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Health Matters: Providence Mission Hospital | 5 S usan Carberry still remembers the moment four decades ago when her back troubles began. "I was playing tennis in college and I jumped up for a smash return," she recalls. "I came down wrong and it felt like my rib cage was in my throat." She spent three days in bed recovering. Now 67, Carberry endured worsening back pain for years as a result of that disc-damaging injury until she met Alexander Taghva, MD. Carberry found Dr. Taghva, a board-certified neurosurgeon, after excruciating sciatic pain down her right leg sent her to Providence Mission Hospital's emergency department. There, she says, "the ER doctor was wonderful and she recommended Dr. Taghva. She was spot-on; he is fabulous." What she liked about her first meeting with Dr. Taghva, Carberry explains, was that "there was no pressure, just education. Although my MRI suggested I'd need artificial disc replacements and/or spinal fusion, Dr. T. said, 'Let's see what else we can do. We have a spinal cord stimulator we can try first.' I liked his approach of starting with the least invasive procedures first." Thirty-six years ago, long before meeting Dr. Taghva, Carberry had undergone a percutaneous lumbar discectomy, and she was in no rush for more back surgery. The discectomy had initially helped with her back pain, but over the past 10 to 12 years, she says, the sciatica came on with a vengeance, sending intense, throbbing pain all the way down her right leg to her ankle and keeping her from sleeping or sitting for the time required for her work as a financial compliance consultant. The San Juan Capistrano resident decided she'd follow Dr. Taghva's guidance and give the spinal cord stimulator (SCS) a try. IMMEDIATE RELIEF Dr. Taghva has performed several hundred SCS implantations as well as serving as an investigator in clinical trials for one of the devices. He also trains other physicians in how to perform SCS procedures. He describes the implant as "a pacemaker for the spine," in that it sends out pulses of electricity that override the pain signals to the brain, a process known as neuromodulation. The procedure involves two steps: a test placement of temporary wires and a device for about a week, to determine if the SCS will be effective, and then, a week or two later, the permanent implantation. The trial procedure is done under "twilight" sedation, and the permanent implantation requires general anesthesia. Each procedure takes less than an hour, and patients go home the same day. "The trial worked phenomenally," Carberry says. "The relief was pretty much immediate, with 95% of my pain gone." Although Carberry is ecstatic about her new pain-free existence, Dr. Taghva says her outcome is not unusual. "Susan's results were great, but on average we see patients get pain relief in the 60% to 80% range. People notice improvements immediately." The doctor adds that he thinks Carberry 's enthusiasm about trying the SCS helped. "Susan has such a positive attitude, and I think that helps patients get through the process." For her part, Carberry is excited to be able to once again garden, ride horseback and walk long distances. And she can now sit without pain. She's also pleased to be able to sleep normally again and stop taking pain medications. "I'm so happy I went to see Dr. T. I trust him completely," she says. Explore classes and support groups hosted by Mission Neuroscience Institute's expert team. Call 844-943-1060 or visit providence.org/missionclasses. Dr. Alexander Taghva SURGICAL TREATMENTS FOR BACK PAIN The right treatment starts with the right diagnosis, which can be tricky, because pinpointing what's causing back pain isn't always easy. Dr. Taghva notes that most patients have a mix of neuropathic pain (aka nerve pain) and mechanical pain, which stems from structural dysfunction or instability of the spine. The spinal cord stimulator can be a helpful diagnostic tool for honing in on the nature of pain, he says. "Sometimes an SCS trial helps us understand what type of pain a patient is suffering from." In cases where the pain stems from functional problems, such as damaged discs, compressed nerves or malaligned vertebrae, surgery may be needed. Here are three of the most often performed: Microdiscectomy. If a disc that provides cushioning between two vertebrae has ruptured (aka herniated) and is causing pressure on the spinal nerves, the surgeon may decide to remove the herniated portion via this procedure. Spinal fusion. Fusions involve adding hardware to join (or fuse) two or more vertebrae permanently. Dr. Taghva recommends this option when nerve compression or pain is caused by instability, malalignment or structural deformity of the spine. The surgery is intended to relieve pressure on spinal cord nerves to stop pain and to stabilize the spine. Artificial disc replacement. Unlike a spinal fusion, this newer option of replacing a degenerating biological disc with an artificial one made of metal (or metal and plastic) allows the spine to still move in the affected area. Dr. Taghva prefers this option for problems in the neck, often as an alternative to anterior cervical discectomy and fusion (ACDF) of the cervical spine.

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