Sculpting tool addresses spinal stenosis

Fluoroscopic procedure corrects root of debilitating lower back pain.

As a child, Judy Ahlquist suffered severe bouts of asthma that sometimes required hospitalization. The nurses that tended to her during those hospital stays made such an impression on Judy that she chose to become a nurse herself.

“Nursing is a caring profession but also a highly technical one; that’s why I liked it,” Judy reveals. “I worked in many areas of nursing over the years but mostly in mother-baby. I have a master’s degree in maternal-infant health nursing from the University of Michigan.

Judy Ahlquist with dance partner Victor Moore

Judy Ahlquist with dance partner Victor Moore

Now 73, Judy retired two years ago after 50 years in nursing.

“Toward the end of my career, I did a lot of home health and hospice nursing. I worked primarily with elderly and dementia patients.”

She also educated nurses-in-training for 30 years.

“I taught nursing at several community colleges in the Washington, DC, area and at Catholic University of America in DC,” she elaborates. 

She also taught at Florida State College at Jacksonville, St. Johns River State College and the University of Phoenix in Jacksonville.

Judy’s nursing experience left her with a half-century of memories. It also contributed to a painful lower back condition that got worse over time.

“I’ve had back pain for many years,” Judy shares. “There wasn’t any specific injury that I can remember that started it. However, as a nurse I did a lot of lifting and moving patients, which certainly didn’t help my back. I developed arthritis in my joints and spine from all the wear and tear.”

Ten years ago, bone chips became lodged between her vertebrae and spinal nerves. That caused excruciating pain, so she had surgery to have the chips removed. Then a few years ago, the pain came back.

“My back pain became extremely bad last year,” she details. “At times, it got as high as a seven or eight on a scale of one to 10. It got to the point that I couldn’t stand for more than five minutes. I couldn’t even walk to the end of my driveway without stopping. I love to dance. It’s my favorite form of exercise. But with the back pain, I couldn’t dance at all.”

Judy sought relief from her primary care provider, who promptly referred her to Kai McGreevy, MD, a board-certified neurologist, pain management specialist and founder of McGreevy NeuroHealth. Dr. McGreevy uses the most advanced treatment modalities to restore his patients’ neurological deficits and ease their pain.

“Ms. Ahlquist presented to our clinic complaining of lower back pain, which she had been suffering with for years,” Dr. McGreevy recalls. “The pain was impairing her quality of life because she was forced to stop doing things she likes to do, particularly dancing.”

In addition to conducting a thorough examination of Judy, Dr. McGreevy also ordered a number of tests, including an MRI. A review of the latter showed that her pain was caused by lumbar spinal stenosis.

Lumbar spinal stenosis is a degenerative narrowing of the spinal canal whereby the spinal nerves become compressed. This condition leads to pain, numbness, tingling, weakness and, sometimes, difficulty walking. Spinal stenosis produces pain that is typically worse with standing and walking and relieved with sitting, bending or stooping.

“The classic illustration of spinal stenosis is an older person with a hunched posture at the supermarket leaning forward on a shopping cart,” Dr. McGreevy describes. “Known as the shopping cart sign, this position is a cardinal feature of lumbar spinal stenosis and is typical in those who have the condition.” 

Sensitive Structures

According to Dr. McGreevy, there are many reasons why the spinal canal becomes narrow in spinal stenosis. However, for patients with degenerative conditions of the spine, the cause is often the thickening of the supportive ligament in the back of the spine.

“As the body tries to strengthen itself in response to the degeneration, this ligament becomes enlarged,” Dr. McGreevy informs. “It bulges forward into the spinal canal, creating pressure on the spinal nerves.

“Nerves are very sensitive structures. They don’t like to experience compression or pressure. When that happens to the spinal nerves, the result is pain, which can worsen with standing and walking.”

Historically, lumbar spinal stenosis was treated with surgery to open the spinal canal and decompress the nerves. However, surgery is not for everyone, Dr. McGreevy asserts. 

“Some patients may not be candidates for surgery due to multiple medical problems,” he elaborates. “Some may develop prolonged hospital stays due to complications, including infections. There is typically a long recovery after hospitalization. While surgery may fix the structural problem, sometimes pain persists or, in some instances, it may worsen over time.”

In treating Judy, Dr. McGreevy began with conservative measures, including epidural steroid injections. When those failed to alleviate her pain, he recommended a new technique called minimally invasive lumbar decompression, or MILD®.

Tissue Sculpting

Unlike other treatments for lumbar spinal stenosis, MILD is a corrective procedure that is designed to reduce the size of the supportive ligament in the back of the spine. By reducing the size of the ligament, pressure on the nerves is relieved. The result is a reduction in pain, numbness and tingling, a return to normal nerve function and improved mobility.

“The MILD procedure actually corrects the root cause of the pain,” Dr. McGreevy explains.

Prior to performing the procedure, Dr. McGreevy measures the thickness of the supportive ligament. He uses that measurement to determine the degree to which the ligament must be reduced to return it to normal size.

“The normal thickness of that ligament is less than 2 millimeters,” Dr. McGreevy details. “In many people with lumbar spinal stenosis, the ligament is twice or three times that size. Ms. Ahlquist’s ligament, for example, measured 4 millimeters.”

The MILD procedure is performed through a tiny puncture in the lower back that is about the size of a baby aspirin, Dr. McGreevy illustrates.

“With the patient under anesthesia, we place an instrument through the puncture and access the ligament using fluoroscopic guidance,” Dr. McGreevy explains. 

Through the portal, the doctor inserts a tissue sculptor that has a tip similar to an apple peeler.

“Using the tissue sculptor, we remove small slices of the ligament until we reach the desired size,” he continues. “While debulking the ligament, we can actually see the amount we’re removing from the body.

“MILD offers a nonsurgical approach to directly decompress the region of interest in an outpatient setting in approximately 30 minutes, with minimal tissue trauma and a low risk for complications. Patients are able to go home the same day and in many cases resume normal activities with less pain and improved standing and walking within a week.”

Dr. McGreevy has performed the MILD procedure on more than 50 patients so far and says the results are consistent with clinical trials that showed 70 to 80 percent improvement in pain over five years.

“More importantly, it showed improvement in mobility and functioning, which results in a better quality of life,” Dr. McGreevy informs.

“Huge Improvement”  

Dr. McGreevy performed Judy’s MILD operation on September 27. She noticed a difference in her condition almost immediately.

“I felt some pain relief right away, and it’s gotten better and better over time,” Judy enthuses. “At this point, my pain level is a two and sometimes a three if I do a lot, but I can handle that. Generally, it’s much, much better.

“Before, I couldn’t walk any distance or stand long enough to do the dishes. Now, I’m able to walk my dogs and stand for fairly long periods of time. I’m not quite back to where I was, but I can dance a little now.

“It’s just amazing that I’m able to get around so much better and do so much more. It’s a huge improvement. Having chronic pain is not fun, so being able to walk around without pain is a godsend. It’s wonderful.”

Judy thinks Dr. McGreevy is wonderful as well.

“He’s a terrific doctor,” she raves. “He’s kind and easy to talk to. He’s very knowledgeable and has a wonderful bedside manner. And he’s up to date on all the latest treatments. Being a nurse, I’m kind of leery of doctors, but I trust Dr. McGreevy. I highly recommend him.”  

© FHCN article by Patti DiPanfilo. Photo courtesy of Judy Ahlquistt. mkb
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