No one thinks when they’re young and cheerleading or tumbling or tackling that the effects of those activities could become crippling as you age. But Angela Wyatt of Gates Mills knows otherwise. She developed an uncommon condition called spondyloptosis.
According to Dr. James Anderson, neurosurgeon with the Spine and Orthopedic Institute at St. Vincent Charity Medical Center, she probably cracked her L-5 vertebra on both sides as a teenager. Now 47, the West Geauga teacher’s vertebra slid off the sacrum. The slip was pinching the nerves in her bowel and bladder.
“It was getting progressively worse. I had numbness in my feet,” she said. After trips to many surgeons, she was referred by her neurologist to Dr. Anderson. “When I went to see him, he said he could not do the surgery I needed, but he had a colleague who could. He brought in Dr. (Lou) Keppler.”
Dr. Lou Keppler, co-director of The Spine and Orthopedic Institute, had seen this before and knew the fix. The Gaines procedure is a difficult surgery and not many people have performed it because it has a high complication rate and involves a sacrum pelvic fusion. “It is rare, but I have experience with this procedure,” said Dr. Keppler.
“A person with spondyloptisis looks as if they’re ready to dive off a diving board,” he explained of Wyatt’s pre-surgical condition. The procedure, which lasted more than 10 hours, involves an anterior (front) and posterior (back) approach. “We take the L-5 out from the front and put the L-4 back on the sacrum from the back,” he said. Using screws and rods, they were able to pull her back into alignment.
The first surgeon to do this procedure was Dr. Art Steffee in 1986. He was a surgeon at St. Vincent Charity and made his name as the inventor of the pedicle screw for spine surgery. Dr. Keppler trained under Dr. Steffee. “We used to put people in body casts and they would have to be in bed for months,” he said. “Once he developed the pedicle screw, we became able to fuse the spine into a more stable state.”
Sounds simple enough, except that it’s not. “The deformity is obscured by anatomy,” explained Dr. Keppler. He had to manage large blood vessels and required the help of a cardiothoracic surgeon to “expose” the L-5 from the front.
Though it was a long surgery, going well into the evening, Dr. Keppler was happy with result. “Because we rearranged the nerves, her foot was weak for a while. Her muscles need to find new alignment and her bone will take about a year to solidify. She will gradually build up her endurance, but once it’s healed, it’s healed for good.”
It was a year in March and Wyatt is feeling strong again. She is grateful for the attention both she and her family received from St. Vincent Charity. “Dr. (John) Bastulli (anesthesiologist) talked to my family and was there all night. Once Dr. Keppler was in there, he was able to straighten my spine better than it ever was before.”
Diane Austin was the nurse in the Intensive Care Unit. “It was late, about 1 a.m. and my mom wanted to stay. Dr. Keppler assured her I would be OK but that I needed to rest. Diane told my mom that she would be by my side all night long and would treat me like I was one of her own,” Wyatt says, choking up a bit.
While she was expected to stay in the hospital 10 days, Wyatt credits Ernestine Javorik, physical therapist, with getting her out in six days. “Ernestine is the reason. She got me up and moving. I firmly believe that if she had not been there, I would have been in the hospital for weeks.”
As for Dr. Keppler, he has never been one to shy away from a difficult surgical case. He will routinely go over and over an operation in his head prior to surgery. “It’s not fair to the patient to say you can’t help them. You’re obliged to help, even if it’s a tough case. You’re in it together-patient and surgeon. If it’s what the patient needs you do it,” he said.