Jonathon “Jon” Alberstadt barely covered a block of his standard four-mile run before it hit him: He couldn’t continue without falling.
“It was scary,” the 62-year-old says of last summer’s experience. “I was used to running or biking every day. But I was scuffing my feet, losing my balance, tripping.”
Jon knew this day might come. In 1995, two successful surgeries relieved compressed nerves in his neck—the source of the persistent pain and muscle weakness in his left arm. Yet doctors cautioned that a similar problem could resurface later in life. The likely culprit: years of wear-and-tear from white-water kayaking, probably compounded by his high-school wrestling career.
So Jon—a recent transplant to the nation’s capital from Erie, Pa., and a proud graduate of both Georgetown Prep and Georgetown Law School—decided to turn to MedStar Georgetown University Hospital for help. He found everything he needed and more in orthopaedic surgeon S. Babak Kalantar, MD.
“I was immediately impressed,” says Jon. A significant assessment, since Jon is the son of a physician, a former hospital board member in Erie and a veteran of about 15 surgeries. “I have had a very active lifestyle and have needed a lot of medical care as a result. It really meant something to me when the first thing Dr. Kalantar said was, ‘Tell me what’s wrong, and take as much time as you need.’”
An hour later, the two were discussing possible reasons for Jon’s deterioration and, more importantly, how to stop it in its tracks. At issue was Jon’s ability to pursue his life’s latest passion—snowboarding.
The diagnosis, however, was not promising. Jon had severe cervical (neck) spinal stenosis—a narrowing of the canal that separates the nerves in the spinal cord from the surrounding vertebrae that make up the bony spinal column. Herniated discs worsened his condition. The combination was squeezing his spinal cord, affecting the nerves that control his extremities. Left untreated, the condition can cause permanent loss of strength and feeling in the arms, hands and legs, sometimes leading to long-term disability and life in a wheelchair.
“He had classic telltale symptoms,” Dr. Kalantar says. “In addition to numbness and lack of balance, Jon was having trouble grasping things, buttoning shirts, using a pen and performing other tasks that require manual dexterity.”
Dr. Kalantar, a fellow snowboarder, sympathized with his patient’s plight. Traditional treatment—a laminectomy with fusion—would put an end to Jon’s avocation. That’s because the procedure, while effective, involves removing the offending bone in the neck and then stabilizing the spinal column with rods, screws and a bone graft. Patients lose range of motion in the neck. As a result, during an accident, they are more likely to suffer serious spinal cord injuries.
So Dr. Kalantar offered a less invasive option: laminoplasty.
Widely used in Japan and gaining a foothold in the U.S., laminoplasty calls for one of the spine’s two laminae—plates of bone in the vertebrae—to be opened vertically but not removed. A parallel shallow groove is made in the other lamina to serve as a hinge, allowing the surgeon to pry open the bone that was sliced through. Wedges are then inserted in the open area to free the compressed nerves and prevent the bones from growing back together and closing the gap. Since no bone is removed, fusion is not necessary and range of motion can be preserved.
MedStar Georgetown University Hospital is one of the few hospitals in the area to offer this approach, which also provides patients with quicker recoveries. With fusion, most patients spend four to six weeks in a hard surgical collar. By contrast, laminoplasty patients wear no collar and are encouraged to start moving the neck within a week of the surgery.
The day after his hospital discharge, Jon started taking two-mile walks; three months later, he was cleared for some activities at his gym. Today, he follows an aggressive routine of physical therapy and works with a personal trainer to regain strength. Best of all, Dr. Kalantar expects his patient will be back snowboarding this winter.
Jon is hopeful and realistic at the same time.
“Even if I don’t progress any further, I’ve been extremely fortunate,” he says. “I can walk, run, write and hold on to things again. I owe it to MedStar Georgetown, Dr. Kalantar, nurse practitioners Kim Zagory and Jill Cunningham, and the other members of his incredibly supportive team.”
What’s Right for You?
Nearly one-third of all degenerative orthopaedic problems originate in the neck. The primary goal of all corrective procedures is to stop the problem from getting worse; the secondary goal is to regain some of what was lost. Laminoplasty is an important option and requires an evaluation to ensure that patients have the right bone alignment, among other factors.
Of course, the best approach is to avoid developing degenerative problems in the first place. Although genetics plays a significant and uncontrollable role, you can reduce your risks through engaging in low-impact exercise and maintaining a healthy weight. Getting enough calcium and vitamin D also can help.