Juanita M

Condition: Failed Back Surgery and Kyphosis, Non-Union
Procedure:  Pedicle subtraction osteotomy, extension to Pelvis

In 2004 Juanita’s back pain seemed to go from a routine annoyance to something more debilitating, so she sought the advice of the spine surgeon that her daughter worked for.  This surgeon diagnosed a slight degree of scoliosis due to disc degeneration in her mid-lumbar spine.  He recommended a very substantial operation, including fusion of her spine from L1 to S1 from both the front (abdominal incision) and back.

In early 2005 she underwent the procedure, and nearly immediately had trouble.  The recovery was very difficult, and she noticed she couldn’t stand up very straight.  Over the first few months her back pain got somewhat better, but her posture got worse, and then the pain returned to more than it had ever been.  Her surgeon pushed her rehab harder, and placed the blame on Juanita for not working hard enough.  Needless to say, the relationship soured.  For five years she continued to try to work through the pain, including multiple rounds of physical therapy and substantial amounts of pain medication.  Then in early 2011 she met with Dr. Kraemer in a last ditch effort to get some relief.

All during the 5+ years, the surgeon led us to believe everything was ok and it was just a long healing process.  Finally, we sought other advice.  We were recommended to go see Dr. Paul Kraemer of the Indiana Spine Group for a second opinion.  Juanita was not wanting anymore surgery due to the extremely painful recovery period. 

Immediately he noted her tendency to stand pitched forward, which she could only compensate for by bending her knees.  She complained of constant pain, fatigue, and the inability to do anything but sit or lay for more than a few minutes.  Her X-rays showed she had none of the normal curvature of her lower back, which is called lordosis, and that her bottom level of fusion, L5-S1 hadn’t healed, called a non-union.  This seemed to be due to her lowest (S1) screws pulling out very early after her original surgery, within the first month, which allowed her whole spine to lean forward, then (mostly) heal there.

 After meeting with Dr. Kraemer, and listening to his explanation of what was wrong, we decided to proceed with the second surgery.  His reassurance was very sincere.  He said this recovery will not be nearly as bad as the first surgery.

Dr. Kraemer performed a complex realignment and fusion procedure on Juanita, called a pedicle subtraction osteotomy.  The change in her posture was immediate, and substantial.  For the first time in years her posture was normal, and she felt like she was really standing upright.  Her recovery seemed much easier, and she could feel like she was making progress.  By three months, instead of being pushed to work harder by her surgeon, she was pushing Dr. Kraemer to release her to full activity.

The surgery occurred on February 28, 2011.  Two weeks and two days post surgery we walked 8 tenths of a mile in our neighborhood and Juanita had a smile on her face the entire time.  She was released to return to work by June, 2011.  Most recently(2012), we just finished walking the entire Super Bowl Village and NFL gift shop.

P.S. There has been one drawback to the extremely successful surgery, she is now back to shopping full time.  OUCH!!!!!!    But I’m glad she’s happy and doing things I haven’t seen her do in years.  We have and will continue to recommend Dr. Kraemer to anyone needing advice concerning back problems and surgery.

From Dr. Kraemer:

Adult revision deformity cases are amongst the most difficult technical challenges in spinal surgery.  Relatively few spine surgeons are trained and proficient in these complex operations. The process really begins at the first visit, with a thorough assessment of the patient’s complaints and medical status, and generation of a problem list.  A surgical solution must hit each point on the problem list, and avoid   medical or surgical hazards along the way.

Looking at Juanita’s xrays above, even without a trained eye, we see the outline of someone who looks like they are standing much more comfortably and naturally.  Her spine has more of the natural sway to the low back (lordosis) and her back muscles are stretched too thin and taut like in the pre-revision xray.

Juanita came through the whole experience beautifully.  Not every patient is a candidate, despite having pain or deformity after a previous operation. The recovery is still difficult.  But for the right patient, the rewards can be tremendous.  The ability to stand upright with minimal pain and minimal effort is something these patients will never take for granted again.  The patient’s expression – a mixture of joy and awe – when standing upright for the first time is my favorite part of the process.

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Bob G

Condition:            T1 Burst fracture from metastatic tumor
Procedure:          T1 corpectomy, C6- T3 PSF

Recently retired, Bob jumped right into doing all the things he never had enough time for before. But he never imagined that enjoying one of his hobbies he would end up at the doctors. After an afternoon of gardening, spreading mulch and laying landscape stones, Bob started to have pain that he had never felt before – intense pain in his right arm, hand and back. The next morning, after waking up with no mobility in his hand he went to the doctor. The X-ray suggested that he had a T-1 vertebral fracture, possibly due to a tumor.  He was given a neck brace, and Dr. Kraemer was recommended for follow-up care and treatment.

Despite no history of cancer, Dr. Kraemer was pretty confident that the CT and MRI findings were of a fracture caused by a metastatic tumor.  Bob met with an oncologist who found other evidence of prostate cancer, and then very quickly back to Dr. Kraemer for treatment, consisting of removal of the diseased vertebra with a cadaveric bone strut and plate, plus a second procedure at the same time through the back of his neck.

“After meeting with Dr. Kraemer we felt assured that we came to the right place.”  During his visits, Bob felt well informed, and felt that he had all of the support that he and his family needed.  “Everyone related to Indiana Spine Group was so helpful in building our trust as a patient and family. From the first visit to the last.”

Today, Bob is working towards a goal of one hundred percent of physical activity, and feels that without the proper treatment that he could have been paralyzed as a result of the fracture. He is grateful that he is able to do all the things he was able to do prior to his injury; including walking both of his daughters down the aisle for their weddings. Bob loves spending time with his family and grandson as much as possible. An avid outdoorsman, Bob not only enjoys gardening but fishing, kayaking, swimming and fishing. “It can be done with faith, trust and proper support.”

Doctor’s Notes

Bob came to me within a few days of finding out he probably had a tumor in his neck and elsewhere in his body, that he might not regain function of his arm, and that his retirement was suddenly looking very short.  He and his family smiled and rolled with the punches as I laid out how we had to figure out what the tumor was, then had to get it out, decompress his spinal cord, and stabilize the cervicothoracic junction, a high stress area of the spine where the neck meets the upper back.

Bob’s surgery went very smoothly, and he was joking again right away.  He still had chemotherapy and radiation to undergo, and he had a pretty tough time recovering from surgery and undergoing medical treatment for the cancer at the same time, but he and his family never wavered.  I always liked seeing his name on the schedule for follow ups, because he always had smile and joke.  Cancer patients can be difficult because there are so many issues in play at once, and it takes a team of physicians to get the job done.  Seeing Bob do so well, from his spine as well as his cancer, has been very rewarding.