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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at The Nebraska Medical Center. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE at THE NEBRASKA MEDICAL CENTER
Fall | Winter 2011

Keeping the Spine Aligned

Rich Kyler is living his dream.

A detective and member of the Omaha SWAT team, Rich had dreamed of working on the police force since he was 15 years old. Nothing was going to take that from him now. Not even a broken back.

For five years, Rich tried to ignore the nagging pain in his lower back. As time progressed, the pain shot down his buttocks and through his legs causing numbness and weakness in one leg that eventually spread to both legs.

“It got to the point that when I woke up in the morning, both legs would be numb by the time I got to the bathroom,” recalls Rich.

It was fear that held him back from seeking help.

“I was afraid to have surgery because I thought there was a 50/50 chance that I wouldn’t be able to go back to work,” he says. “I really like what I do and I couldn’t imagine being restricted to a desk job.”

It was that same fear that finally led him to get help. “I was at a point where I thought I might have to give up my job on the SWAT team,” says Rich. It was ultimately his wife, Tracy Kyler, who pushed Rich to seek medical advice.

“Rich has always been a really nice person,” says Tracy. “But I noticed that he was getting more irritable. I could tell he was miserable. When he mowed the lawn, he was moving slower and slower and would frequently stop to take breaks and stretch.” What was normally a 30-minute mowing job had turned into two hours.

A friend in the medical field recommended Peter Lennarson, MD, a neurosurgeon and director of the Spine Center at The Nebraska Medical Center and assistant professor in the Department of Neurosurgery at the University of Nebraska Medical Center (UNMC). Since Dr. Lennarson joined the staff at the Medical Center in 2005, the Spine Center has grown, both in staff and in the number and complexity of procedures performed.

Dr. Lennarson earned his medical degree at the University of Wisconsin Medical School in Madison. He completed his internship and residency at the University of Iowa College of Medicine and then worked as a neurosurgeon with the United States Air Force for several years.

Dr. Lennarson says he came to The Nebraska Medical Center because of the opportunities an academic research center affords physicians. “If you want to stay up-to-date, you need to be at a place that gives you the time and resources to stay current,” says Dr. Lennarson. “I believe in staying current with new technology and being able to offer the most recent advances to our patients.”

Rich and Tracy Kyler

Dr. Lennarson’s fascination with the nervous system is what led him to the practice of neurosurgery and it’s what pushes him to stay on the leading edge of spine and neck surgery. “It’s a field that’s constantly changing and evolving nearly daily,” says Dr. Lennarson.

Dr. Lennarson specializes in complex spine surgery as well as minimally invasive spine procedures, which often produce less pain, fewer complications, less blood loss and shorter recovery times. “Minimally invasive spine procedures are not offered at every medical center,” says Dr. Lennarson, who has received specialized training in minimally invasive surgery.

Some minimally invasive procedures can allow surgeons to access the spine with a one and one-half inch incision rather than an 8 to 10-inch incision. When possible, Dr. Lennarson likes to use minimally invasive surgery to access the spine through the side rather than the abdomen or back. “When going through the side, you don’t have to cut through the abdominal muscles, which can require long recovery times,” explains Dr. Lennarson. “Going through the back can also be high risk because of the presence of nerves in this area. This minimally invasive technique allows us to really customize our surgeries and expand the options of what we can do with less disruption to the surrounding tissue.”

“He spent an hour talking with us and when we left we felt completely confident in Dr. Lennarson and 100 percent convinced that Rich needed to have surgery.”
Tracy Kyler

When the Kylers sat down to meet with Dr. Lennarson, it didn’t take long for them to figure out that they were in the right place. Dr. Lennarson magnified CT scans of Rich’s spine on a big screen and explained everything in detail. The scans revealed extensive damage. There were several fractures in his spine; a disc had collapsed so that the lower third and fourth vertebrae were compressed; the vertebrae had also slipped out of place and were misaligned and tilted up and down, pinching the nearby nerves.

“He spent an hour talking with us and when we left we felt completely confident in Dr. Lennarson and 100 percent convinced that Rich needed to have surgery,” says Tracy.

“I’m not about quick fixes. I focus on getting to the source of the problem and treating the whole person.”
Peter Lennarson, MD

Rich and his doctors don’t know for sure, but they think much of Rich’s back problems occurred during a car accident in February of 2006 when the Kylers’ truck skidded off the road after hitting black ice. The truck slid down a ditch, flipped over a fence and rolled into a field. Tracy was unconscious and pinned under the truck for more than an hour. She suffered numerous broken bones, a torn spleen and spent the next five months in a hospital bed. Rich walked away with a purple ear, bruised shoulder and an achy back.

“Obviously, my whole body was rattled, but I was more worried about my wife,” he says. After an evaluation at a local emergency room, Rich told doctors he was fine and turned his focus toward helping his wife recover.

About a year after the accident, Rich finally decided to see a neurosurgeon about his back. “He said I probably needed surgery,” says Rich. “But we didn’t feel comfortable with him or his explanation.” Rich and Tracy left feeling confused and even more fearful, so they did nothing.

This time was different. Within several weeks of meeting with Dr. Lennarson, Rich was scheduled for surgery.

Dr. Lennarson says Rich’s case was very complex. “Because the fractures had been there for a number of years, the bones had slipped out of place and had caused bone spurs which had to be removed,” he explains. “The alignment of the spine was off and the bones were partially fused now as the body tried to heal itself.”

“Many surgeons would not have attempted this case or would have just done a quick fix, which would have eventually caused more problems for Rich later down the road,” says Dr. Lennarson. “I’m not about quick fixes. I focus on getting to the source of the problem and treating the whole person.”

Dr. Lennarson determined that the best way to treat Rich was to reach the area through two separate incision points. The first involved a one and one-half inch minimally invasive incision through the side, which entailed splitting muscles instead of cutting through them. “This approach can reduce recovery time, infection risk, scarring, bleeding and pain,” says Dr. Lennarson. Through this small incision, Dr. Lennarson used small instruments to re-expand the collapsed disc, reposition the collapsed vertebrae and place a cage across the disc space to stabilize the area. A bone graft was placed inside the cage to stimulate bone growth.

Left: Kyler’s spine before surgery with
fracture and collapsed disk space.

Right: Kyler’s spine after surgery showing
restoration of the lumbar disk space, disk
re-alignment and stabilized fracture.

During the second part of surgery, Dr. Lennarson made an incision through the back, which allowed him to clean up the broken vertebrae, relieve pressure on the pinched nerves, and place screws and rods through the vertebrae to hold them in place and to stop any abnormal movement of the spine.

Nine hours later, Dr. Lennarson had completed the surgery. “When he came out of surgery, he told me, ‘that was one of the toughest cases I’ve ever done. This guy is built like a tree trunk,’” says Tracy. (This reference now has become Rich’s nickname.) “He said things were so mangled in there that he couldn’t even make out his anatomy at times.”

But the nine hours were well worth it. “When I woke up, I felt great,” says Rich. “For the first time in a long time, I could feel my feet and wiggle them around. I was up and walking the next day. It was amazing. I came in for surgery on Wednesday and was home on Friday.”

Rich’s biggest challenge after surgery was taking it easy. “I went from walking a couple of blocks to five to six miles a day within two to three weeks,” he says. “My back felt great.”

He wanted to go back to work as soon as possible, but Dr. Lennarson urged Rich to rest and allow his body adequate time to heal. “I was constantly telling him not to do too much,” says Tracy. “I practically had to sit on him to get him to sit still.” After three months, Rich went back to work on light duty and was back to work full time after six months.

“This experience was life-changing,” says Rich. “I can’t say enough good things about the Medical Center and Dr. Lennarson and his staff. They made us feel so comfortable. They took the worry from me. I had complete faith in him and his staff.”

Today, Rich is doing many of the things he loves. “He’s running again, swimming, weight lifting and enjoying many of the things we did years ago,” says Tracy. “But the most important part of all of this is that he didn’t have to give up his career on the police force. He’s dreamed of that since he was 15. Dr. Lennarson and his staff have allowed him to keep living his dream.”

The Spine Center

Back and neck pain are common problems that many people experience at some point in their lives. Disorders and injuries related to the spinal column can be painful and debilitating. In severe cases, they can cause permanent disability or loss of movement or feeling below the injured area.

The Nebraska Medical Center Spine Center offers the latest advances in treatment, pain management and rehabilitation to correct many of these problems and allow individuals to live productive and active lifestyles.

The physicians at the Spine Center provide comprehensive care for the treatment of acute and chronic conditions of the spine including congenital, degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. Some of the conditions treated include neck and back pain, degenerative disc disease, spinal stenosis, scoliosis, trauma, neck fractures, osteoporosis fractures, spinal injections, sciatica, herniated discs, spinal deformity, kyphosis, spine fractures, osteoarthritis and degenerative joint disease.

“We provide a very comprehensive, multidisciplinary approach to care that enables us to treat every problem or injury that comes along,” says Peter Lennarson, MD, neurosurgeon and director of the Spine Center. Other members of the Spine Center include: Chris Cornett, MD; Kenneth Follett, MD, PhD; George M. Greene, MD; John D. Hain, MD; and Daniel L. Surdell, MD.

One of the primary benefits of the Spine Center to the patient is that all care is coordinated in one central location from diagnostics to pain management, surgery and outpatient rehabilitation. The patient works directly with a nurse case manager who collects all of the necessary patient information and tests before an appointment is scheduled with the neurosurgeon. In some cases, this may require ordering additional tests prior to the patient’s doctor visit.

“Our primary goal is to relieve symptoms,” says Dr. Lennarson. “Sometimes this can be accomplished with a combination of physical therapy and pain management. If physical therapy and pain management do not resolve the problem, and the pain prevents you from living the quality of life you’d like, then surgery may be something you want to consider.”

“Surgery for spine conditions can be extremely effective,” says Dr. Lennarson. “The majority of our patients get relief from their problem. The key is performing the right surgery, in the right area, at the right time. We do a lot of complex spinal surgery and revision of previous surgeries that were completed elsewhere.”

Dr. Lennarson says he and his staff spend a lot of time with patients educating them and talking to them so they can understand what their primary problem is and make sure they address their major complaints. “We work closely with patients with the ultimate goal of decreasing their pain and improving their quality of life,” says Dr. Lennarson.

Next article in the Fall | Winter 2011 issue of One Thousand And One:
Renewing Life