Sebastian neurosurgeon Dr. Brad McCollom is keenly aware that the very thought of surgery generates high levels of stress and fear in many back pain sufferers. Perhaps Grandma Gladys or Uncle Bob related scary surgery stories from “back in the day,” tales so harrowing that the sufferer has allowed a back issue to remain un-checked for years.
With cutting-edge technology and medical advancements, the scary stories from years ago are far from today’s reality, says McCollom. As a matter of fact, of the patients he sees who seek solutions for their back or neck pain, only about 10 to 20 percent will actually need to undergo surgery.
McCollom specializes in low back pain, degenerated or herniated disks, neck pain, spine fracture and other spinal conditions, as well as carpal tunnel syndrome, ulnar nerve entrapment and brain tumors.
He attended Western University of Health Sciences in Southern California, completed his residency at the Long Island Jewish Medical Center and Michigan State University Consortium and practiced in Detroit, moving to Sebastian in 2004.
Always fascinated by the nervous system, McCollom calls it “the last frontier of the body. It is still kind of the unknown. I like fixing a problem and seeing the results right away. Patients come in with pain, (undergo a procedure) and then there is no pain – and they are very happy. That is harder to do in other areas (of medicine).”
In today’s spinal surgery, he emphasized, “complications are very rare, good outcomes are quite high. We are not going to do a surgery that doesn’t correspond to the symptoms. We don’t take it lightly. Still, there are many, many patients who have been ignoring the issue for years. It is better to get as much information as possible from professionals.”
Most of McCollom’s North County patients are older residents, many with chronic spine-related pain most often occurring in the seven-vertebrae cervical (neck) and the five-vetebrae lumbar (lower back) areas. With the aging process often comes deterioration of the bones, joints, and disks (rubbery, cushion-like connective tissues which act as shock absorbers between the vertebrae). Much of this deterioration is the result of long-term arthritis, and can manifest itself in pinched nerves, sciatic issues and spinal stenosis (narrowing of the spinal canal).
Another common problem McCollom sees are herniated disks, which he describes as “the jelly popping out of the donut.” A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a crack in the tougher exterior, where it can put pressure on a nerve and can cause nerve damage (neuropathy) resulting in numbness or weakness in an arm or leg, buttock pain, leg cramps, difficulty walking, even sciatica. Many people experience no symptoms from a herniated disk and most patients don’t need surgery to correct the problem.
Carpal tunnel syndrome is usually the result of overworking the hands by performing repetitive motion tasks all day long. The stress and strain of constantly doing the same thing eventually causes the nine tendons that run through the carpal tunnel (wrist area), to become swollen, putting pressure on the median nerve, which causes tingling, numbness and pain in the thumb, index and middle fingers. In younger patients (60s and under), McCollom says, trauma and congenital issues are most often the cause of spinal pain.
The key to “an optimal surgical outcome,” says McCollom, is to be very specific in matching the symptoms to the area of the spine where the nerve(s) affecting the site of the pain are located. The best test in determining the root of the problem is the MRI. Other tests that may be used include X-Rays, CAT scans, and an enhanced CAT scan, with an injection of dye into the spinal column.
But, he reiterates, “Just because you’re seeing a surgeon doesn’t necessarily mean you’re going to have surgery.” Often the problem can be successfully handled with other options, including physical therapy, pain management, epidurals, acupuncture, injections or other medications. “We look at all those things before we consider surgery,” he says.
If a non-surgical solution is indicated, McCollom will refer the patient to another physician or facility. “There are good facilities in the area,” he says.
When surgical procedures are indicated for a damaged disk, a physician will stabilize the spine by removing the damaged disk and placing a metal rod to the vertebrae above and below the damaged area. This procedure is called fusion.
Artificial replacement discs are also a possibility and have been in use for about six years. However, McCollom says, the artificial discs have not been around long enough to complete a comprehensive study, and preliminary literature so far has indicated they are generally not any more beneficial than fusion.
For a painful compression fracture, a minimally invasive procedure called vertebroplasty is often employed. When a vertebra fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Vertebrae may also become weakened by cancer. In vertebroplasty, physicians use image guidance to inject a permanent cement mixture into the fractured bone through a hollow needle. This technique relieves pain by preventing the vertebrae from further collapse.
In the vast majority of the cases which do involve surgery, the result is a good outcome, with virtually immediate relief from pain, and a return to normal or near-normal activity. Recovery time, explained McCollom, can range from “a couple of weeks, and you don’t need a collar” for a single vertebra fusion, to 10-12 weeks if more than one vertebra is involved. The more vertebrae are involved, the longer it will take for the area to stabilize.
A newer approach, McCollom says, is accessing the site through a smaller incision in the side of the spine, which means a shorter recovery time. However, this approach cannot always be utilized; it depends on the individual patient and on the number of vertebrae involved.
In Florida, golfers make up a significant percentage of back injury patients, as they are especially susceptible because of the torque placed on the spinal column when repeatedly striving for the “perfect swing.” After an injury that requires back surgery, even with an optimal outcome, McCollom says, “the way those guys are twisting, I recommend that the patient not golf anymore.” He knows, however, that most golfers aren‘t going to heed that advice.
“Tiger Woods had lumbar surgery, and he’s already back out there playing. Tiger is tweaking those disc fibers with every single swing,“ said McCollom, and predicted Woods would be back in the hospital with a re-injury.
Another sports figure, Denver Broncos quarterback Peyton Manning, has had a 2-level cervical fusion procedure. “He’s back playing now; it didn’t slow him down.”
The nervous system is a very sophisticated electrical system, and McCollom anticipates “exciting advances,” including functional neurosurgery, the treatment of conditions where the normal function of the central nervous system (brain and spinal cord) is altered but the anatomy may or may not be normal. Such conditions can include chronic pain, spasticity, movement disorders (Parkinson’s disease, dystonia, tremor etc.), psychiatric conditions and epilepsy, even addictions, such as obsessive eating disorders.
“There are incredible possibilities,” McCollom says.
