No Backing Down Outpatient procedures make spinal surgery less invasive, painful By Camille Mojica Rey (Monterey County Herald Staff Writer)

An estimated 25 million people in the United States suffer from chronic back pain. In some cases the pain is disabling and severe enough to need corrective surgery.

Five years ago, spinal surgery would have required a four or five day hospital stay and cost about $5,000 more than it does today.

Thanks to the push by the managed-care industry, physicians and scientists have developed ways to make spinal surgery less expensive. Advanced instruments, new surgical techniques and designer drugs now allow spinal surgery to be done on an outpatient basis.

The good news for those suffering from back pain is that outpatient procedures are, by definition, less invasive and have shorter recovery time.

Dr Mark Howard of Monterey is the first surgeon in the area to perform outpatient spinal surgery.

"If you have to have back surgery, it's a nice technique," said Howard.

One of the most common surgical corrections needed is the complete or partial removal of a damaged spinal disk.

As a person ages the disks - cartilage that serves as cushions between the vertebrae - can rupture, causing the soft inner layer to protrude through the harder outer layer.

These ruptured - or herniated - portions of the disk put pressure on nerve roots that send electrical impulses to the extremities. The pressure can cause pain, loss of feeling or weakness in various parts of the body, depending on which disk is ruptured.

In addition to aging, injuries can also cause a disk to rupture.

"Most people with disk problems get better without surgery," explained Howard. About 85 percent of herniated disks correct themselves over time, he said.

For those whose pain continues, Howard can now offer a high-tech, low-cost alternative: outpatient microdiskectomy and laminectomy.

The surgery is not for everyone, Howard warned. "It takes someone who is motivated to do this," he said.

Howard found such a candidate in Patrick Dowd, 54, of Carmel Valley. He is one of the first in Monterey County to have this procedure done.

Dowd is a guidance counselor at Seaside High School and, for 18 years, has been a volunteer firefighter with Carmel Valley Fire Department.

On Aug. 26, Dowd responded to a 3 a.m. call for help from a paraplegic who had fallen out of bed. Not wanting to wake other volunteers, Dowd lifted the man back into bed.

He felt the injury in his back instantly.

What started as a minor pain continued to worsen. Eventually, Dowd could not control the calf muscle in his right leg. He walked with a limp and could not lift himself up on to the tips of his right toes.

Dowd was also in constant pain which he described as a burning cramping sensation reaching from his lower back, across his buttocks and shooting down his right leg.

In September, Dowd was hospitalized because he was unable to move.

"That was as severe a pain as I've felt in my life," he said.

Physical therapy relieved some of the pain, but Dowd was unable to resume his firefighting or active lifestyle.

So, on Dec. 7, Dowd checked into the Monterey Peninsula Surgery Center at 7 a.m. Howard, a surgical team and the center's staff had Dowd on his way home six hours later.

The microsurgery Howard performed lasted two hours. The surgeon made an incision only 1 1/2 inches long, exposing a circular area about the size of a silver dollar on Dowd's lower back.

Using a microscope, and special tools, Howard removed the herniated portion of the disk and its soft contents to prevent future ruptures.

Things felt better immediately after the surgery," Dowd said. Howard had reserved a bed at the local hospice, but Dowd said he believed he could manage the pain. "I decided I'd rather be at home," he said.

On Monday, Dowd was so free of pain that he went for a two-mile walk. He has lost his limp and only has mild numbness in his toes that he thinks will go away.

"I'm back to being a real person."