Finally, Back to Health

The UMMC orthopedic center was decorated with the lacrosse sticks and baseball jerseys of former patients, but the atmosphere was professional and efficient. After a spinal X-ray and questions about her symptoms, the diagnosis took about 10 minutes. When Ludwig clipped the X-ray and the MRI film to the imaging lights, it was easy to see why.

Roberta, he explained, was suffering from a disorder called lumbar spinal stenosis, a constriction of the fluid-filled canal that contains the spinal cord.

A combination of age, genetics and the accumulated wear and tear of her active lifestyle had resulted in a gradual but dramatic displacement of her spine between the fourth and fifth lumbar vertebrae--a condition known as spondylolisthesis. The fifth lumbar vertebra and those above it had pushed forward. As this occurred, the spine had sought to strengthen itself by generating more bone within the misaligned joint -- an arthritic condition that pinched the spinal canal even more than the misalignment. The benign, fluid-filled cyst in the area compounded the problem.

An MRI of her back just below the misalignment, Ludwig pointed out, showed a perfectly circular spinal canal about 1½ inches in diameter: "There she has the spine of a 30-year-old woman."

But where it passed through the problem area, a succeeding MRI showed, her spinal canal was pinched into a constricted four-pointed star -- choked to less than one-fourth its normal diameter.

"This is a very common condition in 40- to 50-year-olds," Ludwig said, "but it's often confusing because its severity varies and it produces different symptoms in different people. Some people have relatively little pain and disability and elect just to live with it and watch a lot of TV."

In the case of Roberta, whom Ludwig described as "a very young and active 50," he recommended surgery.

"I can't guarantee that it will stop pains above your legs and lower back, but I think it will. I'm pretty sure that's just pain radiating up from below through your muscles and other nerves. But I guarantee it will stop the leg pain, which you say is both the worst pain and where this all started."

"How soon can you operate?" Roberta replied.

The Open Back

The following week Roberta was wheeled into an orthopedic operating room in the impressively modern UMMC in downtown Baltimore, just a few blocks north of Camden Yards. There doctors are developing procedures for remote surgery so a doctor can operate on a patient half a world away using surgical tools linked by satellite.

Roberta's procedure was more basic. Ludwig performs some 300 similar operations a year, sometimes four a day.

Once Roberta was scrubbed, draped, anesthetized and positioned facedown on the operating table, Ludwig opened a 6½-inch incision along her spinal ridge, beginning just above her buttocks. With scalpel and retractors he spent 20 minutes slicing through and pulling aside her back muscles to expose her spine at the junction of the fourth and fifth lumbar vertebrae.