Marsha was a 36 year-old businesswoman with two young children. She was referred to me by another patient and came to see me from the east coast. She had the spontaneous onset of back pain about eight years ago. Everything possible had been tried, but she continued to spiral downward with increasing pain.

In 2005, she had an MRI scan done that showed some mild degeneration of the discs in her lower back. These were normal for her age. A surgeon recommended she undergo two artificial discs at L3-4 and L4-5. They did not help her pain, and in fact, she got worse. The discs buckled, and a year later, they were removed at another hospital on the west coast. During this operation, they went back in through her abdomen to remove these artificial discs. In this situation, the major blood vessels are scarred down and attached to the discs. It is a very difficult procedure, and during the operation, her major vein, the vena cava, was torn. Her ureter (tube from the kidneys to the bladder) was also torn. Both were repaired, but she was left with residual swelling of her feet due to the partial disruption of the vena cava. A year later she had L5-S1 fused for ongoing low back pain.

When she saw me, she still had ongoing low back pain, thoracic pain, and neck pain. Two other spine surgeons had recommended to her that she should undergo a two-level fusion in her neck. Her MRI of her neck was normal for her age showing just some mild degeneration.

She desperately wanted to go back to work. Her husband was threatening to leave her. She was on drugs to wean her off narcotics but was having a difficult time. She was extremely motivated to get better but completely trapped by her pain and lack of a plan to solve her pain problem.

None of her surgeries were helpful or necessary. Yet the spine world was offering her only more surgery. I do not know the end of this story. I spent a couple of extra hours with her explaining the DOCC protocol to her in detail. She is fully engaged and I do think over 12-24 months she can become pain-free and functional. It is upsetting to me that she does have the three-level fusion in her lower back and residual swelling in her feet. If she had been able to engage in the structured rehab before any surgery, she might have completely come back to normal. Now she will have some permanent structural limitations.

BF