Around Christmas, the new pain started. Muscle spasms and cramps in Miles Murri’s right leg that felt like blasts of lightning, burning and shocking. And in his lower back, the pain was constant, the torturous kind that makes nighttime hours interminable and prevents any chance of a comfortable rest.
Murri is no stranger to back pain or the intricacies of medicine and treatment. Murri, D.O., is a fourth-year anesthesiology resident at the UF College of Medicine who had experienced occasional muscle spasms over the past five years. Sometimes the pain followed a hard run. But this winter, the pain felt different. It began with soreness and stiffness in his back after a game of basketball. A few days later, he lifted weights at the gym, including deadlifts and squats.
“A couple of days after that, I experienced this new pain,” Murri said. “I couldn’t sleep at night because I just couldn’t get comfortable. Sitting down was so painful that I could barely drive. The pain was unlike anything I’ve ever experienced.”
Murri endured nearly two months of excruciating pain before finding relief close to home. An MRI showed he had a large disk herniation with compression of a sciatic nerve root (S1). Herniated disks, which are problems with the rubbery cushions between vertebrae in the spine, can press on nerves, causing the type of radiating leg pain he was experiencing.
In mid-February, he underwent a life-changing minimally invasive endoscopic microdiscectomy performed by Sanjeev Kumar, M.D., assistant professor of anesthesiology in the UF College of Medicine’s division of pain medicine.
Endoscopic microdiscectomy, currently offered at UF Health only by pain medicine physicians, is an effective and potentially less traumatic option for certain types of moderately complex spine pathology. It is one of a full spectrum of endoscopic spine procedures provided by UF Health Pain Medicine, which is one of the very few academic pain medicine programs in the country that offer these options to patients and trainees.
In the endoscopic microdiscectomy procedure, an endoscope with a tiny high-definition camera is inserted through a very small incision, allowing the surgeon to visualize the area from a close distance. Surgeons use microscopic instruments and shave part of the disk that is compressing the nerve, relieving pain. With a minimal incision, patients can typically recover faster and experience less postoperative pain than they would from a more traditional surgery.
The endoscopic procedure also minimizes trauma to the surrounding spine structures, particularly muscle. Depending on the level, approach, and occasionally the pathology, bone does not typically need to be removed. After the herniated part of the disc is removed, the remaining “gel” (nucleus) inside the disc is cauterized, making it harder. Part of the outer layer of the disc (annulus) from where the nucleus leaked out is sealed with bipolar radiofrequency electrocautery.
“This option for spine pathologies does not cause instability or scarring inside and outside the spinal canal in most cases and still resolves the pathology with positive outcomes for our patients,” Kumar said. “I am grateful for the faith that Dr. Murri put in me, allowing me to operate and remove the large disc herniation.”
Five weeks after the procedure, Murri’s back pain has almost entirely resolved. A follow-up MRI showed significant decompression of the herniated disc and S1 nerve, and his sciatic nerve pain is completely gone. “Everything I was hoping for after the surgery has come to pass,” he said.
Minimally invasive options
In recent years, UF Health Pain Medicine has expanded its options to treat various types of acute and chronic pain and grown its accredited fellowship program in tandem. Six fellows currently have the option to gain hands-on experience in the most advanced pain medicine interventions.
In addition to endoscopic spinal decompression procedures, these interventions include minimally invasive lumbar decompression procedures, such as Mild and Vertiflex, to treat low back pain.
Many minimally invasive procedures can be performed on an outpatient basis, some without general anesthesia, allowing patients to resume daily activities soon afterward. In Murri’s case, recovery was smooth. Aside from stiffness in his back, he experienced minimal postoperative pain, and he was able to stop taking Tylenol within one day.
Procedures such as endoscopic spinal decompression do not interfere with the spine’s stability and leave open the possibility for a more traditional spinal surgery in the future, if needed. If Murri experiences re-herniation, for example, a repeat of endoscopic microdiscectomy vs. a traditional microdiscectomy would still be an option.
‘A lot to live for’
Murri will continue to be careful for several weeks while fully recovering. Ultimately, he expects to be able to resume his active lifestyle with few modifications. For that, he thanks Kumar and Amir Jafari, D.O., a pain medicine fellow who was also involved in his care, as well as the team at UF Health who gave him back his freedom of movement.
“I feel extremely lucky that this procedure was offered by our chronic pain program at UF,” Murri said. “One of the reasons I went into medicine was because of someone who truly fixed a significant problem for me after I broke my femur when I was a teenager. I think about Dr. Kumar in a similar way, as someone who really changed my life.”
After the darkness of chronic pain, Murri is taking nothing for granted. “I feel grateful just to be able to walk without pain,” he said. “I have a lot to live for.”