Full Interview With Dr. Kenneth Light

Almost everybody knows someone who seems to have back problems. How many of 
those go wrong?

Dr. Light:  There are about 250,000 laminectomies done every year and it's said
 in this country that of 1/3 of all spinal operations result in failure. So, 
that would be about a hundred thousand failures a year.

So, every day you're seeing someone who went to a doctor to get something fixed
and now you have to fix that, correct?
Dr. Light: Pretty much.

What are the most common procedures that have the most mistakes?
Dr. Light:  You can categorize them as mistakes and then you can categorize 
them as the natural history of the problem that results in a less than optimal 
result. A mistake would be that the doctor operates on the wrong disc or the 
wrong level. Fortunately, that does not happen that often, but I would say it 
probably happens about one out of every 1,000 cases, maybe a little bit less. 
Then, there's a type of problem where the cause of the pain is obscure, meaning
 the cause of the pain isn't obvious and the doctor thinks the cause of the 
pain is one disc when in essence it might be a combination of discs. So, only a
 part of the problem is corrected. Then, there's the type of problem that 
happens where the doctor does the proper operation, but by virtue of the way 
that the operation is completed the problem returns. So, the most obvious and 
common situation is somebody that has a herniated disc in the lumbar spine. One
 of the most popular operations for that is called microdiscectomy. 
Microdiscectomy means that the doctor makes a very tiny opening in the back, 
the smallest possible opening that he can make. Then, there's a common belief 
that if you just go in and take out one tiny little piece of the disc that the 
problem is solved and because you've done so little that, that cures the 
problem. When in essence that isn't quite how it happens. It happens like that 
for maybe 60 or 70 percent of people. There's another 30 percent of patients  
where the little piece of the disc that herniates and is removed is just the 
tip of the iceberg.  Just under the surface there's a large fragment of disc 
material that the next time the patient coughs or increases their 
intraabdominal pressure it's pushed out again in to the spinal cannel and 
compresses the nerve. That happens approximately one out of five cases. One out
 of five people who have microdiscectomy have recurrent herniation of the disc 
and that's an ongoing problem. There's another issue that comes out that 
happens, when you remove the disc the disc is part of the natural shock 
absorber of the spine. So, when you remove part of the disc you remove some of 
the shock absorbing qualities of the spine. There are a group of people maybe 
again one out of five that once the disc is removed they develop a condition 
called mechanical back pain or arthritic back pain because they've lost the 
normal cartilage in the spine. The disc space narrows the spine starts to shift
 in an irregular fashion and that in and of itself is a cause of back pain. So,
 another 1/5  of the patients who have microdiscectomies develop arthritic back
 pain as a result of it. So, those are two very common causes of failure in 
that situation.

Would you say that most of your patients who come here after having surgery and
 it did not work for one reason or another, do they come back within five years
 of that surgery or within five months?
Dr. Light: I would say that most people, if they know that they're going to 
have a failed operation usually it occurs sometime in the first year or two 
following the operation. There is another group of patients, another possible 
cause of failure and in this case we're going to discuss this is the cause of 
the problem in spinal surgery. One of the most common operations we do is a 
spinal fusion. What a spinal fusion really is, is the doctor takes a piece of 
bone and places it between the two vertebral bodies and the two vertebrae wind 
up fusing together or joining together as one vertebrae. So, what that really 
does is it solves the problem of the disc in that area. In other words, there's
 no more disc. If there's no more disc there's no more pinching of the nerve. 
If there's no movement of that disc space, then there's no more nerve 
irritation. So, what it does is it solves that problem. But what it does is 
first of all it makes the spine very straight and the spine is meant to have a 
curve in it.

Would you say to stay away from spinal fusions?
Dr. Light: If you can. There are certain problems where spinal fusions are 
absolutely necessary. If you have a condition known as spondylolisthesis where 
one vertebrae has slipped in relationship to the next that slippage or a 
malposition of the vertebrae pinches the nerves, in that situation the doctor 
has to put the vertebrae back and has to fuse it. Otherwise there's no way of 
holding it. If you have a condition such as scoliosis or curvature of the spine
 the only way to straighten the spine and keep it straight really is to fuse 
it. So, if you have one of those two things you have to have it fused. There 
are specific situations where it's unavoidable, but nowadays we have better 
things than spinal fusions. We have these things called disc replacements and 
they are clearly superior to spinal fusions. Hopefully everybody will be able 
to keep the movement in their spine with a disc replacement and avoid having a 
spinal fusion.

Have you ever done what you did with Sharion before and did you come up with 
Dr. Light: I've done it one other time. I did it at the time that I did her 
operation. So, her story is very simple. She fell and hit her head and injured 
the C 5-6 disc. She went on and was treated conservatively and then eventually 
underwent spinal fusion. Then, gradually over the years the discs on either 
side of the spinal fusion disintegrated so to speak. She was left with terrible
 pain that originated on both sides of the fusion. In addition, the fusion 
itself was fused in an awkward position and what it did is it made the discs 
above have to work twice as hard when the patient looked straight ahead because
 the disc below, the C 5-6 disc, was fused in a flexed or kyphotic posture. So,
 every time she looked straight ahead she had to tip her head back and put 
stress on the disc above. So, she had a fusion that was not fused in an 
appropriate position and she had degeneration of either discs, discs on either 

Is it painful?
Dr. Light: It was painful. She was miserable. She had to take pain medication 
on a regular basis; she had to stop performing her normal activities. She'd get
 numbness in her hands, weakness in her hands. She wasn't able to work, she was
 not very happy.

This information is intended for additional research purposes only. It is not 
to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any
 medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no 
responsibility for the depth or accuracy of physician statements. Procedures or
 medicines apply to different people and medical factors; always consult your 
physician on medical matters. 
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