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Transparency, understanding and trust are key to a successful spine surgery

Sereece Snow manages a specialty-service department for a national bank in St. Louis. Her job can be very challenging and stressful, so when she started experiencing fatigue, muscle weakness and numbness in her arms and hands, she chalked it up to her job. 

Sereece says, “We are constantly implementing new programs or software and it’s nothing for me to work 60-75 hours a week.” She brushed each new symptom aside and blamed stress. “I had no idea I was sick. I was tired all the time and figured the issues I was having with my arms and hands had to do with the tension in my back and shoulders.” 

Sereece says she realized there was something truly wrong when she was grocery shopping with her daughter and her body just locked up. Her legs would not move, so she slumped to the floor and waited for the pain to subside. Finally, she was able to rise and walk and they quickly left the store.

Two days later, her body locked up again. She called her parents and they rushed her to the emergency room at a local hospital. “I was told it was my fibromyalgia flaring up. I was sent home and told to take ibuprofen.” 

She continued experiencing painful episodes, and two weeks later Sereece began having trouble typing. Her fingers would curl up, and then not move. When she tried to stand up, she felt extreme pain in her arms and could not lift her laptop. She went to the emergency room again and was sent home with pain medication and muscle relaxers. The ER doctor thought it was fibromyalgia at its worst.

The pain and numbness soon spread. “It felt like there was electricity running down my arms, but with numbness, too, so I was constantly rubbing my hands. Then it started in my feet.”  She says she was also experiencing a tightness around her waist, like she had an elastic band squeezing her midsection. 

The pain and numbness spread. “It felt like there was electricity running down my arms, but with numbness, too, so I was constantly rubbing my hands. Then it started in my feet.”  She says she was also experiencing a tightness around her waist, like she had an elastic band squeezing her midsection. 

Over the next few weeks, Sereece saw several doctors, including her primary care physician, who blamed her symptoms on extra weight. “The doctor said my blood work showed that my A1C was now an 8.2 where it had previously been around 6.5. He told me he believed I was now a full-blown diabetic and I was experiencing neuropathy. At this point, I was exhausted and in constant pain and I did not feel like I was being heard. I was being told the answer to my problems was to lose weight.” Sereece says she was not at an ideal weight for her height, but not obese. “I think he gave that as an answer because he didn’t have any answers.”

After several weeks, many more doctor visits, an MRI, and a final trip to the ER, Sereece was told she needed emergency surgery. When the physicians learned she was a smoker, however, she was told she could not have surgery because smoking inhibits the healing process. Surgery was deemed too dangerous and the doctors suggested exploring other options. “I was exhausted and voiced my frustration. I had wasted my time and money and energy at appointments and ER visits. Their attitude towards me was indifferent and they made me feel very lesser-than after I voiced frustration at the last ER visit cost.” She left the hospital discouraged and frustrated. She says, “I do believe they treated me differently because they didn’t think I could pay the bill, most likely based on bias.”

During the weeks of doctor visits and trying to find the cause of her symptoms, Sereece’s new primary care physician suggested she see Matthew Goodwin, MD, PhD – a spine surgeon for Washington University Orthopedics. After her terrible experience at the most recent ER visit, she knew she needed to see a spine specialist at Barnes-Jewish Hospital.

At her first appointment with Dr. Goodwin, she recalls completing the paperwork to indicate her pain. It asked if the phrase “short circuiting” described the sensation of her symptoms, and she knew right away she was in the right place. 

It turns out, part of Sereece’s spinal cord was crushed. Sereece says, “Dr. Goodwin showed me my MRI and where my vertebrae were destroyed. He took the time to explain everything and told me I needed surgery, preferably sooner rather than later. He said he may not be able to restore me back to fully-normal, and that I may still have pain, but he had to stop the progression of spinal cord damage.”

Before Sereece could commit to surgery, there were some barriers to address. She notified Dr. Goodwin that she would not take blood transfusions due to her religious beliefs. She was relieved when Dr. Goodwin understood and set her up with the right resources to help navigate the process. He reassured her he was trained to perform the surgery without having to give a blood transfusion, and that his nurse, Bernie, would walk her through the process. Dr. Goodwin also told Sereece she would have to quit smoking prior to surgery. “Dr. Goodwin told me that he would do his part, but I had to do my part because otherwise the fusion would not heal properly and I’d be right back to where I am now.” 

To prepare for her surgery, Sereece began working on herself. She quit smoking and saw a nutritionist in order to lower her A1C.

“Dr. Goodwin assured me of everything, and his nurse was so great and really helped me every step of the way. She knew I was sick and listened to my experience, which really made a difference. She made sure I was prepared for surgery and knew when to stop certain medications. She also held me accountable for quitting smoking by giving me nicotine tests.”

Everything was falling into place so Sereece could have the best outcome on her surgery, but soon another obstacle appeared. 

Sereece had another MRI so Dr. Goodwin could finalize his plan for surgery. Sereece recalls, “He noticed an artery in the front of my neck was growing into the vertebral body right where a screw would typically be placed. He said it would complicate the surgery and that he’d have to go in and place the cage off center, increasing the risk of the artery being nicked.” 

Dr. Goodwin says, “Sereece was an extraordinary patient. First, at the end of our first visit, she repeated back to me the major points of our interaction very thoroughly and articulately, which patients don’t normally do. It was really remarkable and made me realize she was special, which she then went on to prove. Second, in a very short amount of time she quit smoking and got her A1C down, which probably helped towards her great outcome as much as anything else. Finally, when planning surgeries, I always review the local anatomy to be sure I know every millimeter (mm) of where we will be. Her vertebral artery took an abnormal path into, rather than beside, her C5 vertebral body. Because I was taking her C6 vertebral body out, placing a cage and bone graft in its place, and a plate in front of it, I would be placing screws into C5 and C7 to secure the plate. Had we not seen this anomaly, we could have really caused some major problems, especially given that she does not receive blood transfusions. However, we were able to do exactly what we wanted and place it just a mm off-center to avoid the vessel.”

Sereece says, “I already felt extremely anxious. I was scared. I didn’t want a blood transfusion and I had already prepared myself not to come out of surgery. I cleaned out my entire office at work, but I did not share my insecurities with my family or co-workers. I didn’t want my kids to be scared. I didn’t want to let my parents down. I didn’t know if I would make it out of surgery, but knew I wouldn’t be able to go on living without the surgery. Dr. Goodwin must have seen the fear in my face that morning.  He held my hand and reassured me that a lot of people have had the same surgery and done very well. Then they rolled me back to the operating room.”

On the day of surgery, Sereece says that Dr. Goodwin kept her family up to date with phone calls every two hours. 

Dr. Goodwin says, “While I would love to take credit for that, the OR staff does an exceptional job of updating the family throughout the surgery; it is a whole team effort in the OR. Her surgery went great – she had quite a bit of calcified material pressing on her spinal cord, but we were able to do exactly what we wanted to do: take out C6 to get the pressure off her spinal cord and place a cage and plate slightly to the left to avoid hitting the vertebral artery that was going into her C5 bone. Her spinal cord was really being compressed.”

Immediately after she came out of surgery, Sereece could move her fingers and her numbness had improved. The next day she was up walking with little assistance and released within a few days.

Sereece’s recovery was smooth and she was back to work several weeks later, starting with half days for the first two weeks. She took all the precautions, and even wore her brace longer than was necessary.  She says the numbness and tingling in her hands is totally gone and she now has full strength and use of her hands again.

Sereece says, “Dr. Goodwin is an excellent doctor. I trust him with everything. He is very confident, but not arrogant. He helped me be accountable for my part in this process, and he and Bernie stick with you all the way through surgery. He’s very passionate about the work he does. I think he looked at every problem as a challenge to overcome, and it drove both of us to succeed. He made a successful story out of me. I chose Dr. Goodwin because I trust him. I am so grateful and thankful because going in, I did not think I was coming out. But I did!” 

Dr. Goodwin, “I really do think trust and transparency are key components of the surgeon-patient relationship. I always talk to patients about their risks, whether it is due to smoking or a high A1C, and explain that between the two of us, we share those risks. I will do all the things on my end to minimize risk for the patient, down to looking at every vessel near where I will be operating. And if the patient can trust me when I tell them the things they can change to minimize risk on their end, it is much easier to have great outcomes.”

Sereece says, “Prior to surgery, I was not paying attention to the alarms my body was sending me. Now, I am much more conscious about my body and how it's feeling. I am taking better care of myself. My sugars are back to normal and I am able to exercise, run, and walk. My neck gets tired, but I pay attention to it and get up and walk around and try not to sit at the computer as much. All the numbness and shooting pains are gone.”

Dr. Goodwin commented, “I am not surprised Sereece has done well – she is a special person and one of the brightest people I have had the privilege of helping. Not only that, but her commitment to understand the pathology, quit smoking and correct her blood sugar (A1C) really made a big difference in her outcome. She took real ownership of her health, like I imagine she does of all projects she leads, and it really paid off!”