- Orthopaedic & Neurosurgery Specialists PC (ONS)

 
Degenerative Spondylolisthesis

For two years, Carole Delvecchio of Trumbell, CT dealt with gradually developing pain in her right hip that ran down to her foot that progressively eroded her quality of life.  At 66 she had to give up her job as a nurse that she dearly loved and became virtually housebound. Being a medical professional, she honed in on the purported experts in her condition, who emphatically told her that there was nothing to be done for her. She underwent epidural injections in her back, tried to manage the pain with medications and even tried acupuncture. Nothing seemed to work.  In fact, her doctor told her that her condition was “permanent and chronic” and that “there wasn’t a surgeon around that could do anything to help.”

Desperate and determined, Carole continued to search for answers.  She was referred to neurosurgeon Dr. Scott Simon to have an electric stimulation devise implanted into her back to treat the pain. During her visit to Dr. Simon, he reviewed her MRI and discovered that the quality of the MRI was so inferior that he doubted that an accurate diagnosis could have been made using them. He ordered a new MRI to be taken immediately and asked her to return to his office afterward. After reviewing the images he told her, “I can help you.” 

Carole had a degenerative spondylolisthesis, a condition where one vertebra shifts out in front of another, causing back pain and leg pain due to nerve compression.  On May 9, 2011, Dr. Simon and Dr. Paul Apostolides performed a minimally invasive laminectomy, fusion, and fixation to decompress the nerves and stabilize the spine. Today Carole is 100% pain free and has regained her life. “Dr. Simon has literally given me my life back,” she said.

 

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 Spinal Instability and Disc Degeneration

“Major spinal disorders have afflicted my father's side of our family for decades but most of my relatives were nearly 30 years older than I when their problems started. So when sharp pain shooting down my leg began to wake me up at night, I was very worried that the decades of heavy work-related travel combined with sitting behind a desk for very long hours were catching up with me. An MRI and exam revealed that I had severe spinal stenosis, scoliosis and degenerative disc disease. 

A New Yorker for 30 years, I was inclined to believe the notion that if you had a medical problem, you had to see a ‘top surgeon in the city.’ So I went to that top doctor and had spine surgery at a major New York hospital, which was not successful. My problems worsened. 

In the meantime, my father, age 85, developed a serious spinal problem that required a 10-hour, complicated spinal fusion. Furthermore, he had quadruple bypass surgery a year and a half before, making him a high risk patient. That was when I met Dr. Amory Fiore, the talented neurosurgeon who performed the difficult surgery on my father that rescued him from severe pain and restored his ability to walk.  

So when my own spine condition deteriorated two years later, I turned to my father's surgeon in Greenwich for help. Dr. Fiore said I would need a spinal fusion on the same disc that was operated on in New York. He and his colleague Dr. Paul Apostolides did the surgery, and this time I recovered beautifully. I did my PT religiously, walked a mile with my dog each day, and within months I was completely pain free.  

Eighteen months later, I started to have pain in my lower spine. An MRI showed instability in two more vertebra and disc degeneration. Dr. Fiore said I would need another surgery to fix the problem. This time they did a triple spinal fusion. Surprisingly, I was up and out of bed and doing stairs at Greenwich Hospital the next afternoon. Again, my recovery went smoothly, and since then I have had no pain and have regained complete mobility. I have even played 18 holes of golf with my surgeon. Now, if only Dr. Fiore could come up with a surgery to fix my golf game… 

I am so thankful to Dr. Fiore, Dr. Apostolides and the ONS therapists for not only giving me my life back but allowing me to have more fun in my life too.” 

E.S, Purchase, NY

 

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"Dear Dr. Apostolides,

Thank you so much for finding the time to come and celebrate my grandmother's 102nd birthday with us. We were so pleased to see you. You are a very special person to both of us a nd we know that 'Amy' would not have had the quality of life and additional years if she had not had the surgery that you so skillfully performed. Thanks you again for joining us for this joyful celebration."

R.B., New York, New York

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Spinal Tumor

 

Rick McKeough had been fighting cancer, which began as male breast cancer, since November of 1999. After his initial treatment with chemo and radiation, he was symptom free for five years. However, three years ago, the cancer metastasized to his lumbar. He endured intense pain for six months despite taking narcotic pain medication and curtailing many activities.  He had to stop playing golf, which had been very helpful in managing the stress of his illness. His radiation oncologist, Dr. Frank Masino of Stamford Hospital suggested he might be a candidate for treatment with CyberKnife®, a noninvasive image-guided robotic radiosurgery system that delivers highly precise beams of radiation to its target.  He sent Rick for an evaluation with neurosurgeon Dr. Scott Simon

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"Rick had two options," explained Dr. Simon. "He could undergo an extensive spinal surgery to remove part of the tumor with a spinal fusion, or he could be treated with Cyberknife to try to shrink the tumor non-invasively by pin pointing radiation directly to the tumor site."  Rich chose Cyberknife.

First, a quick, out-patient procedure was performed by Dr. Simon under local anesthesia to implant small gold markers, known as fiducials into the soft tissues near the tumor region to help guide the radiation beams. CT scans and an MRI was then done in order to map the areas of the tumor that are to be targeted by the Cyberknife.

After a dry run to check radiation beam alignment, Dr. Simon and the Cyberknife team at Stamford Hospital administered four treatments over four days, each one lasting about two hours. By the end of the second day, Rick already felt some relief from the pain.  At the end of the fourth treatment, the pain was gone. Rick was thrilled, even more so when he was able to return to golf just a couple of days later. He has been pain free ever since.

“The Cyberknife allows us to use maximum doses of radiation, with minimal risk to the normal surrounding tissue," said Dr. Simon. "Rick responded quickly but every patient is different, and it can take anywhere from a few days to a few weeks to experience the full benefit of the treatment."

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Minimally Invasive Decompression and Fusion for Bilateral L5 Pars Fractures

 

Now 21 years old and a senior in college, Victoria Patrello began having problems with her back when she was 12 years old. She was a competitive gymnast at the time, and the 24 hours of training a week had put excessive stress on her back. As a result, she developed stress fractures in her spine that never healed, which allowed for excess motion where her spine joined her pelvis. 

Initially she was able to put up with the discomfort, but in time it got worse. Sometimes the pain was so bad, she couldn’t go to school. “It felt like my back was on fire, so I was told to quit gymnastics and give my body time to heal. Eventually pain prevented me from sleeping. I remember one solid week when I was 14, when I couldn’t sleep at all.” Vicki recalled getting shooting pains down her legs when she rolled over. Eventually neither standing nor sitting were comfortably. After stopping gymnastics and giving her back a rest, she felt better. She tried playing other sports but soon found that just turning the wrong way could cause excruciating pain that lasted for days.

Vicki tried physical therapy but it too aggravated her condition. Two attempts with bracing her back were also unsuccessful. The last treatment she tried before deciding to undergo surgery was personal training at a gym that specialized in sports-related injuries. “My back stopped hurting for at least four years and then all of a sudden, the pain came back one summer,” she said. “I decided to do the surgery because I was sick of being in pain.”

In order to reestablish a solid connection between the spine and the pelvis, Dr. Scott Simon, assisted by Dr. Paul Apostolides, performed a minimally invasive decompression and spinal fusion on Vicki in June 2009. They removed the disc between L5 and S1 and replaced it with bone and a small cage. Through two small, one-inch incisions, they placed screws into the two vertebrae and connected them with two rods in order to immobilize the vertebrae to allow them to fuse together.

Vicki spent three days in the hospital and recovered at home over the next two weeks, after which she gradually went back to driving and getting around on her own. “I’m very glad I had the surgery. Now I'm back to living a normal life. I get a full night’s sleep and wake up without my back hurting. I am even back to weight training and using the elliptical at school.

 

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Lumbar Laminectomy Instrumentation and Fusion

 

For over fifteen years, Darien High School computer technology trainer Ralph Chianelli frequently suffered from back and leg pain. After a while, household projects became more and more difficult and by the time he was 58, he was easily fatigued and having difficulty walking short distances. Eventually, riding in a car was agonizing and he could no longer enjoy his favorite hobby, working on cars.

After consulting chiropractors, orthopaedic surgeons and neurosurgeons as well as following programs of physical therapy and exercise, he went to see Dr. Paul Apostolides, a neurosurgeon recommended to him by his brother-in-law.

“Upon reading my MRI, he explained that my problem was due to severe spinal stenosis and spondylolisthesis or slip-of-the-bone,” said Ralph. “The spinal canal had severely narrowed putting pressure on the spinal nerves which caused my leg pain. In addition, one vertebra had slipped in front of the other and was moving abnormally, causing my back pain. Fortunately, there was a surgery that could help me.”

Dr. Apostolides with Dr. Amory Fiore, performed a laminectomy to widen the spinal canal and decompress the spinal nerves. Then, an instrumentation and fusion were performed to treat the instability using titanium screws and rods, medical grade plastic inter-body cages and bone graft.

Ralph’s recovery was steady through a post-operative routine of physical therapy and a home exercise program. He returned to his job after a two and a half month break to recuperate. Six months later, Ralph and his wife made a three-week trip to China and climbed the Great Wall. “I could never have made the trip before the surgery. It gave me my life back. I feel great!” he said.
 

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Reconstructive Neck surgery

Stamford resident Kimberly Olson was 17 when she was in a roll-over car accident that severely injured her neck. Dr. Paul Apostolides was on call that night and remembers meeting Kimberly in the Greenwich Hospital ER, "She was awake, alert, scared and in a lot of pain. Fortunately, she was able to move her arms and legs." X-rays revealed multiple fractures of the cervical spine.

When Kimberly's parents arrived, they learned their daughter's broken neck could result in long-term pain, loss of feeling, or even permanent paralysis in her limbs. "After reviewing numerous MRIs, CTs, and x-rays, Dr. Apostolides explained that he would have to virtually reconstruct Kimberly's neck," recalled Kimberly’s mother Lorraine. "His assessment of her condition was tough to hear, although he was optimistic about her chances for recovery."

Dr. Apostolides and Dr. Amory Fiore performed the operation, which required decompressing the spinal cord and nerves and realigning, stabilizing and fusing together four adjacent vertebrae in the lower cervical spine using titanium plates, screws and rods and bone graft.

After surgery, Kimberly was placed in a cervical brace to support the neck while it healed. Her recovery was steady and six and a half weeks later, she left for her freshman year in college.

"The surgery exceeded all expectations," said Lorraine. "I can't imagine what would have happened if Dr. Apostolides hadn't walked into the emergency room that night."

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Lumbar Discectomy

At 86 years of age, Esther Burlingham of State College, PA is a healthy and active woman, accustomed to an independent lifestyle that includes gardening, volunteer work and traveling. She awoke one morning with considerable pain in her back and right leg. The previous afternoon she had spent raking and pulling weeds in her garden and her physician in Pennsylvania concluded that she had badly strained a muscle. The pain grew worse over time and after five weeks of physical therapy and pain medication, her condition had deteriorated significantly. Searing pain shot into her right thigh whenever she attempted to bear weight on it and she could no longer walk without leaning on a walker. Climbing stairs was all but impossible.

With great difficulty, Esther traveled to Westchester County to visit her daughters for Thanksgiving. They brought her to ONS to see Dr. Mark Camel. Upon reading an MRI of her lower back, he determined that the source of her pain was pressure on the spinal nerve created by a ruptured disc. A 45-minute procedure called a discectomy could end her suffering.

She underwent the operation to remove disc fragments and material from the damaged disc. By the afternoon on the day of surgery she was up and walking with less difficulty, and in less than two weeks she was walking and climbing stairs unassisted.

“What a relief,” said Esther. “I had become so disabled, that I was really concerned I might lose my independence. The surgery was as successful as Dr. Camel predicted and it exceeded my expectations. I only wish I’d had it done sooner.”

 

The ONS philosophy centers on a team approach. Patients are matched to the physician specialist best suited for their condition. Call 203.869.1145 to schedule an appointment with one of our Spine Center physicians.