Millions of Americans suffer from chronic pain that affects the quality of their lives. Some chronic pain is so debilitating that sufferers are unable to work and others are unable to engage in the routine activities of daily life. Chronic pain is also expensive, costing billions of dollars in medical treatments, lost productivity in the workplace and lost income in the workforce. According to a 2011 Institute of Medicine report, chronic pain affects more people than heart disease, diabetes and cancer combined.

Dr. Kurtom and Patient

Wayne Howard, age 64, retired CEO of Choptank Community Health System, knows about enduring severe chronic low back and leg pain due to spinal stenosis—the narrowing of the spinal canal causing compression on the nerves in the lower back. Spinal stenosis is a degenerative process that is progressive over time as the spine ages. Howard lived with this pain for over 20 years, trying different procedures, but none relieved the pain that worsened during this time.

"The treatment of spinal stenosis is usually conservative at first, with medical and pain management in addition to physical therapy," said Khalid Kurtom, MD, FAANS, neurosurgeon at Chesapeake Neurological Surgery, part of Shore Medical Group, an affiliate of University of Maryland Shore Regional Health, and Clinical Assistant Professor in the Neurosurgery Department at the University of Maryland School of Medicine.

"I tried many solutions to overcome or control my pain," Howard said, "including pain management clinics and prescription medicine. I had a series of injections in my back that at first eliminated the pain for about 8 or 9 months, but subsequent injections didn't last as long. I saw many doctors, but no one gave me a lot of hope." He didn't want to try surgery because other physicians had told him that he might have only a 40-50% chance to be without pain.

"I am one of the most conservative surgeons in finding ways to avoid surgery if possible," Dr. Kurtom said. "I spend more time in my office telling people not to have surgery than offering surgery. In fact, a lot of patients are frustrated by my approach because they want a quick fix." He tells patients that surgery is the last resort, and it is to their benefit to forgo surgery until all other options are exhausted. "Surgery is not offered until patients have failed all conservative management," Dr. Kurtom added.

Once surgery becomes an option, Dr. Kurtom performs a minimally invasive laminectomy that involves decompressing the spinal canal. He makes a tiny skin incision, inserting a small hollow tube that serves as a working channel to the deep regions of the spine. Using micro instruments, he completes the decompression. In contrast to traditional open surgery, this process does not damage the tissue between the skin and the spine. As a result, when the surgery is completed and the tube is withdrawn, all the muscles, ligaments and joints are left intact. Most patients have this operation as an outpatient and are able to return to work within one to two weeks after surgery. "Despite the drastic differences in postoperative recovery and outcomes, minimally invasive spine surgery is only utilized by a small number of surgeons nationally," Dr. Kurtom said. "The limited exposure makes this approach technically challenging with a steep learning curve for surgeons who are trained to do traditional open procedures."

"I was amazed how quickly I was up and walking," Howard said. "I was moving around every day, right after surgery." Post surgical treatment involved physical therapy to strengthen his core muscles. "My goal was to get through surgery and physical therapy and get back on the golf course." Since his surgery, Howard has not needed any painkillers, including over-the-counter remedies. He no longer limps and can stand up straight. He is enjoying playing golf, walking and swimming again. "I'm getting along fine," he told Dr. Kurtom, "but you didn't improve my golf game." Dr. Kurtom recommends that all patients suffering from back or neck pain, shooting pain down arms or legs, or experiencing muscle weakness, start with their primary care physicians. "These physicians are trained to assess the overall condition, order the appropriate test to make the diagnosis and refer to neurosurgery as needed," he said. "Chronic pain is at times devastating, especially to people who enjoy being active. Treatment is essential to give people their lives back. Culturally, people are encouraged to be tough and deal with their pain. It is not until they have their pain treated that they realize how much they have lost and now gained back."

Howard agrees. He has no pain whatsoever or any other after-effects from the surgery. "I feel like I'm 10 years younger," he said. Howard, a native Eastern Shoreman, values local health care. He praised the Chesapeake Neurological Surgery and the UM Shore Medical Center at Easton staff. "Having worked in the health care environment," he said, "I found that my experience with the whole Shore Regional Health team was a positive use of everyone's services to get the job done. I value the local, personal touch that you get with Shore Regional Health."

Chesapeake Neurological Surgery is an affiliate of University of Maryland Shore Medical Group, the multi-specialty practice of University of Maryland Shore Regional Health. For additional information about the services provided by Khalid Kurtom, MD, FAANS, neurosurgeon at Chesapeake Neurological Surgery, which is located at 403 Purdy Street, Suite 204, in Easton, call 410-820-9117.

Photo: Wayne Howard (left) has experienced a much higher quality of life after undergoing minimally invasive spine surgery performed by Khalid Kurtom, MD, FAANS, (right) of Chesapeake Neurological Surgery, part of University of Maryland Shore Medical Group.