OHSU Doctor Uses New Computer-Aided Treatment for Upper Back Problems

02/17/00    Portland, Ore.

Scoliosis wasn't enough to keep 62-year-old Betty Apland from staying active for decades. Weight lifting, golf, bowling and camping enriched her life. Then, about a year ago, things changed. She began to suffer middle back pain, which just wouldn't go away. "It kept me up nights," said Apland. "At times the pain was so bad it drove me to tears. That's when I decided to go to Oregon Health Sciences University." Last April, Apland became one of the first patients in the country to undergo a computer-aided operation at OHSU called pedicle screw fixation to stabilize her spine and diminish her pain considerably.

Six months later, Apland claims she is able to return to her active lifestyle. "It was a miracle," Apland said. "I'm playing golf and doing everything else I did before the pain." Now, the same operation provides hope for thousands of patients looking for relief.

The procedure, performed and partially developed by Robert Hart, M.D., assistant professor of orthopedics and rehabilitation at OHSU, involves screws inserted into the thoracic region of the spine for stability and pain reduction. The operation is particularly useful in treating tumors, fractures and deformities such as scoliosis.

"Surgeons have used screws to fuse vertebrae in the lumbar region or lower back for more than a decade," Hart said. "But until now, this operation wasn't really an option for most patients with problems in the thoracic or middle region of the spine."

Technology is what makes this procedure possible. Hart uses three-dimensional computer imagery to guide his work. A tracking device is connected to the patient's spine. That device is then linked with a computer to create a digital map to be used during surgery.

Before the advent of this new technology, screws were not a practical option for patients with middle back problems due to the fact that vertebrae in the thoracic region are smaller than vertebrae in the lumbar region. Doctors were worried about fractures of the vertebrae caused by the screws as well as the close proximity of the screws to the spinal cord. Due to those concerns, hooks or wires were often used to stabilize the central spine.

"The computer guidance and use of smaller screws reduces the chance of injury to the spinal cord," said Hart. "The benefit of using screws in place of hooks or wires is stronger fixation, with the goal that this will help increase the chance of healing as well reduce the number of vertebral segments required for the fusion."
Patients at OHSU are some of the first in the country to undergo this new procedure, and so far, the outcomes are quite positive. Nine months after her surgery, Apland continues down the road to recovery. While she says she isn't completely pain-free, her outlook remains good. "I can't say I'm 100 percent," said Apland. "But as things stand right now, 80 percent is definitely good enough."