Photo source: ABC 2 WMAR Baltimore
When Rodney Wente started experiencing pain and discomfort in his lower back, he knew that it couldn’t be good news. He was already dealing with rheumatoid arthritis, an autoimmune condition that caused inflammation all over his body. He was getting older, and his body was beginning to fail. When the pain and discomfort became too much for him to deal with, he went in to see his doctor.
Wente was diagnosed with bone spurs in the lumbar region, or lower back, and underwent lumbar fusion surgery to have them removed. The spinal surgery took a toll on his body, and exacerbated his already difficult to handle rheumatoid arthritis. Since the problem of rheumatoid arthritis is due to the immune system, the symptoms and inflammation occur all over the body symmetrically, including in the spine where his surgery had taken place.
Though he had removed the bone spurs, his spine would slowly weaken and decline over the next twenty years, and it wasn’t long before he could barely lift his head. In time, he lost the ability to lift his head altogether, and had to manually lift his head by taking his head in his hands and lifting it up. The rest of the time, his chin was buried in his chest, making it extremely difficult for him to navigate life.
For twenty years, Wente could not see where he was going without lifting up his own chin. He lost the ability to drive, to go on long walks, to admire the sunset, and to enjoy a meal with his wife. He began researching a solution, but it seemed that the only solution that could fix his problem was inaccessible. It was a second spinal surgery that would give him the ability to keep his head propped up, but the surgery was so risky that he could not find a doctor to perform it. For a while, it seemed that he would be unable to overcome his situation, and if he had not persevered in seeking out a specialist, that very may well have been the case.
Spinal fusion surgery
Part of the difficulty of Wente’s situation was attempting to find a surgeon who would operate on Wente’s back with the knowledge that he had already received one spinal fusion surgery. In a spinal fusion surgery, two of the vertebrae of the spine are essentially welded or fused together using bone grafts or an artificial joiner. The idea is that by fusing the two vertebrae into one long bone, inflammation and pain due to weak or damaged joints is prevented.
The problem with fusion surgery is that the spine becomes significantly less mobile once it heals, and the individual’s motor functioning becomes permanently altered. In Wente’s situation, the entirety of his spinal column had become weakened due to his rheumatoid arthritis, and the prospect of a second spinal fusion surgery would leave him even further immobilized. The risk versus reward of such a surgery was not balanced enough for most surgeons to consider Wente eligible for the surgery.
However, Wente’s situation was becoming unbearable. Though dangerous, a second spinal fusion surgery would ideally give him the ability to keep his head up. It would do nothing to address the underlying issue of rheumatoid arthritis, and it would leave him greatly immobilized in other ways, leaving both his lower back and his neck largely immobilized. All he knew was that, the more time that passed, the weaker his body was becoming.
Complications of RA
Many who suffer from advanced rheumatoid arthritis have the option to undergo spinal fusion surgery at some point in the progression of their disease. As in Wente’s case, the two options for surgery are in the lower back, called a lumbar fusion, or in the neck, called a cervical fusion. Since Wente had bone spurs in the lumbar region of his spine, he underwent lumbar fusion first, and went on later to develop the cervical complication that he suffered from for twenty years.
The condition that left Wente unable to move his head on his own is called cervical spondylosis with cervical myelopathy, often referred to as cervical spondylotic myelopathy (CSM). This term translates loosely to a degenerative condition of the spine in the neck that damages the spinal cord. Left unchecked for long enough, the condition can lead to paralysis or incontinence, and can leave a patient wheelchair-bound or bedridden.
Another common condition associated with rheumatoid arthritis is occipital neuralgia, in which the nerves running along the top of the head are inflamed or injured. Due to the severity of Wente’s condition, it is likely that he also experienced the symptoms associated with occipital neuralgia, including shooting or throbbing pains in the back of the head and base of the skull. It is not uncommon for rheumatoid arthritis patients to have both conditions at the same time.
In rheumatoid arthritis patients who have one or both conditions of CSM and occipital neuralgia, cervical spine surgery is the most common treatment. The only thing preventing Wente from receiving the surgery was the fact that he had previously received a lumbar fusion surgery. Receiving both would mean that he would be largely immobilized in both his lower back and his neck, an unfavorable best possible outcome in the eyes of many surgeons.
Taking the risk
Wente finally found a willing surgeon in Dr. Anant Kumar at Presbyterian/St. Luke’s Medical Center in Colorado. Dr. Kumar knew that fusing Wente’s cervical spine would mean that he would most likely be unable to look down. After twenty years of being unable to look up, Wente did not see this as an unfavorable outcome. Still, Dr. Kumar had his reservations, and he did his best to make them clear.
After numerous conversations regarding the possible outcomes of the surgery, Kumar and Wente finally agreed that the best course of action would be the cervical fusion. Wente was scared by Dr. Kumar’s consultations, which Dr. Kumar made clear was his intention, but Wente was not scared enough to cause him to withdraw his desire to undergo the surgery. Wente’s wife was scared too, but knew that her husband would never be happy again if he was forced to live the whole rest of his life unable to lift his head. With all hopes riding on the surgery, Wente’s spine was operated on for the second time.
Dr. Kumar has been performing complex spinal surgeries since the late 80s. He is able to perform surgeries involving artificial discs of both the cervical and lumbar spine, and has experience in correcting complex deformities and removing spinal tumors. If there was someone who could help Wente, it was Dr. Kumar, but that didn’t mean that Dr. Kumar was absolutely confident about the outcome of the surgery.
After the surgery, Wente woke up bandaged and in a neck brace. But the first thing he saw was the world right in front of him. Both he and his wife celebrated the successful surgery, and though Wente’s battle with rheumatoid arthritis is far from over, he now looks forward to the prospect of living his life with his eyes forward. Wente is eager to resume driving and taking care of himself, and reminds us all that sometimes, the pain of playing it safe and not making a change is worse than taking even the most dangerous risk.