Not long ago, Nallas Lawson was in so much pain that she couldn’t walk the few feet from her backyard deck to her peach tree without help. A severe foot drop — difficulty raising the foot or dragging of the foot — was causing frequent falls, and she suffered from weakness and numbness in her legs. She relied on a scooter at work.
“I have to walk class to class because I’m a schoolteacher and I was in a lot of pain,” Nallas said.
Because she underwent a kidney transplant in 2011, she has to closely monitor the medications she takes, including Tylenol. She tried everything to alleviate the pain, including over-the-counter creams, drops and patches.
“It would help for like six hours, and then we’d have to apply more,” Nallas said. “I was in tremendous pain.”
Nallas, who lives in Ocala, has battled several serious medical conditions, including high blood pressure. Her neurological problems began after a bad fall in 2016, and she was diagnosed and treated for multifocal motor neuropathy, a painful neurological condition, without success. She was ultimately referred to William J. Triggs, MD, an associate professor in the department of neurology at the UF College of Medicine, where she had the kidney transplant years before.
After she underwent an MRI, Triggs referred her to neurosurgery to relieve stenosis in her spine. Spinal stenosis is a narrowing of the spaces in the spine, often a result of aging, which puts pressure on nerves. However, because of her medical history, including immunosuppression related to the transplant, her neurosurgeon, Nohra Chalouhi, MD, an assistant professor in the department of neurosurgery at the UF College of Medicine, was concerned about the potentially difficult recovery process, including wound healing.
A Minimally Invasive Solution
Nallas was referred to Sanjeev Kumar, MD, an associate professor of anesthesiology at the UF College of Medicine, medical director of UF Health Pain Medicine — Springhill and an interventional pain physician. He offered an option that would transform her life: endoscopic spinal decompression.
This minimally invasive procedure involves a small endoscope inserted into the spinal canal. The procedure uses high-definition visualization, continuous irrigation — which helps maintain clear visualization of the surgical field and stem bleeding from small blood vessels — and small instruments to remove or decompress a disk or open up space for a nerve to relieve spinal nohrasis.
Patients typically have less postoperative pain, heal faster because of the small incisions and experience less tissue trauma than they would with a traditional surgery.
“We actually have an eye inside the spine,” Kumar said. “Because the tissue trauma is so minimal, the healing is very quick.”
Nallas had the outpatient procedure three days before Christmas. When she woke in the recovery room, she immediately noticed improvements. She had full sensation in her legs and improvement in her foot drop, which is caused by compression of the nerve or nerves that give strength to the foot muscles.
“When we relieve the compression on the nerve, immediately the nerve bounces back, and the foot drop and weakness in the leg recovers pretty quickly,” Kumar said.
Just six weeks later, Nallas was able to return to work. “This surgery has changed my life in that I’m able to walk to class without pain,” she said.
“I just have two little scars where they went in there with the camera and where they went in with the tool to alleviate the problems,” Nallas said, comparing the scarring to the size of a mole.
Kumar said her postoperative MRI indicated a successful outcome.
A Minimal Footprint
Although not appropriate for complex spine cases such as scoliosis corrections, endoscopic spine surgery can be an excellent option for patients with one or two levels of spinal stenosis, herniated disks, cysts in the spine, scar tissue removal from previous spine surgeries or abnormal bone growth that causes painful false joints in the spine.
“It’s a very minimally invasive surgery, and it can achieve almost everything that an open spine surgery can do,” Kumar said. “We are able to accomplish our goals with a very minimal footprint.”
The endoscopic procedure leaves open the possibility of future procedures, including traditional spine surgery, if a patient’s pain returns.
Nearly four months after the procedure, Nallas is pain-free and focusing on the joys of a more active life. These days, she is up and about around her home and community, tending to her vegetable pots on her back porch, completing household chores and strolling through the flea market with her husband. She recently bought an exercise bike that she has started to use in the mornings.
And she hasn’t had to apply any cream since the surgery.
"Only a Phone Call Away"
Nallas said her experience at UF Health was overwhelmingly positive, noting that Kumar was friendly, knowledgeable and easily accessible if she had concerns.
“They were only a phone call away,” she said. “I could call them any time, and I could talk to either him or his assistant.”
Although she was initially wary of surgery, Nallas said she would recommend the procedure without reservation.
“I would recommend this surgery highly,” she said. “To have pain-free days, that’s awesome. That’s amazing. It’s something I haven’t experienced in a while.”