesday, May 29, 2001

Wayne Memorial Hospital has become the first in eastern North Carolina to conduct a new surgical treatment for slipped, ruptured or bulging discs in the lower neck.

Dr. Robert Lacin persuaded hospital employee Gail Rogers to try the new procedure on May 18, less than a month after the technique won federal approval. Dr. Barry Katz assisted with the surgery,

Ms. Rogers said it didn't take much to talk her into becoming the hospital's first candidate for the surgery. She had lived with chronic neck pain for some time, but a sudden motion had triggered pain that didn't go away. The pain started in the neck and extended down her left arm to her fingertips.

"I had reached a point I just wanted something done," she said.

One of the cushions between her neck bones had failed. These cushions are called discs because of their shape. They are made of a gelatinous material called collagen. When one fails, the neck vertebrae are knocked out of alignment and can "pinch" nerve clusters branching off the spinal cord. The standard procedure is to remove the disc and try to get the two bones it separates to grow together.

Disc problems can arise from accidents or other trauma, Dr. Lacin said, but not always. "A lot of people just wake up with a twisted neck," he said. There is some evidence to support a relationship between disc problems and genetic soft-tissue deformities, but not all cases can be explained.

Dr. Lacin said that about 50 percent of the patients with similar neck problems can respond to pain medication and cortisone treatments. When a patient does not respond or when there is evidence of nerve or spinal cord dysfunction, an operation is necessary. About 150,000 cervical fusions are performed in the United States each year.

There are two common surgeries used for this problem, but they can have side effects that the new procedure avoids, Dr. Lacin said.

One technique involves scraping bone from the patient's hip and using it to fill in the gap in the neck. This enables the bones to fuse together. Often, "hip harvest" patients report no more neck pain, but some complain of pain in the hip.

The other common technique developed about five years ago, involves implanting a metal plate that holds the neck vertebrae together. Holes have to be drilled into the vertebrae. Since the plate protrudes off the spine, it can put pressure on the esophagus and is sometimes associated with swallowing difficulties.

The new procedure uses a device developed by Sulzer Spine-Tech in Switzerland, called the "BAK/C." It is a cylindrical titanium screw that is inserted in between the vertebrae to restore proper alignment. Instead of requiring grafts of bone from the hip to promote fusion, the screw scrapes enough bone during insertion to help the vertebrae grow together around the implant.

The BAK/C can relieve pressure due to problem discs on any lower neck nerves.

For Ms. Rogers, the problem disc was between the fifth and sixth vertebrae in her neck, where the bones were pinching a nerve root. Nerve roots branch off from the points all along the spine. The one being pinched in Ms. Rogers' neck affects nerves in the thumb and index finger.

Sulzer-sponsored studies have shown higher rates of fusion and fewer complications when the new procedure is used, Dr. Lacin said. Sulzer representatives trained Dr. Lacin in the procedure and sent a coach to attend Ms. Rogers' surgery. The procedure took less than an hour, Dr. Lacin said, and within two hours his patient was back home.

"There was almost immediate pain relief in my neck, shoulder and arm," Ms. Rogers said. "There is some post-surgery pain, but not a severe." She reports no problems with mobility. She is currently on medical leave recovering.

Dr. Lacin said he is proud that the neural surgery department at Wayne Memorial Hospital has embraced the cutting-edge technology. He said Wayne Memorial has a growing reputation for neural surgery and gets referrals from all over eastern North Carolina.

"We just started six years ago," he said of the department, "and suddenly, we are doing a lot of new things."

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