From massgeneralbrigham.org
For months, 57-year-old Steve Bricker lived with unrelenting pain.
The source was a synovial cyst located near his spine. This fluid-filled sac was pressing against his lower back nerves, sending pain radiating from the lower back to the feet. Over about 14 months, the pain shooting down his right side got more and more intense.
"At its worst, I'd rate the pain as a 9 or 9.5 on a 10-point scale," said Steve, a resident of York, Maine. "The only way I could find relief was to lie flat on my back. Living my life became very, very difficult. It was terrible."
After several failed attempts to treat the sciatica, Steve set out on his own to find a solution. His research led him to Mass General Brigham Spine Care and spine surgeon Pat Bovonratwet, MD, who specializes in minimally invasive and endoscopic spine surgery.
'This is the guy'
When Steve started experiencing pain, a local doctor sent him to physical therapy. It didn't help. Eventually, he had an MRI, which showed a synovial cyst near his spine.
Sometimes a synovial cyst can be drained or ruptured with a needle. In Steve's case, doctors tried twice without success, as the cyst was in a hard-to-reach location. Meanwhile, steroid injections intended to calm inflammation and pain only brought temporary relief.
"I finally asked one of my local surgeons, 'What's next for me?'" Steve recalled. "He said, 'Probably a spinal fusion.' That's when I decided to take matters into my own hands and look at other options."
Following some research on minimally invasive spine surgical options, Steve called Mass General Brigham and was referred to Dr. Bovonratwet.
"I shared his background and bio with my father, who's a retired endocrinologist," Steve said. "He said, 'Steve, you've got to do whatever it takes to have him take care of you. This is the guy.'"
Removing cyst via minimally invasive tubular decompression
With his father's vote of confidence, Steve scheduled an appointment with Dr. Bovonratwet at Mass General Brigham Healthcare Center (Danvers). At the visit, Dr. Bovonratwet reviewed an MRI scan and proposed an approach for removing the synovial cyst: minimally invasive tubular decompression.
With tubular decompression, the surgeon uses specialized instruments to gently separate the muscles near the spine. A small, thin tube, about the size of a nickel, is then placed to provide access to the spine.
Using a surgical microscope for visualization, the surgeon takes out a small portion of the lamina (part of the vertebral bone) to safely access and remove the cyst. The spine's natural stabilizing structures, including the spinous process and interspinous ligament, are preserved. Unlike in traditional open spine surgery, no muscles are stripped or cut.
"Tubular and endoscopic decompressions are contemporary, minimally invasive spine surgical techniques that allow us to relieve nerve compression with minimal disruption to surrounding tissues," Dr. Bovonratwet said.
After that visit, Steve knew he was in good hands. "I saw that Dr. Bovonratwet was a kind, lovely man and a great communicator who explained everything very thoroughly," Steve said.
Why high-volume experience matters
Dr. Bovonratwet, who is on the faculty of Harvard Medical School, performs tubular and endoscopic decompressions at Massachusetts General Hospital, Mass General Outpatient Surgery Center in Danvers, and Salem Hospital. On average, he conducts these procedures three or four times a day.
"The more you do it, the more efficient you become. At a high-volume center like ours, with dedicated expertise in minimally invasive and endoscopic spine surgery, these procedures can often be completed in around 60 to 90 minutes," he said. "We can consistently achieve the goal of decompressing the nerves, giving patients the same durable outcome as an open procedure."
Steve's surgery was scheduled for three months after his consultation with Dr. Bovonratwet. It could not have come soon enough.
Before heading to Florida for the holiday season, Steve had a third steroid injection to address his worsening pain. It delivered only about 24 hours of relief. He spent the final weeks before surgery taking pain medications and lying on his back as often as possible.
Finally, the day of surgery arrived. It was the first spine surgery performed at the Mass General Outpatient Surgery Center in Danvers — and the first spine case performed in a freestanding outpatient surgery center within the Mass General Brigham system. Steve was nervous but eager to proceed.
When he woke up from surgery, Steve no longer felt the severe nerve pain that had plagued him for so long. He dreaded the prospect of getting up to walk. But once he did, that all-too-familiar pain shooting down his right leg didn't return. He went home the same afternoon.
"I wasn't ready to call it a cure, but I felt there was enough change that this was going to go as projected," he said. "I couldn't wait to see how my recovery went."
Enjoying a pain-free life again
Immediately after the operation, Dr. Bovonratwet had told Steve that his nerve was red and inflamed from having the cyst pressing against it for so long—but that it would heal quickly. Indeed, Steve was completely pain-free within a few months.
The minimally invasive techniques that Dr. Bovonratwet employed have helped speed Steve's recovery. Since no muscle was cut, he hasn't required any pain medications beyond Tylenol. And other than avoiding lifting heavy objects, he is as active as he was a couple years ago.
"Everyone on my care team at Mass General Brigham was top-notch. Just wonderful," Steve said. "I can't say enough about Dr. Bovonratwet, his communication skills, and his expertise. I've passed on his name to as many people with similar needs as me as I could."
While stressing that some cases of sciatica will require open surgery, Dr. Bovonratwet hopes to increase awareness about tubular and endoscopic spine surgery.
"A lot of patients still don't know this may be an option for them," he said. "I would love for people to see Steve's story and learn that they may be a candidate for these modern minimally invasive procedures.
"Spine surgery has advanced dramatically over the years. Operations that once required large incisions and a hospital stay can now, in select patients, be performed through an incision the size of a nickel or pencil tip, often allowing patients to return home the same day."
https://www.massgeneralbrigham.org/en/patient-stories/steve-spine-surgery-story
