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Finding the right treatment for your spine problem

January 07, 2013
by Colleen Shaddox

Susan Cusano and Nina Kadan-Lottick, share an unhappy distinction: Far too early, they felt like frail, elderly women. Cusano, 55, could barely walk. Kadan-Lottick spent her early forties gradually cutting back on activities until she was no longer playing outside with her children.

Both women are patients at the Yale-New Haven Hospital Spine Center at One Long Wharf in New Haven, where doctors stopped their debilitating pain and helped them reclaim their lives. Neurosurgeon Khalid Abbed worked with orthopedic surgeon Jonathan Grauer to build the center’s interdisciplinary team. Other active physicians include orthopaedists Peter G. Whang and James Yue, and neurosurgeons Maxwell Laurans, and Michael DiLuna.

Their goal was to have a variety of specialists under the same roof to allow for optimal treatment of any spinal ailment, whether surgical or not, in the most convenient and efficient manner possible.

Focus on collaborative care

The two doctors provide surgical solutions or help certain patients avoid surgery, and are working to set up a system that will literally allow a patient to be sent down the hall to a medical spine specialist or other caregiver. “We can send them to physical therapists who we routinely communicate with,” says Dr. Grauer.

The center is located in a large suite complete with X-ray machines, and the physical therapy gym has windows that overlook the Long Island Sound. There are plans for a pain management procedure room. Clinicians work in a hub surrounded by exam rooms, so it is simple for providers to review a diagnostic scan together or collaborate on a treatment plan.

The center’s staff will continue to expand to include a physiatrist, a clinician who specializes in treating pain and helping patients regain function.

Treating complex problems

Cusano and Kadan-Lottick, two patients who were treated with surgery, found it reassuring that they were able to check out all of their options.

Cusano came to Dr. Grauer with significant lower extremity symptoms related to her lumbar spine. She had been seen elsewhere, but was still looking for a physician who would spend the time necessary to get to the root of her complex problem. “I felt like I was 100,” remembers Cusano.

Dr. Grauer examined her thoroughly and obtained necessary imaging. In light of the fact that her nonsurgical treatments hadn’t helped, he recommended surgery—specifically a decompression and fusion.

Cusano didn’t relish having an operation, but is now happy with her decision. “I’m raking. I’m shoveling snow. I just lifted a dishwasher with my daughter,” she says.

Kadan-Lottick says, “I really had to psych myself up to walk from my garage to my office.” A compression of her spinal cord was causing her pain. Kadan-Lottick, herself a pediatric oncologist, found herself immediately impressed with Dr. Abbed, whose training includes a fellowship in orthopaedic and neurosurgical spine surgery.

Ultimately, she chose a surgery that drew on Dr. Abbed’s specialized training—a multilevel minimally invasive decompression and stabilization procedure that dramatically decreased her recovery time, blood loss, muscle injury and length of hospital stay compared with conventional open surgical options. She was walking the next day, and Dr. Abbed helped her craft a rehabilitation plan.

“I really feel like I had been living the life of someone decades older,” says Kadan-Lottick, now two years out from her surgery. Now she is hiking, skiing, and biking with her family again.

Diverse group of providers

Although both Drs. Abbed and Grauer are surgeons, Dr. Abbed says most spine patients will not need surgery, so he always seeks non-operative alternatives first for those who can benefit from them. “It used to be the hardest part of my job when I saw someone who was hurting and they weren’t candidates for surgery, so I couldn’t help them,” remembers Dr. Abbed. “Now we have the ability to get them the non-operative treatment they need.”

Doctors give specific instructions to the physical therapists, who routinely discuss the patient’s progress with the surgeon, who can adjust the treatment as necessary.

“Therapy is very specific to the individual,” says Jhasson Brooks, lead physical therapist for the center. The goal may be to provide pre-op or post-op therapy for surgical patients or help a patient avoid surgery by providing education and a comprehensive exercise program. “We can bring them to a point where we reduce their pain, teach proper body mechanics, and prevent further injuries,” he says.

Susan Cusano first saw the new Spine Center on a recent follow up visit. She loved the facility, but the change she sees in herself is even more impressive. “I remember sitting there crying,” she says of her first visit. Today there are no more tears.