Joint Forces

Veteran reservist winning the battle against back pain.

In March, Steve Selman marked his 30th year in the Army Reserve. Seventeen of those years were spent on active duty tours, including one with the 1st Armored Division during the Iraq War. In the years that followed, Steve lived with a painful reminder of his time in Iraq.

Photo courtesy of Physician Partners of America.

Steve Selman

“In 2003, right after the war started, I was a captain running a forward command post in southern Iraq,” Steve, 47, remembers. “One day, as it neared dusk and visibility was fading, a Category 4 sandstorm came up on us without warning, and the wind became fierce.

“I yelled at the sergeants to grab the tent before it blew away. As I grabbed it, a huge gust of wind blew that swept up both me and the tent. The wind carried me about 50 feet and threw me against a nearby truck. I hit the very top of the truck with my back flat, then fell about nine feet to the ground.

“At that point, I was partially paralyzed. I couldn’t move my legs. Once we rode out the storm, I was medevaced to Kuwait City for treatment. After about a day and a half, I was able to move my legs, but I still couldn’t walk. They then medevaced me to a military hospital in Germany, where I spent six weeks recuperating. After that, I was redeployed to finish my tour.”

Heading back into the fray so quickly may not have been the best decision for Steve. He did so based on a sense of duty to his country and his fellow soldiers, who were away from their families and fighting to survive in a war zone, not because he was healthy enough to return.

“I told the doctor I was better than I really was just so he would clear me to redeploy,” Steve admits. “That was a mistake, because I’ve been dealing with chronic back pain ever since.

“Over the years, my back pain flared up every three or four months. When it flared, I could hardly walk and often had to use a cane. Doing anything physical, even putting on my shoes, was extremely challenging. But the pain always got better after a few days.

“My back pain went from a nine or 10 on the pain scale to a two or three, which is manageable, in a matter of months.” – Steve

“Then in December 2018, something changed. I started having massive nerve pain down my legs that I never felt before. I had to use my cane to walk all the time. But unlike previous flare-ups, this pain didn’t get better. It got worse. On a scale of one to 10, the pain was a nine or 10. I’ve never experienced pain like that before.”

Fortunately, a friend told Steve about Physician Partners of America. There, he met with the practice’s chief medical officer, Dr. Abraham Rivera. The doctor began his evaluation by reviewing Steve’s MRI and performing a series of diagnostic nerve blocks to assess Steve’s condition.

“By administering the nerve blocks, I learned that there were several suspicious areas in Steve’s spine, and I was able to pinpoint the source of his pain,” Dr. Rivera reports. “Once my evaluation was concluded, I diagnosed Steve with radiculopathy, a ruptured disc and a pinched nerve, along with low back pain.”

Team Techniques

To help Steve achieve pain relief, Dr. Rivera joined forces with Dr. James St. Louis, director of Physician Partners of America’s Minimally Invasive Spine Group. Dr. St. Louis performs minimally invasive laser spine surgery. He determined that Steve was a good candidate for the surgery.

“Upon evaluating Steve, I discovered that a damaged disc in his lower spine was pinching the nerves exiting through the openings in the spinal column, called foramen,” Dr. St. Louis explains. “Pressure on the nerves caused the pain in his back and down his legs.

“To address Steve’s condition, I chose to perform two minimally invasive laser spine procedures, a laminotomy and a foraminotomy. The goal of performing those procedures was to decompress Steve’s nerves and relieve his painful symptoms.”

A lamina is a part of the vertebral arch. A pair of laminae join with the bony projections that jut from the middle of the vertebrae, called spinous processes, to provide a point of attachment for the spine’s muscles and ligaments. A laminotomy is the removal of some of the lamina to relieve pressure from the bone pressing on the spinal cord.

“Minimally invasive laser laminotomy is performed through a half-inch incision in the back,” Dr. St. Louis reports. “The incision is carefully placed with the help of a special x-ray called C-arm fluoroscopy. Laminotomy is carried out using a scope with a camera, and the surgeon operates while visualizing images from the camera on a computer screen.

“Once the incision is made, we insert a series of tubes to dilate the muscles that sit on top of the bone and create an opening in the lamina using a laser, a small drill and a Kerrison. We use rongeurs to remove the pieces of bone that were in the lamina.”

To relieve pressure on spinal nerves, Dr. St. Louis uses a Kerrison to remove some of the bone surrounding the area where the nerves exit the spinal cord. This is a foraminotomy. Because laminotomy and foraminotomy are performed minimally invasively, recovery is short and complications are rare.

“I typically instruct patients to walk for an hour the day after surgery in three 20-minute intervals,” Dr. St. Louis describes. “Total recovery time depends on the patient’s degree of activity. If they’re returning to a desk job, they can go back within a week. If they do manual labor, they must wait anywhere from two weeks to a month.”

“Amazing Transformation”

Steve reports that he didn’t feel pain relief right away following his minimally invasive laser spine surgery. But Dr. Rivera and Dr. St. Louis reassured him that he would feel better with time.

“They told me my nerves were irritated from the surgery and I had to give myself a chance to heal,” Steve relates. “I was a tad skeptical because I went through several procedures. But before long, I started feeling a difference.

“Two months after my procedures, I felt great, a lot better than I had in years. The pain wasn’t completely gone, but there was an incalculable difference in how I was feeling versus how I felt in the past.

“My back pain went from a nine or 10 on the pain scale to a two or three, which is manageable, in a matter of months. It was an amazing transformation. My injury may require additional procedures in the future, but for now, I’m winning the battle against my back pain.”

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    • Physician Partners of America

      Physician Partners of America is proud to be a pioneer in the field of laser spine surgery procedures. Minimally invasive spine procedures can often be performed using incisions smaller than 1 inch, compared to incisions of 5 inches or more u... Read More

    • James St. Louis, DO

      James St. Louis, DO, earned his Bachelor of Science and Masters of Science degrees from the University of Wisconsin, La Crosse. He received his osteopathic medicine degree from the Kansas City University of Medicine and Biosciences, and comple... Read More

    • Abraham Rivera, MD

      Abraham Rivera, MD, earned his Doctor of Medicine degree from the University of Puerto Rico School of Medicine and completed a residency in anesthesiology and pain management at Albany Medical Center in New York. Dr. Rivera’s decades of experie... Read More