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Oh, My Aching Back!

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AT 67, LAURIE RAEBURN FIGURED he was “too damn young to be in a wheelchair.” But that’s where he knew he was headed unless he underwent back surgery, a long and potentially risky operation to correct the severe scoliosis—curvature of the spine—that had plagued him for years. He had been diagnosed with the disease in 1960; it grew progressively worse through the decades, and his spine had actually become twisted. Four years ago he found he couldn’t walk for more than a few feet or stand for more than a few seconds. His pain was constant.

Raeburn, a Mira Mesa resident who retired in January from the commercial lighting business, had tried to relieve the pain by injections, regular visits to a chiropractor and wearing a brace. Nothing worked. “I have a good, positive attitude, and I’ve always set goals for myself,” he says. “It became my goal to get this taken care of.”

Through his physician at UCSD Medical Center, Raeburn was referred to Dr. William R. Taylor, a neurosurgeon at the hospital and an associate clinical professor of neurological surgery at the University of California, San Diego.

“There’s no other way to put it,” Raeburn says. “Dr. Taylor saved me, and I hardly have any scars to show for it.” In the span of a few weeks this past summer, Taylor operated twice on Raeburn using a new procedure called extreme lateral interbody infusion—XLIF for short. Unlike traditional spinal surgery, which essentially fillets a patient with a long incision down the back, XLIF allows a surgeon to access the spine through minor incisions in the body’s side, along what’s known as the flank. Surgery is performed using a combination of an expandable retractor and nerve sensors to avoid damage.

The result? After each operation, Raeburn was out of the hospital in just a few days, off pain pills and quickly gaining the mobility he had lost from the scoliosis. He rides a stationary bicycle and is temporarily using a cane to avoid falling. By this month, he won’t have to wear a brace. Most importantly, he is pain-free. “This is cutting-edge stuff,” says Taylor. “Laurie is one of probably only five or 10 people in the world who’ve had scoliosis corrected by minimally invasive surgery.”

FOR YEARS, SPINAL SURGERY has been moving into the realm of endoscopy and less-invasive procedures. The XLIF method, though, is truly a huge advancement, says Taylor. While the scoliosis procedure was rare, common uses for the new surgery include relieving the nagging, chronic back pain that physicians say affects about 10 million adults each year—disc degeneration, a herniated disc (that famous “slipped disc”) and middle lumbar stenosis (narrowing of the vertebral column that puts pressure on nerve roots).

There are significant benefits to the minimally invasive method, Taylor says. Entry to the spine through small incisions in a patient’s side avoids disrupting major back muscles and tissues, as traditional surgery does. Equally important, there is less blood loss, transfusions aren’t required, and the procedure can take as little as 45 minutes—compared to three to five hours for the older way—meaning less anesthesia is required. Patients do not typically have to go to the intensive care unit following surgery and are usually checked out of the hospital in a day or two, compared to four to six days for regular back surgery. Recovery time at home also is considerably reduced. Costs are less, and the procedure is covered by insurance.

XLIF is part of a surgery system developed by NuVasive, a San Diego company that develops and designs products for use in minimally disruptive surgical treatments for the spine. Since the procedure was launched last year at the annual meeting of the North American Spine Society, which was held in San Diego, it has been performed about 500 times around the country, says Alexis Lukianov, president and CEO of NuVasive. Taylor, at UCSD, was one of the first to employ it.

“We’ve had extremely positive feedback from surgeons,” Lukianov says. “It’s not unusual to have a patient walking just a few hours after surgery. One doctor told us he had a patient [after the surgery] ask if he’d actually even had it.”

Most common back surgeries can now be performed using the XLIF procedure, Taylor says. This includes spinal fusion, discectomy (removing an intervertebral disc to relieve pressure on a nerve root or the spinal cord) and laminectomy (removing the rear part of a vertebra to gain access to the spinal cord or nerve roots).

Taylor has even successfully used the XLIF procedure on an 86-year-old man, who couldn’t have traditional, open-back surgery because of his age.

What’s surprising, Taylor says, is that most patients who would benefit from minimally invasive back surgery are not getting it.

“Probably 95 percent of those eligible for the procedure don’t know about it,” he says. “You have to be a good consumer. Patients should ask around and see what doctors are doing it.”

As for Laurie Raeburn, he’s set a new goal for himself. An avid bass fisherman, he’s confident it won’t be long before he’s back on a lake, sitting in a boat for maybe eight hours at a stretch—something he hasn’t comfortably been able to do for a long time.

His first big haul, he thinks, should probably go to Taylor.

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