Neck and back procedures help 72-year-old return to independence

February 10, 2020 Providence News Team

Dr. Barbara Lazio talks with Bob Nakutin about his procedure during a recent follow-up appointment.Bob Nakutin, 72, struggled for weeks with simple daily activities using his hands and wrists. His right index finger lacked strength and felt, to him, like it was dangling off his hand. He couldn’t feel the tab on his zippers to pull them up, and couldn’t muster enough force in his hand to turn the key in his car’s ignition.

Unfortunately, the symptoms progressively worsened and Bob made the decision to stop driving to protect himself and innocent people on the road. It was at that point he knew this was a bigger problem than just aches and pains that came with aging, and he sought help from his primary care physician.

Bob’s physician was concerned with the results of his X-ray and MRI scans, and swiftly referred him to Providence Medical Group - Southwest Washington Neurosurgery. While nervous and skeptical at first, after his first meeting with board-certified and fellowship-trained neurosurgeon, Barbara Lazio, M.D., Bob felt more at ease with Dr. Lazio’s proposed treatment plan. She patiently and thoroughly helped Bob understand that he had three large bone spurs in his neck that needed to be removed immediately.

“Providence as a whole is such a different feeling compared to going somewhere else. It is so patient-oriented, other places seemed so rushed, Bob said. “After Dr. Lazio told me what she felt I needed, she asked if I had any questions or concerns, and she meant that. She didn’t make me feel rushed or overwhelmed, and she wanted me to feel as comfortable as possible.”

Days later, Dr. Lazio successfully performed a multilevel anterior cervical discectomy and fusion. During the surgical procedure, the spine is exposed, and the discs and bone spurs that are growing between the vertebrae are removed to relieve the pinching on the spinal cord and the nerves. The disc space is filled with a small bone graft from a donor and some of the patient’s own bone from the spurs that were removed. A plate holds it in place permanently while the patient’s bone fuses solidly over several weeks to months.

“It occurred to me, what if I hadn’t had this done?” Bob asked. “Would those bone spurs have kept growing and further compress the spinal cord? If the spinal cord gets severed in your neck you’re dead. Dr. Lazio saved my life.”

After recovery at Providence St. Peter Hospital, Bob was transferred to a skilled nursing facility closer to home in Hoquiam. During his time at the facility, Bob quickly saw progress in many areas of his life. “Even my handwriting improved,” he recalled. “It had gotten far worse as the bone spurs were compressing the spinal cord. A month later I had to sign something and I was like a kid at Christmas when I saw my signature was back.”


Neurosurgery consult for debilitating, extreme sciatica pain

Months later, Bob began experiencing a separate source of pain in his leg, unrelated to his neck surgery earlier in the year. Bob asked his primary care physician for another referral to Dr. Lazio, whom he trusted to give him compassionate and expert care.

Dr. Lazio diagnosed him with sciatica, a common nerve pain that will affect as many as 40 percent of people during their lifetime and becomes more frequent in aging populations. Sciatica is a general term that describes nerve pain affecting the low back, hip, or leg, most commonly caused by pinched or irritated nerves in the low back.

For most patients, Dr. Lazio suggests they can find relief from sciatica flare-ups with physical therapy, over the counter pain medication and steroid injections. When symptoms are mild, patients can choose not to do surgery at all. When it persists despite nonsurgical methods, tailored surgery can fix the patient’s exact problem such as a herniated disc, spinal stenosis, or malalignment.

In this case, Dr. Lazio recommended surgery as the best source of treatment because Bob was experiencing an excruciating and incapacitating level of pain that didn’t respond to alternative surgical treatments.He couldn’t sleep or find a comfortable position to lay down because of the screaming pain down his leg.

“When there is significant malalignment of the vertebrae, or they are unstable, it can cause the spinal canal to become too small and pinch on the nerves that go to the legs. This makes it difficult and painful for patients to walk,” Dr. Lazio said. “When the walking becomes very limited and does not respond to physical therapy and epidural steroid injections, we consider surgery to relieve pinched nerves, and fusion if needed to keep the vertebrae properly aligned.”

After surgery, Bob spent two weeks back at the skilled nursing facility participating in daily physical therapy exercises to help him reach a quick, full recovery.


Treating the patient with a holistic approach to compassionate care

Today, almost a year after his neck and back surgeries, Bob chooses to continue outpatient physical therapy up to three days a week to stay healthy and strong. He said he values his health and mobility more than ever.

“Now, I feel better than I deserve. And I’m thankful,” Bob stated as he reflected on how far he has come from life-saving surgery to now living an independent, pain-free life. “There were so many things I took for granted before, like using a handheld can opener. The world opened up with all of these things I couldn’t do before my surgeries.”

Bob praised Dr. Lazio for her surgical skill and passion for her patient’s wellbeing. “I told Dr. Lazio, your gift is not what’s in your brain. Your gift is what you do with your heart. There are a lot of people who can study well and pass the test, but they don’t have that certain humanity that you bring to the table. That makes a big difference from my side of the equation.”

Dr. Lazio said she believes in treating each patient with the dignity and respect they deserve and to help them feel comfortable before, during and after surgery.

“I value the importance of taking care of the whole patient, understanding what they are trying to achieve through treatment.” Dr. Lazio said. “I could tell Bob was a fiercely independent person, and his well-being depended on this. My goal in treating him was to allow him to be independent. When I was involved in teaching medical students and residents, I looked for people who not only had high test scores but who could connect with people.”

After multiple surgeries in one calendar year, Bob is grateful every day to be alive and to have his quality of life back. His gratitude inspires him to encourage every person he meets to appreciate the human connection in one another, like how he felt with the caregivers at Providence.

“Don’t stop hugging each other,” Bob pleads. “I hugged Dr. Lazio to thank her. The hug came from the heart. She saved my life. Literally.”

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