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Neurosurgery
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Neurosurgery

NeurosurgeryChristy Talbott sleeps through the night now that the throbbing pain she used to feel when she rolled on her left side no longer jars her awake. The pain that felt like a piece of steel had pierced her skull when she wound up on her back is gone, too.

Undisturbed sleep was an immediate effect of Talbott’s March 2009 spinal surgery, a procedure performed by neurosurgeon David Kee, M.D., of Carolina Neurosurgical Services, at FirstHealth Moore Regional Hospital. “I’m sleeping through the night,” she says. “I no longer need to take any medication to help me sleep.”

Talbott’s problem, later diagnosed as a ruptured disc, began in 2001 with tingling and numbness in her left arm. She tried pain injections, but the condition worsened. Two years later, she had nearly eight hours of surgery during which the damaged disc was replaced with cadaver bone fused with a titanium plate.

That helped, but the problem persisted, ultimately becoming so bad that Talbott’s left arm began to atrophy from lack of use.

For several years, memories of her first surgery and a subsequent night in intensive care kept Talbott from even considering a second surgery. Then she heard about the new team of neurosurgeons at Moore Regional and made an appointment with Dr. Kee.

Talbott worked the morning of her surgery, but took a day off afterward. She describes the recent procedure as “a fraction of what the original surgery was.”

“I’m glad I finally did it,” she says.

Spinal fusion surgery

Neurosurgeon David Kee Jr., M.D., attributes Christy Talbott’s painful problem to a ruptured disc and says that she had a similar condition, the first involving a different disc, several years earlier. Another neurosurgeon corrected the original problem in 2003, but with a surgical procedure that lasted nearly eight hours and included an overnight stay in intensive care.

David Kee Jr., M.D.
David Kee Jr., M.D.

With improved technology, Dr. Kee was able to do Talbott’s March 2009 surgery as an outpatient procedure that lasted only 45 minutes.

“I offered her essentially the same surgery,” he says, “but she went home the same day and did very well.”

Dr. Kee went through Talbott’s old incision to remove a titanium plate that had been placed during the first surgery. He replaced it with a hard-plastic PEEK (polyethyl ether ketone) cage that he attached to the neighboring vertebrae with a putty mixture that encourages bone growth.

“The cage is radiolucent (see-through),” Dr. Kee says, “so we can actually see bone growth occurring.”

Spinal cord stimulators

According to neurosurgeon Bruce Jaufmann, M.D., neurostimulation patients often say they haven’t felt so well in years. “A lot of times, they have been on pretty heavy narcotics, but have not had a lot of success managing their pain with them,” he says. “They’ve run through the gamut of treatment over a long time.”

Bruce Jaufmann, M.D.
Bruce Jaufmann, M.D.

Long-term neurostimulation therapy involves the permanent, although reversible, implant of a spinal cord stimulator. First, however, patients must undergo psychological screening and several phases of testing and evaluation to determine if they would be good candidates. After that, a physician specializing in pain medicine conducts a clinical test to determine the appropriate electrical impulse level and if the patient is comfortable with operating the device. P aul Kuzma, M.D., is one of several anesthesiologists at Pinehurst Anesthesia Associates who conduct the stimulator trials. He says the best candidates are usually patients with back or back and leg pain who have tried “conservative” pain therapies such as medication, bracing, physical therapy, epidurals or surgery for a long time but without success. “Those patients who don’t respond to the simple therapies we may consider for a spinal cord stimulator,” he says.

A trial can last for three days to a week, long enough for the patient to live with the device in his daily environment while going about regular daily activities. If the trial is successful, Dr. Jaufmann surgically places a permanent stimulator under the skin of the abdomen, inserting coated wire leads under the skin and into the spinal canal. The procedure is typically done as an outpatient procedure involving a local anesthetic and usually while the patient is awake but sedated.

Neurostimulation therapy has been available for more than 30 years, but the technology has improved significantly during that time, especially in the size of the generator and the batteries. The generators are now very small, unlike early devices that were roughly the size of two hockey pucks. Batteries are about the size of a silver dollar. Current technology also includes more electrodes and more options for programming.

Neurostimulation therapy
NeurosurgeryFor 25 years, Roger Dreisbach tried just about everything to ease the chronic pain in his lower back. Prescription and over-the-counter medications, acupuncture, epidurals, even two back surgeries—nothing seemed to help the Southern Pines resident for very long.

Then a physician assistant at the FirstHealth Back & Neck Pain Center suggested that he might be a candidate for a spinal cord stimulator. After a brief trial period to determine if he was appropriate for long-term therapy, Dreisbach got his implanted device in April 2009 and is now “doing wonderful.”

“It’s very amazing,” he says.

Spinal cord stimulation, or neurostimulation, uses electrical current to treat chronic pain with a small electronic system that sends mild electrical impulses to the spinal cord through coated medical wire leads. Programming directs the electrical impulses to cover the specific areas where the pain is felt, essentially blocking the way the body interprets pain signals.

Since getting his spinal cord stimulator, Dreisbach no longer needs pain medication, not even the over-the-counter Advil he had used for so long.

“I don’t have any pain,” he says. “I lower the (electrical impulse) level when I go to bed, and I turn it up a bit in the morning and do my daily routine. It’s wonderful.”

Two neurosurgery offices
The four neurosurgeons with Carolina Neurosurgical Services are Larry V. Carson, M.D.; Bruce P. Jaufmann, M.D.; David B. Kee Jr., M.D.; and Carol M. Wadon, M.D. All are board certified in neurosurgery and also have academic appointments to the faculty at the University of North Carolina at Chapel Hill.

Appointments can be made at either of the two Carolina Neurosurgical Services locations:

5 FirstVillage Drive
Pinehurst
(Pinehurst Surgical building)
Telephone: (910) 295-0215
3650 Cape Center Drive
Suite 100
Fayetteville
Telephone: (910) 484-9802