In the summer of 2006, she got the tattoo.

It had been three years plus since her surgery, and the tattoo said it all.
A lotus flower, a symbol of rebirth, was etched into the small of her back, placed triumphantly over a slender six-inch scar that ran from her tailbone up her spine. The scar and now the flower of rebirth marked the spot where pain and desolation had once ruled, causing Stephanie to wonder whether she would ever live like a normal person again.

“Today I feel like I’m a walking miracle,” Stephanie says, five years after undergoing spine surgery for two severely herniated discs. “I thought I’d be lucky if I ever got back to being functional.”

A magazine and book editor, Stephanie is grateful to Thomas Saul, MD, a Mayfield Clinic neurosurgeon who performed a laminectomy and discectomy for herniated discs in the vertebral junctions known as L4-L5 and L5-S1. The operation took place at Cincinnati’s Good Samaritan Hospital.

Stephanie had a history of periodic back pain that dated back to adolescence. “I’d feel it while playing sports, but back then it wasn’t the kind of disability and pain that makes you non-functional,” she recalls. “It would come and go. I’d pull my back out one or two times a year from overdoing. It was throw-your-back-out pain, sort of a weekend-warrior level. I took ibuprofen and would lie down, and a few days later it would be OK.”

The weekend-warrior pain morphed into something more worrisome in late 2002. Stephanie, who was 31 years old, went to her primary care physician, who prescribed ibuprofen and muscle relaxants, and the pain abated over a period of six weeks. A few months later, however, it returned with a vengeance.

“The pain was a constant electric burning all the way down my left leg that never let up,” Stephanie says. “The only position that was reasonably comfortable was lying on my stomach. Sitting was horrible, and I’m an editor – you sit! Standing was painful, and walking was difficult because the bottom of my foot was numb.

“I worked a lot of partial days,” she continues. “For about a month I was unable to work an eight-hour day. Some days I could not work at all. Living with that kind of pain changed my personality. Because the pain was constant, it was hard to deal with any other kind of demand. It was all I could do to deal with the pain; it was all I could do to not scream.”

When people asked Stephanie what had caused the injury, she was at a loss for words. “I would say, truthfully, ‘I don’t know.’ I had no idea. All I knew was that it had started hurting and instead of going away it got worse. For six weeks I was in continuous pain.”

In late March of 2003, Stephanie’s primary care physician admitted her to Good Samaritan Hospital overnight so that she could be given morphine. Dr. Saul, who was working at the hospital that day, came to see her and reviewed her MRI. He told Stephanie that she had a “textbook case” of herniated discs. The two herniations, on the left, were at the lowest two joints of her spine. “The herniations were very large, and that is why she had such debilitating pain,” Dr. Saul says.

Dr. Saul told Stephanie he could treat her with an epidural but, because of the severity of the herniations, the relief would not be permanent. With surgery, he said, she would have only a 5 percent chance of recurrence. “He said, ‘Don’t worry, you’re going to be fine. We’ll get you fixed up,’ ” Stephanie recalls. “I was convinced I’d be in pain forever.”

Stephanie spent one night in the hospital. She had an office appointment with Dr. Saul two weeks later to discuss expectations and risk, and her surgery was scheduled for a week after that.

“People asked me, ‘Are you nervous, worried?’ That never occurred to me,” Stephanie says. “I had no other options. My life would have been severely limited. This was my only option.”

During the 90-minute procedure, Dr. Saul made an incision in the midline of the low back region. The incision was longer than usual because he needed to work at two levels of her spine. When the back of the spine was exposed, he used a high-speed drill to shave down and remove the left side of the bones and gain access to the spinal canal. He was then able to visualize the sac containing her nerve roots and the two specific nerves that were being pinched by the herniated discs.

“While carefully moving the nerve roots, I could see the herniated disc material,” Dr. Saul says. “With microscopic instruments under high magnification, I was able to pull the fragments of disc out and release the pressure on the nerve roots. Having accomplished this, I felt confident that she would be relieved of her pain.”

When Stephanie woke up in recovery, she was groggy but awake enough to realize that Dr. Saul had indeed removed the pain along with the offending disc material. “I almost cried from sheer relief,” Stephanie says.

Stephanie went home 24 hours later, the long incision neatly closed with 31 staples. She took a week off from work, worked 20 hours the second week, then returned to work full-time. The numbness in her foot, which was still present after surgery, had completely subsided within a period of three weeks. She worked with a physical therapist once a week for six weeks and then did exercises for a year. Nine months after surgery, she took up fencing.

“I’m incredibly lucky that I had Dr. Saul and was able to recover so completely,” Stephanie says. “I’ve had a few small pains, but not once have I experienced the pain that led to my surgery. I also take care of my back. I try not to lift things that are too heavy. And I avoid the Marine Corps-type hikes that my mom and stepdad like to take. They’ll try to get me to go, and I just say no thank you.”

Dr. Saul is quick to point out that a procedure’s ultimate success depends on the patient as well as the surgeon. “Stephanie should take a lot of the credit for her excellent result from her surgery,” he says. “Her motivation and desire to be well are primary reasons why she did well. She committed to her postoperative rehabilitation program, and that makes a big difference in surgical outcomes. She should certainly be proud of herself.”

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