Minimally invasive procedure relieves long-time back and leg pain

Larry Van Carson M.D.

PINEHURST – For two years, Dianna Moss dealt with ever-increasing pain in her right leg and lower back.

Although she continued to work full time as a nursing instructor at Sandhills Community College and part time as a registered nurse at FirstHealth Moore Regional Hospital, she could barely walk and was in considerable pain by the end of each day. Two years ago, she developed numbness and tingling in her right leg, both feet and her toes.

“My quality of life was terrible,” she says.

On March 1, Larry Van Carson, M.D., of Carolina Neurosurgical Services, performed a spinal fusion procedure on Moss’s back that has changed her life. Thanks to the minimally invasive surgery, a first for Moore Regional Hospital, Moss left the hospital on March 3 with no pain, numbness or tingling in her legs. By the end of the month, she was back at work at the community college.

“I have gone from being a cripple to walking daily with no leg pain whatsoever,” Moss says. “Dr. Carson has given me my life back.”

According to Dr. Carson, Moss’s pain was caused by several problems, but the most significant issue involved a “slippage of the spine,” or spondylolisthesis. The condition causes a bone in the spine (vertebra) to slip forward, out of alignment, and onto the bone below it.

“Because there is instability and movement there, you have pain,” says Dr. Carson. “The nerve roots get stretched, and it hurts. Some people continue to have pain or progressive neurological deficits or weakness. The pain usually drives people in to see a doctor.”

Moss’s condition was further complicated by arthritis and spinal stenosis, a condition in which the spinal canal narrows and compresses the spinal cord and nerves.

During her two-year quest to get relief from her pain, Moss talked to several different physicians and tried a variety of treatments: acupuncture, physical therapy, epidurals and a “cocktail” of non-narcotic analgesics and muscle relaxers. In January, she had a radiofrequency ablation at the FirstHealth Back & Neck Pain Center. That helped the arthritis, but did nothing to improve her mobility or ease the severe leg pain.

When multiple CT scans indicated that she needed spinal surgery, she asked her physician at the Back & Neck Pain Center to refer her to a surgeon who would do a minimally invasive procedure that wouldn’t require months away from work and a long recuperation. He sent her to Dr. Carson.

“My sister had invasive, large-incision surgery last year, and I did not want that,” she says.

Dr. Carson’s “novel approach” to Moss’s situation – a combination of the minimally invasive spinal fusion and decompression laminectomy – helped her avoid the large-incision surgery that she dreaded and that her sister had endured.

He stabilized Moss’s spine and relieved the pressure on her spinal nerves by removing a disc, fusing the area with a titanium rod and screws, and inserting a mesh-like bag into which he placed sterilized ground bone particles that will eventually create a fusion.

Instead of the trauma caused by cutting through muscle, he made five small “stab” incisions, a central incision of about 2 inches over the spinal cord and two incisions of about an inch each on either side.

Dr. Carson calls Moss’s prognosis “excellent.”

“She’s out of pain, she’s back to work, and she’s not taking any narcotics,” he says. “That’s a success. These minimally invasive surgeries offer relief from instability and allow patients to get back to the activities of their daily living when most of the time they’ve been in pain for years.”