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Winthrop University Hospital

World Class Spinal Care Transforms the Lives of One Grateful Family

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.
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.

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 cyst extrusion.

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 his heart.

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
Winter/Spring 2011

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