Patient success profiles: Ruth Peoples

Ruth Peoples and Dr. Andrew Cash at the Desert Institute of Spine Care.

Editor's note: This story was originally published in Health Care Quarterly, a magazine about Southern Nevada's health care industry. Stories in Health Care Quarterly were submitted by doctors and their affiliates.

Diagnosis: Spine pain

Patient of: Dr. Andrew Cash, Desert Institute of Spine Care

It started as a normal day for Ruth Peoples.

She enjoyed her cooking career on a military base, when one day, she lifted a big pot out of a deep sink, turned, and pain struck in her low back.

She visited a doctor in California, where she was living. He performed a procedure that was complicated by a staph infection in her spine and underwent no fewer than 14 spine surgeries. The pain increased after each surgery, eventually rendering her disabled, bedridden and isolated.

Peoples was referred to me when she moved to Nevada to be closer to her grandkids. By that time, nearly her entire low back was fused from L2 to S1. She had 10 screws, one of which was broken and two 10-inch rods. She had four discs that had been removed and replaced with plastic polymer implants. She had multiple revision surgeries, fusions, bone grafts, cadaver bone — she had fused 80 percent of her lumbar spine, and probably 100 percent of her functional lumbar spine.

She was suffering from a psychological condition called “learned helplessness” that occurs in people with chronic pain. When there is no perceived escape from back pain, people learn not to even try. They become extremely depressed, anxious and completely hopeless that they will ever experience relief again.

What could we do to help alleviate Peoples’ pain that hadn’t already been done? Upon initial evaluation, I recommended a spinal cord stimulator — the last case scenario after surgery has failed. After 14 previous spine surgeries, how could the screws possibly be revised with a significantly better result?

Fortunately, Peoples opted against the spinal cord stimulator and held out for two years, as new technology surrounding the SI joint was in development.

The SI joint is the joint between the sacrum and ilium bones at the very bottom of the spine. The sacrum is a triangular bone, with is an iliac cone on each side — they wedge together like an arch-stone. The stresses for the entire body weight flow through the sacroiliac (SI) joints and down through the legs.

I was aware of the SI joint procedure, but the effectiveness was unproven and I didn’t want to experiment on anyone. So, I waited to review the two-year data of the procedure and then decided to become an early adapter. I had done so much research on the procedure with other doctors and centers that performed the surgery. It is among the most revolutionary breakthroughs in spine surgery today.

Peoples received diagnostic injections into the SI joint to confirm that the SI joint procedure would work for her. The pain relief she experienced was the evidence that she needed to move forward with one last surgery.

The SI joint procedure is minimally invasive outpatient surgery that takes only about an hour. I’ve got the incision down to one inch, allowing me to provide a fusion with very little trauma and tissue damage. The instrumentation provides a surgical pathway between the muscles without cutting them, so after the procedure they can simply shift back to their normal, undamaged position.

Peoples told me that after surgery the nurses went in to change the bandage thinking it was going to look like any other back surgery, and they were shocked. “They couldn’t find a scar — (Peoples) just had a little bandage over it like it was a paper cut.”

The rehabilitation for this procedure is remarkably easy for patients. Post-operative stay lasts only an hour or two. Patients use a walker for three weeks so they don’t put too much weight on the surgical side while healing occurs, but in some cases this can be shortened. After the patient resumes full weight on the affected leg, three weeks of physical therapy begins, but some patients do not even need that, depending on the level of activity.

It is remarkable how SI conditions are so underdiagnosed in the medical community — and I was part of that group just three years ago. We didn’t have a procedure to actually adequately fix the SI joint. The only time an SI procedure would work is if somebody ripped their entire pelvis apart, called an open-book pelvis fracture, and we would open their pelvis in the front, like an OB/GYN approach to the pelvis, and put a 6-holed plate on the front pelvic bones and then do the SI joint procedure from the side. It worked for that specific condition, but it was incredibly rare because most people with an open-book pelvis fracture die before they hit the trauma bay.

There was not a good solution for people who either wear out their SI joint over time or have a less traumatic injury, as the procedures previously developed to treat those conditions had too low a success rate. The technology simply was not advanced enough for surgery. Physical therapists, chiropractors and pain management doctors can provide treatment in a three to six month window, but once it becomes a chronic condition, if the SI joint does not simply heal itself, they are extremely limited to repeat injections or life-long pain medications possibly facing addiction and internal organ damage.

Peoples’ pain is gone. She was excited to cook Thanksgiving dinner for her family last year, for the first time since her injury. She has plans to travel, and is re-learning to love life. I am working to educate the Las Vegas medical community about this innovation, hoping that Peoples’ success story will help other people with SI pain find the relief that they desperately crave.

Dr. Cash is a fellowship-trained and board-certified orthopedic spine surgeon, as well as the founder of the Desert Institute of Spine Care in Las Vegas and The Minimally Invasive Spine Institute, a surgery center especially for outpatient spinal surgeries.

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