CHARLOTTE – Sherry Clayton, 74, has always been active. She loves gardening, traveling and her independence.
Like many people her age, she had arthritis – but it didn’t keep her from doing the things she loved. She kept pain at bay by being active, doing physical therapy and taking anti-inflammatory medication.
Then, in June 2021, her pain became too much. An MRI revealed that she had lumbar spinal stenosis, a disease that occurs when the space inside the spine becomes too small, placing pressure on the spinal cord and nerve roots. The condition is often attributed to the long-term effects of arthritis.
“It can happen from degenerative changes in the spine, which usually occur in advanced age,” said Clayton’s surgeon, Dr. Nasir Khatri of Novant Health Spine Specialists – Randolph Road. “Patients typically have back and leg pain that’s worse when walking and standing and improves with leaning forward and sitting down.”
The condition is more common in older populations. One out of every 1,000 people over the age of 65 is likely to develop spinal stenosis, according to the National Institutes of Health (NIH).
Chronic pain exacted a toll on Clayton. When she went shopping, she needed to take frequent breaks to sit. “I became isolated,” she said. “It was hard to get out. When I went to the store, if I couldn’t get a close parking spot, I’d just leave.”
Clayton, a resident of Fort Mill, South Carolina, saw two spine surgeons, both of whom recommended spinal fusion surgery – but even that wouldn’t guarantee she’d be pain-free. And surgery comes with its own risks, especially for older adults.
Only a few Charlotte doctors can perform the procedure
Not being one to accept the status quo, Clayton did some research. She found the website for Vertos Medical and liked what she read about the minimally invasive lumbar decompression (mild®) procedure, which led her to Khatri. He and his partner, Dr. Jacob Wang, are two of just a handful of doctors in the Charlotte area trained on the procedure.
Vertos is a medical device company that manufactures the specialized equipment necessary to perform the procedure.
“This can be performed in patients of all ages,” Khatri said. “That’s one of the best things about it compared to more traditional spine surgery where you require general anesthesia – which has its own risks – along with a large incision and hardware. This procedure leaves nothing behind. It’s done with just some sedation – not general anesthesia. The anesthesia is closer to what you’d have before a colonoscopy. On top of that, the incision is very small. There’s no significant downtime. Patients can get back to doing whatever they want to do the very next day.”
“There’s not even a stitch or a staple,” he continued. “You put a Band-Aid over it because it’s such a small incision.”
Even non-invasive procedures carry risks, but the risks associated with this procedure are minimal. “A large study found that the overall risk is essentially the same as with a simple epidural injection,” Khatri said. “It’s very rare to have any significant side effects.” In fact, that recent study led to a resurgence in mild procedures being performed. The procedure won FDA approval in 2006.
The procedure doesn’t preclude future surgeries, if they’re needed. “If patients don’t have the outcome we were hoping for, they’re still a candidate for more invasive spine surgery,” Khatri said.
‘An incision the size of baby aspirin’
About six weeks after her initial consultation with Khatri, Clayton went to Novant Health Presbyterian Medical Center – the very hospital where she was born – to have the same-day procedure.
The procedure is image-guided, Khatri explained. “I’m able to use just a simple, small incision because a fluoroscopy machine (a form of X-ray) helps guide my instruments to the right spot.”
The technique allows surgeons to “restore space in the spinal canal for patients who are suffering from chronic back and leg pain,” Khatri said. “A series of tools are inserted through an incision the size of a baby aspirin to scoop out thick arthritic ligament which is causing compression on the spine.”
It isn’t for everyone with back pain. “It’s indicated for patients who have neurogenic claudication – aching, heaviness in their back and legs with walking and standing which improves with leaning forward on a shopping cart or sitting down,” Khatri said.
Because Clayton was already so active, Khatri didn’t even recommend post-op physical therapy for her. He does for many patients, though.
“Patients don’t necessarily have to do physical therapy, but I usually recommend it,” he said. “Given that spinal stenosis is such a progressive, chronic condition, I like to get patients feeling better with the mild procedure and then get them into PT to rebuild their stamina, strength and flexibility and potentially increase their muscle mass, as well.”
‘A walking miracle’
Clayton’s life returned to normal almost immediately.
“I felt good that night,” she said. “I took it easy for a couple of days, but other than that, I have no restrictions. I have told so many people about Dr. Khatri and this procedure. One of my friends is seeing him this week.”
Clayton can now go to the store – without worrying about how close her parking space is. And she can get all her shopping done in one trip. Pain used to sometimes force her to leave the store before she’d gotten everything on her list.
She even has the data to back up how much better she’s doing. “Like a lot of people, I use an Apple watch,” she said. “It doesn’t just tell you how many steps you’ve walked in a day. It can tell you about your body’s symmetry and steadiness. Mine used to always send me notifications that I was a fall risk. Now, it’s all back to normal.”
Khatri reported: “At her two-week follow-up appointment, she reported having nearly 75% pain relief and, more importantly, improved function. Based on her Apple Watch data, she is now walking double the steps she could before.”
She’s sleeping better, too. “Sleeping well is hard with spinal stenosis,” she said. “But it’s possible now. I’m not locked into one position all night, and I don’t wake up and dread getting out of bed. I no longer wake up and just sit for an hour to get prepared for the day.”
She’s traveling again. She’s been to the beach and the mountains and, early this spring, she’ll fly to New York.
“Everyone I met at Novant Health was wonderful,” Clayton said. “Dr. Khatri is so compassionate. You can tell right away he’s going to do his best to get you better. I wouldn’t have thought I could get back to this point. And I want other people to know: There is hope. I tell everyone ‘I’m a walking miracle.’”