Back surgery patients find relief in DeFuniak Springs

By Joyce Owen
Sun Reporter

DEFUNIAK SPRINGS - "Is that the old pain or a new pain?" Dr. Anthony (Tony) Mork asked throughout the operative procedure, constantly adjusting the placement of instruments based on the comments of his patient.

Doctors Mork and Scott Haufe treat patients with stenosis (narrowing of the spinal column that causes pressure on the nerves), fused spines and those whose failed back surgery has left them in pain.

The minimally invasive surgery is so new, MicroSpine, at the Healthmark Regional Medical Center in DeFuniak Springs is only the second clinic to perform it.

Patients come to them with pain, reduced range of motion and limited physical abilities. Within hours of the surgery, the patients are cautiously testing the limits of their newfound relief.

Carolyn Smail of Lady Lake, Fla., came to the clinic seeking relief of her chronic back pain. In 1972, Smail had spinal fusion between the fifth and sixth vertebra located at the base of the neck. The procedure was successful and held up very well, but she had extensive scar tissue.

A crippling condition

Over the years, Smail had other problems with her spine, but two laminectomies (open back surgeries) for herniated and bulging discs, helped to keep her going.

"I was doing fine and functioning. Then, in June, 1999, I fell at work and it (the fall) seemed to aggravate the whole thing."

Smail saw a newspaper ad for a back pain seminar in Ocala with a free consultation and evaluation of a patient's MRI's and x-rays.

"I was quite impressed. Dr. Haufe reviewed my x-rays and findings and told me where I was hurting. And he was right." Smail explained that most doctors start by asking the patient where it hurts. As a medical records consultant she was familiar with medical procedures and her own history.

"I had been told by a surgeon, the last one, don't let a surgeon touch your back." She remembered asking the doctor, "What about you, you are a surgeon? And he said, 'I won't touch it.'"

At a follow-up evaluation at Healthmark, Mork confirmed Haufe's diagnosis.

"I asked how many procedures it would take," said Smail. She remembers the number, 11, top to bottom, starting with the cervical area.

Smail and her friend, Corrine Whitehead, drove from Lady Lake on the morning of the surgery. There was no requirement that she be at the hospital early; all blood work and pre-operative procedures were done during the evaluation.

Before her surgery on July 31, Mork reviewed his previous evaluation. He was not looking at 11 surgeries he said, just looking at each procedure as a way to reduce her pain.

"If you fuse the spine, it tends to overwork the level above the fusion. I find if we can break the cycle of pain, we can give relief. And sometimes do fewer procedures."

The procedure

"How are you?" asked Mork.

"I'm hurting."

Smail was having the first procedure at C4, the fourth cervical disc in her neck. Her pain and range of motion were checked.

Sitting in the office, Smail demonstrated her limited neck movement. Her face winced at the attempt. Up to that point, she could have been a visitor to the hospital. Smail carried her body well, and as she walked there was little hint of the pain she was experiencing. But as she talked, it was evident she was ready for relief.

"You mean what are my goals?" she said when asked what she hoped to gain from the surgery. "I want to re-enter an active lifestyle. I used to do synchronized swimming. Now I'm down to waterwalking. I want to re-enter the workforce and encourage anyone I come in contact with about the arthroscopic surgery as opposed to open back surgery."

Mork explained to her what was going to happen during the surgery. Smail had heard it before, but the doctor was going over the procedure to reassure her. She would feel relief soon, he promised.

"Remember that neck movement. We'll have you do that again after surgery and see the difference," he said.

Smail smiled weakly, but there was concern, she asked if her friend could join her. "This is as close as you come to brain surgery," she said. "Your back is like dominoes, you take one domino out and that creates a problem - then there is degeneration and accidents. You fall, you have a car accident. I am here to get some relief. I have pain in my neck and down my arm.

"You can get pretty discouraged. When we found this clinic, it was like a light at the end of a tunnel," said Smail.

"I use a cocktail with four medications that allow the patients to be awake but not in pain," said Haufe, the anesthesiologist. Combining his unique anesthesia with techniques learned at a spinal clinic in Tampa, Mork and Haufe developed a new procedure.

"The difference in our procedure and other surgeries-the patient is awake and able to confirm when the problem is solved. Also, through pre-diagnosis, we can find the pain and focus on one area. It is safe, people can tell you when you are near a nerve by the pain they feel," Mork explained.

The minimally invasive surgery uses a series of stainless steel dilating tubes in ever-increasing diameter that are inserted through a very small opening in the skin and down to the spine. After carefully numbing the area, Mork places the smallest of the tubes through the skin using a small metal hammer.

Tap, tap, tap, the hammer rings out as the first tube pierces her skin. Smail is resting comfortably, responding to Mork and Haufe as they talk with her throughout the procedure. Her only complaint is her dry mouth and her uncomfortable position. She is laying face down with her head lowered, but there is no way to provide relief during the surgery.

Mork increases the opening by dropping the next size tube over the first and screwing it into position. This goes on approximately nine times until the largest tube, half an inch in diameter, is in place. When the last tube is positioned, he removes the others creating the operating portal.

"It is sort of like operating through a drinking straw," Mork said.

Through the opening, Mork uses fiber optics and high definition cameras to view the area. All the equipment, lasers, suction and surgical instruments are inserted into this small opening.

"The key to performing the surgery is three-dimensional perception, knowing which way is up," Mork explained. "I am searching for a pre-screening test to help me find doctors who can learn to do the surgery. I would like to train others to do what I do, but you almost have to be born with the ability (to see three-dimensionally)."

With lasers, Mork removes scar tissue and bone fragments, vapors flashing in the tube as he works. Watching on monitors above the patient, Mork gradually moves closer to the spine, layer by microscopic layer.

Mork and Haufe talk to Smail, asking questions: Can you feel this? Are you in pain? Patients tell the doctor when a nerve is pinched and more importantly, when the pain is gone.

Haufe stops the anesthesia. Within five minutes, the affects have worn off.

"How are you feeling?"

"I just want something to drink."

"Is there any pain?"

With the tube still in place, Smail turns her head from side to side. Slowly at first, she hesitates at the point she felt pain before. She waits for the pain, and then feeling none, she turns her head completely.

"There is no pain. I am comfortable."

The surgery is complete; Mork removes the tube and the opening closes. Only two stitches beneath the skin are required. One hour and five minutes have elapsed.

As the doctor dictates his notes, a nurse places two small bandages over the opening.

Smail attempts to sit up as she is moved from the operating table. She moves easily. The nurses help her roll onto a gurney and she turns her head left and right showing no discomfort.

Within 15 minutes, she is in recovery, sipping fluids and completely awake. Mork joins her. "Can you turn your head, Carolyn?"

Smail's face brightens as she turns one way and the other. There is no pain and she is able to completely turn her head to each side.

Smail will stay in town until Thursday. Mork likes the patients to stay nearby for a day or two. "It helps to keep them away from home and their regular routine. They feel so much better, they tend to over-do."

Why DeFuniak Springs? After surveying 10 hospitals in Florida, the doctors found Healthmark to be just what they needed. The location is ideal for the doctors, who live in Santa Rosa Beach, and for visiting patients who have traveled from as far away as California and Connecticut. The doctors perform two procedures a day and have no additional hospital duties, such as on-call or emergencies. To date, the clinic has treated 30 patients since it opened in mid-June.

Mork is from Minneapolis. He earned his M.D. from Creighton Medical School in Omaha, Neb. After six years of private practice in Long Beach, Calif., he worked at the Wiltse Spine Institute in Long Beach. Most recently, he worked at G.C.O.C. Spinal Institute in Tampa. He has performed over a thousand arthroscopic spinal surgeries.

Haufe is from Sarasota. He received his M.D. from the University of South Florida. He is Board Certified in Anesthesiology. Prior to the opening of MicroSpine, he was Chief of the Pain Management Department in Fort Pierce, Fla. and Chief of Anesthesiology with American Medical Care.