Extreme spine surgery now available in Michiana

If you have ever groaned, "Oh, my aching back!" you are not alone. Back pain is one of the most common medical problems.

For most people, the pain goes away on its own. But for others, it can lead to surgery and months of recovery.

Back surgery is a big decision. Many decide to live with the pain rather than have surgery on the spine.

But now, an extreme spine surgery is putting patients back on their feet faster than ever.



Part One: The Preparation

It's a quiet morning outside George Demeyer's New Carlisle farm.

"I was born a farmer and lived that way all my life," he explains.

But farming has gotten harder these days because of chronic back pain.

"You abuse yourself over the years," George admits.

The years spent on the farm, in addition to his work as foreman at a steel plant in New Carlisle, took a toll on George's back. Now retired from the steel plant, he has decided to get his back problems fixed.

"I told everybody, 'This is George's year to go in the shop,'" he jokes.

George's "body shop" is an operating room at the St. Joseph Regional Medical Center.

His "mechanic" is Dr. Thomas Mango, a surgeon who is performing what is called Extreme Lateral Interbody Fusion. The first in northern Indiana to perform the surgery, he has done it countless times at a hospital out east.

"It's not that extreme. It's really a lateral approach to the spine," he explains.

It is important to note that this procedure is not for herniated discs, but rather for people who need disc replacement.

Dr. Mango meets with George and his wife right before beginning the surgery.

"We're going to go in on your left side, so you're going to be right side down," Dr. Mango explains to his patient. "We're going to come right in here and put the implant in. It's going to go almost completely across the bone."

By going through George's side instead of through his back or front, extreme lateral is actually less invasive.

"We don't have to cut any of the muscles -- we just spread them apart," Dr. Mango explains. "What we do in approaching from the side is we avoid the big vessels in the front -- the great vessels in front. We avoid the nerves in the back. It allows us access to the disc to put in a very large… basically, it's a cinderblock."

Photojournalist Don Schoenfeld and I suit up for surgery, and Dr. Mango and fellow surgeon Annette Smith scrub in.

Dr. Mango and his team get George positioned. They have to insert a number of needles into George's body in order to monitor his nerves.

So while this team of nine prepares to make George among the first in northern Indiana to have this revolutionary back surgery, George is undoubtedly thinking of getting back to work in his very own field of dreams




Part Two: The Procedure

Everyone in the operating room has to wear lead jackets, because Dr. Mango will call for x-rays throughout the surgery.

"We are lining up the center of the disc. We have a mark on the patient exactly where the center of the disc is, based on the x-ray," Dr. Mango explains. "We are now going to make our incision to start to approach that area."

After making the incision, Dr. Mango uses a retractor to move George's muscles out of the way. A three-inch incision is the only one Dr. Mango will make.

"We don't have to cut any of the muscles, we just spread them apart," he explains. "Going in from the side, we are going to be away from the center axis of rotation of the spine, so it doesn't hurt as much."

Close monitoring lets Dr. Mango know where George's nerve is, so that he can stay clear.

A large camera is brought in so Dr. Mango can get a better look at the disc.

It is now time for this surgeon to use his tools on a patient who has worked machinery all his life.

"When you look down here now, this needle is right in the disc, and this white, glistening stuff that you are looking at here is the disc itself," he explains.

If George were awake, he might be surprised by the mechanics that go into removing his bad disc. The doctor uses some hand tools and a little hammering in order to work the pieces into place -- all while watching the x-rays.

Dr. Mango points out that George has lost almost no blood -- a definite advantage of the procedure.

With many tools that may look similar to a well-stocked tool shed, it's time to pick an implant that will replace George's disc.

Dr. Mango places the implant into position with some gentle tapping, and ultimately secures it in place with a few large screws.

He asks for more x-rays to ensure that everything is in the correct position.

Two and a half hours after George was wheeled in, Dr. Mango is happy with what he sees. His team gives him a short round of applause, and then it's time to stitch up George's incision.

"It went fine," Dr. Mango tells me. "This is a great procedure that works really well for patients. He'll get up, he'll be walking this afternoon."

George was up and walking just two hours after surgery, and a month later he is doing great. His wife says it's hard to keep him down.

NewsCenter 16 would like to thank the surgical team at the St. Joseph Regional Medical Center for allowing us to watch this operation from the operating room. Additionally, we thank George Demeyer for allowing us to follow his procedure.



For more information on this procedure, please use the links below. You can also contact Dr. Mango at the address or phone numbers listed below.

Thomas J. Mango, M.D.
South Bend Orthopaedics
53880 Carmichael Dr
South Bend, IN 46635
Phone: 1-574-247-9441 or 1-800-424-0367

www.xlif.com - XLIF: The Power of X

The Society of Lateral Access Surgery


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