AANS Neurosurgeon | Volume 29, Number 1, 2020

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A Journey From Chronic Pain to Motorcycle Riding: The Story Behind One Spine Registry Patient

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“I can’t say enough good things about Dr. Knightly,” said Joanne Matina, who used to experience such excruciating back pain that she wanted to “jump off a mountain.” She believed her life was over, as intervention after intervention failed to stop her pain. She later let John Knightly, MD, FAANS, perform what was the fourth operation on her back, hoping he could help. However, when she woke up from that surgery, she was upset for a surprising reason.

Matina’s back pain started, many years prior, when she was hospitalized for a hysterectomy. Immediately after the surgery, she knew something was wrong with her back. “Why did you do something to my back?” She asked over and over, as she realized pain was coming from her back, and not the site of her incision. Though it took time for the full story to come out, she later learned that the surgical team had hit her back while transferring her to the operating table, rupturing two of her discs.

This began a long and painful chain of events for Matina, who underwent several more surgeries and months-long sessions of treatment seeking relief from the pain. Finally, one of the surgeries focused on her sciatic nerve; however, it only lessened the pain, and was not a complete cure.

Recovery Met with More Setbacks
While her back pain was under control, she met another medical challenge and Matina was diagnosed with a brain tumor. Though depressed and without appetite, she insisted on postponing the surgery required for treatment. Her son, a high school senior that year, was involved in the myriad activities that consume senior year, including playing football, and she didn’t want to miss a moment. After her son’s senior year and a family vacation, she underwent brain surgery, trusting her outcome to Brian Beyerl, MD, FAANS, who is part of Atlantic Neurosurgical Specialists.

“The worst part of that experience happened in my own home. I got home and wanted a shower in the worst way. My husband got the chair in the shower and got me settled. Only when I tried to wash my hair did I realize that all of it had been shaved for the surgery, and I began to cry. Still fully dressed, my husband jumped into the shower to hold me and tell me he loved me with or without hair.”

“Though I worked part time in my own business through most of my recovery, it took a year for my hair to grow back and for me to really feel like myself again. Miraculously the surgery was a total success and the brain tumor, a meningioma, was gone.”

Then her back started bothering her again. Because she had such success with Dr. Beyerl, she decided to meet with another one of the practice’s neurosurgeons, Dr. Knightly. After studying her MRI and CAT scan, he told her that she was the perfect candidate for a type of minimally invasive surgery he was doing. The incision would be very small, the operation very short — he guessed it would take 45 minutes — and the recovery would leave her, “ … at the least, a lot better than you are now.”

Despite his assurances, Matina took some time to consider the surgery, weighing the unbearable pain she was living with against the unknowns that could be the result of the surgery. She eventually decided to “go for it.”

Living Life, Pain-Free
When she awoke after the surgery upset, she immediately asked her friends why Dr. Knightly hadn’t performed the surgery. She felt nothing — no post-operative pain, nor any of her original pain — it was nothing her past experiences with back surgery had led her to expect upon waking up after surgery.

The only evidence of the surgery was a small bandage on her back, covering an incision so small that it didn’t leave a scar. Dr. Knightly told her that the surgery had gone longer than expected — 1.5 hours — as he found severe spinal stenosis, a bulging disc and a large bone spur. He said it was very good she had the surgery when she did, as her condition would have continued to worsen. Thanks to the surgery, Matina is now completely pain-free.

She left the hospital the afternoon of that surgery four months ago, and hasn’t looked back. At 76-years-old, Matina is very involved with the senior community she lives in, serving on its board and as vice president of the women’s club. She also joined a motorcycle group, and recently purchased a three-wheel trike motorcycle and has accessorized with style — the requisite leather jacket is black with purple flowers — keeping her both safe and stylish.

“Dr. Knightly is the reason I’m on a motorcycle, even though he made me wait a few more months than I thought I needed. He relieves so much pain for people. Unless you’ve lived with that kind of chronic pain, I don’t think you can really understand what it means to have it go away. He is just wonderful and I tell all my friends that he is the neurosurgeon for them,” said Matina.

Using Spine Registry Data to Improve Quality of Life
Matina and the details of her surgery are part of the patient data collected under the National Neurosurgery Quality and Outcomes Database (N²QOD). Dr. Knightly’s practice, Atlantic Neurosurgical Specialists, joined N²QOD to track the quality of surgical care for the most common neurosurgical procedures.

“N²QOD provides us a platform to collect clinical data proving what we do, as neurosurgeons, is beneficial for our patients’ quality of life,” said Dr. Knightly.

Matina’s data, and that of the more than 16,000 other patients already in the spine registry, will be used to establish risk-adjusted national benchmarks for the cost and quality of procedures and to demonstrate and establish the comparative effectiveness of neurosurgical procedures. While hospitals track outcomes throughout the patient’s stay, or perhaps for up to three months, N²QOD is tracking for a minimum of 12 months, so that the long-term results of the procedures can be documented.

“With the data already in the lumbar module, we can create a tool that allows me, as a surgeon, to sit with a patient, review the data that matches his or her profile and manage expectations. Not that — in general — motorcycles should be part of patient expectations,” added Dr. Knightly.

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