Spine Specialist Explains When Surgery is Recommended
with James Stoll, M.D.
Dr. James Stoll specializes in surgery on people with spinal disorders. His patients include teens to 100-year-olds who see him because of ruptured discs and for arthritic conditions, usually in the lower back. Among the most common of arthritic conditions is lumbar spinal stenosis. "It's the main reason people have spinal surgery in this country," Dr. Stoll said.
Who is at risk?
Spinal stenosis is a narrowing of the tunnel that carries the nerves of the spinal canal. It is almost always caused by arthritis so those with a family history of the disease are most at risk. In addition, Dr. Stoll noted, "Some people are born with small spinal canals, which increases risk."
The symptoms
Patients with spinal stenosis may complain of lower back pain, sometimes radiating through the buttocks or down the legs, muscle weakness in the legs, numbness or tingling - all caused by the pressure on the spinal nerves. An MRI is usually ordered to determine the degree of the problem and to rule out other conditions, such as herniated discs.
Non-surgical treatment is almost always tried before surgery. It usually includes anti-inflammatory medication, physical therapy to strengthen the back and abdomen, and cortisone injections to reduce inflammation and pain. If these do not help, surgery becomes an option. "In my practice, I consider surgery when a patient can't even walk a block without pain," Dr. Stoll said.
James Stoll, M.D., Orthopaedic Surgeon,
Columbia St. Mary's
"I love seeing a patient who comes to me as their primary surgeon, but fifty percent of my surgeries are revisions from somebody else's work. I am not speaking malpractice here, not at all. But sometimes the disease process is so bad that the initial treatment does not completely solve the problem. That's where I come in. If I have the skills to handle the tough stuff, doing a simple surgery is a happy thing for me…plus we have the staff to deal with complications."
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Spinal stenosis surgery
The type of surgery done for spinal stenosis is called a decompressive lumbar laminectory, which in layman's terms is a widening of the lower spinal canal. The operation is inpatient surgery, usually done under general anesthetic with about a one- to two-day hospitalization. Patients usually feel improvement of their condition in about two weeks, with full recovery in about eight to 10 weeks.
Following surgery, once a patient is able to do them, exercises are prescribed to help strengthen the back muscles. These can usually be done at home. "One can think of surgery as a tune-up to get a patient back to the point where they can actually do the maintenance exercises," Dr. Stoll said.
Operating with specialty teams
Beginning in pre-op, all patients at Columbia St. Mary's are assigned to specialty nursing teams. "I have the same group of people I've trained helping me with every operation," Dr. Stoll said. "They've seen this same operation two hundred times or more and that makes the surgery extremely efficient. This is important because the main complications in surgery are often directly related to the time under anesthesia, so the less time we waste, the less complications.
"On the floor side, we also have teams of nurses who are specialty trained. There are joint nurses. There are spine nurses. These are teams with extraordinarily high levels of experience who know what to expect from each type of surgery. Patients are more comfortable knowing that the nurses know what's going on.
"If I were asked to state what makes Columbia St. Mary's unique to spinal surgery, I would say it is the level of patient care we offer," Dr. Stoll concluded.
Free Lecture: "Oh, My Aching Back"
Wednesday, March 6, 7-8:30 p.m.
Columbia Hospital Auditorium
Speaker: James Stoll, M.D., Orthopaedic Surgeon, Columbia St. Mary's
Dr. James Stoll will discuss back and neck problems, including appropriate evaluation techniques, and both surgical and non-surgical treatment options. To register for this free program or for more information, call 414-326-1745.
