Charles Fogarty started paying more attention to his persistent back pain soon after he was discharged from the Army in 2006. Over the next 12 years, it would grow progressively worse to the point of being debilitating some days.
The first orthopedist at a different health system that he saw said Charles’ condition was just something he was going to have to live with. Another prescribed a course of steroid injections that never approached the intended effect. Meanwhile, Charles also started seeing a chiropractor.
The worse Charles’ pain became, the more elusive the treatment felt to him.
All the while, his wife continued searching for an alternative. He was referred to Zarina S. Ali, MD, assistant professor of neurosurgery and a neurosurgeon at the Perelman School of Medicine at the University of Pennsylvania.
“By the time he came to see me, Charles had significant back pain with radiating leg pain,” Dr. Ali says. “I got some additional imaging and then proposed a surgical treatment option that included fusion and a laminectomy for the decompression of his spinal sack and nerves.”
A ‘night and day’ difference
Charles had the surgery on July 30, 2018. Almost immediately, he recognized a difference. “Before the surgery, I could barely walk. I was limping everywhere,” he says. “The day after the surgery, I was in pain, but I could walk.”
He was discharged from the hospital three days after the surgery. A nurse checked on his incisions at home, and a physical therapist visited a few times over the next month. “I couldn’t have asked for a better recovery,” Charles says. “I was told the recovery would be about six to 12 weeks, but I was back to work four weeks later.”
Dr. Ali also told Charles, who’s 40, to expect about 50- to 70-percent relief from his pain.
“I can’t say I’m 100 percent, but I’m pretty close to it,” he says. “I’m definitely much more than 70 percent.”
“There’s not always a clear understanding of where the patient’s pain originates. So, if their pain is multifactorial, we’re addressing one component of it with surgery. That’s why I never promise patients 100-percent relief,” Dr. Ali says. “I’m happy that his pain was dramatically improved. What I care about even more with my patients is, can they get back to doing the things that they were doing before their surgery?”
Charles can. Actually, he’s far more active now than he was over the 12 years between the start of his back pain and his surgery. He has two kids, a three-year-old son and a 13-year-old daughter. Prior to his surgery, he couldn’t even hold his son, let alone pick him up. He’s also doing all sorts of projects around his house and taking long walks on the boardwalk with his family when they visit Ocean City, NJ, a frequent summertime destination for them.
“It’s night and day compared to how I was before the surgery and how I am now,” Charles says. “I’m still a little sore, but, for the most part, I can do anything.”
New attention to recovery
Dr. Ali attributes at least some of Charles’ remarkable turnaround to something called Enhanced Recovery After Surgery. It’s a protocol she developed to optimize recovery from spine and peripheral nerve surgery. “It’s really a 360-degree approach to the patient, figuring out how we can improve their care,” she says. “For me, that begins when I meet them for the first time and describe what their treatment is going to entail.”
A study published earlier this year in the Journal of Neurosurgery: Spine showed that when the protocol was used, fewer patients needed pain medications a month after surgery. Earlier studies have shown that up to seven percent of patients who undergo spinal surgeries continue to take opioids a year after surgery.
The enhanced recovery protocol at Penn includes a personalized, safe, and effective pain management plan to help prevent opioid dependency. It also calls for the patient to be up and moving a few times a day starting the day after surgery to improve blood flow and encourage healing.
Charles was concerned with the inherent risks of spinal surgery, including the pain management that would follow it. “Ultimately, it was worth the risk,” he says, “The pain had gotten so much worse. Eventually, I wouldn’t have been able to take it.”
Now, nearly a year removed from his surgery, he’s back to living life on his terms and being the dad he always wanted to be.