Taking a walk on the beach, catching a
baseball game - perhaps routine considerations
for many families as they
make weekend plans - yet, for Jane and
Robert Costello of Dix Hills, the ability
to get out and enjoy such activities is
something they don't take for granted.
Jane and Robert Costello, pictured with
their daughter Haley, are grateful for the
world class spinal care they received at
Winthrop-University Hospital, which has
enabled them to get back to their active
lifestyles and enjoy a newfound appreciation
for spending time together as a family.
Today, the couple - both of whom
suffered bouts with back pain so severe
that it left Jane, a long-time athlete,
paralyzed, and Robert, a once minor
league baseball player, severely impaired
- are deeply appreciative of their quality
of life, thanks to the extraordinary care
they received at the hands of Nancy
Epstein, MD, Chief of Neurosurgical
Spine and Education at Winthrop-University Hospital.
"I shutter to think what things
would be like if Jane and I never met
Dr. Epstein," said Mr. Costello recently.
"My wife and I exercise every day and are
raising our daughter to appreciate how
important it is to live a healthy lifestyle -
and that would not have been possible
without Dr. Epstein and the remarkable
care that we received at Winthrop."
For years, Mrs. Costello, an avid
athlete, whose favorite pastimes included
skiing, tennis and horseback riding,
pushed through persistent back pain to
do the things she enjoyed most. Knowing
surgery would likely be an inevitable
treatment, Mrs. Costello did everything
in her power to postpone it. She turned
to steroid injections to deal with the pain;
when the injections were no longer effective,
visits to the chiropractor became
another form of therapy.
But when a routine chiropractic
manipulation went terribly wrong,
Mrs. Costello's world was suddenly
turned upside down. Within just two
days, she was completely numb from
her mid-section down to her legs.
Terrified and desperate for answers,
Mrs. Costello turned to the experts at
Winthrop-University Hospital for help.
Upon visiting the Hospital's
Emergency Room, comprehensive MRI
and CT studies revealed severe spinal
stenosis (narrowing of the spinal canal),
and calcification of the yellow ligament
- a series of bands of elastic tissue that
connect the lamina in the back of the
spine. In addition, a synovial cyst - a
benign, fluid-filled sac which extruded
from its normal position in the facet
joint - filled her lower thoracic spinal
canal producing marked spinal cord
compression and partial paralysis. This
markedly limited Mrs. Costello's ability
to walk as well as feel her legs.
Mrs. Costello was immediately
evaluated by Dr. Epstein and it quickly
became clear that she would need to
undergo emergency spinal surgery. To
address Mrs. Costello's condition, Dr.
Epstein preformed a laminectomy - an
operation that involves the removal of
multiple vertebral laminae - the portion
of the spine which forms the
"back" of the spinal canal. The multilevel
laminectomy included not only
the removal of the laminae and an
enlarged, hardened yellow ligament,
but also the removal of the synovial
With this decompression of the
spinal cord and the sac containing
important neural tissue in the area, new
space was created for the neural structures,
allowing room for their expansion
and return of function. In addition,
Mrs. Costello underwent a non-instrumented
(no rods or screws) fusion
utilizing her own bone chips and an
artificial bone graft expander, which
added stability to another area of the
spine which showed mild slippages on
the preoperative studies.
Following her extensive surgery,
Mrs. Costello spent a full week at
Winthrop. While there, she was cared
for by a dynamic team of nurses, physician
assistants and specialists in the
Hospital's Step Down Unit. Remarkably,
Mrs. Costello's first post-operative evaluation
just one week after her discharge
was completely normal.
"Mrs. Costello had normal strength,
normal sensation, and all normal bodily
functions were in tact," said Dr. Epstein.
"What's more, the pain and weakness
that had rendered her paraplegic and
wheelchair-bound were gone."
Nevertheless, Mrs. Costello still
faced a long road to recovery. For the
next several months, she had to refrain
from any bending or stretching and
from performing many routine daily
activities like cooking and cleaning the
house. What's more, she wore a spinal
brace whenever she was out of bed to
facilitate the healing process.
"Spinal bracing helps healing by
keeping the spine aligned. This allows
the bone chips to grow together without
disruption and to progress towards
fusion," said Dr. Epstein.
In addition to wearing a brace, Mrs.
Costello took recommended supplements
of vitamins and minerals and a
spinal stimulator was used to further
enhance the fusion. As part of her rehabilitation,
Mrs. Costello participated in
physical therapy and took up swimming
as a form of therapy. Gradually, she was
able to wean off the spinal brace and
soon thereafter, felt good enough to get
back on her horse and take a ride around
her backyard - something she recalls as
one of the highlights of her recovery.
Today, as she enjoys a newfound
love for swimming and spending time
with her family, Mrs. Costello looks
back in marvel at just how far she's
come. Recognizing the vital role that
everyone who cared for her during her
time at Winthrop played, there is one
person who stands out as having the
greatest influence - Dr. Epstein.
"Every day that my feet hit the floor
and I take a step, I thank that woman,"
said Mrs. Costello.
Mr. Costello is equally grateful -
not only for the world class care that
has enabled his wife to reclaim her life,
but for the same superior medical attention
that he received which has allowed
him to continue to care for the needs of
his family, something he holds dear to
Like his wife, Mr. Costello struggled
with bouts of severe back pain over the
years. But a passion for playing sports
such as baseball and basketball kept him
active. He too had undergone a laminectomy
at another healthcare institution
several years earlier, but a recent routine
workout in the gym sent him into a medical
tailspin. As numbness and pain in his
right leg grew progressively worse, Mr.
Costello turned to Dr. Epstein for help.
"Though I was scared, I felt confident
in the way Dr. Epstein handled
Jane's situation and knew that I was in
the right hands," said Mr. Costello.
Upon arriving at Winthrop's
Emergency Department, imaging studies
quickly revealed Mr. Costello's severe
lumbar stenosis accompanied by a massive
recurrent disc herniation. Together,
both contributed to severe compression
of the nerve tissue that resulted in cauda
equina syndrome (partial paralysis of the
legs) and a bilateral foot drop, which
affected his right leg more than his left.
These acute conditions required an
emergency decompressive lumbar
laminectomy with disc excision.
"Mr. Costello's surgery also included
a non-instrumented posterolateral
fusion that utilized his own bone and
an artificial bone substitute. He did not
require instrumentation such as rods or
screws which markedly reduced his hospital
stay and risk of infection, among
other factors," said Dr. Epstein.
Mr. Costello's first postoperative
evaluation was also a success and with
the help of a back brace, he, like his wife,
went on to make a full recovery. Today,
as the back brace he once wore hangs in
his garage to serve as a reminder of just
how far he's come, Mr. Costello is
amazed at just how good he feels.
"I can literally jump out of bed!"
he exclaimed. "Because of Dr. Epstein's
skill and compassion, I am living a
wonderful life. I can earn a living and
support my family, and our daughter
doesn't have to grow up watching both
of her parents live in pain."
"This lovely couple did well following
their emergency spinal surgeries,
dealing with very different problems,
because they came to Winthrop immediately
and did not delay their treatment.
Had they waited any longer, the paralysis
they both developed would most likely
have become permanent and irreversible,"
said Dr. Epstein. "These two patients
underscore just how effective the right
operation can be in the right patient at
the right institution."
For more information about
advanced spinal surgery techniques at
Winthrop, call 1-866-WINTHROP.
Vol. 21, No. 1
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