From Operating Room to Recovery Room: Dr. Polly’s Story of Strength & Insight

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Hi, everyone. Welcome to Spine Talks, where we bring unparalleled

 

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access to world-class experts, like the surgeon who is sitting

 

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next to me today. I’m delighted to introduce Dr.

 

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David Polli, and today, we are going to be talking about a

 

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very unique patient journey, and that is his own patient

 

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journey.

 

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My name is David Polli, and I am a retired spine

 

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surgeon. I had a unique experience of developing an

 

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acute cervical radiculopathy, so I lost the strength

 

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in my right arm and my biceps and my deltoid, and I

 

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couldn’t feed myself. Uh, and so I had to

 

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go through the decision process and work with a

 

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surgeon colleague friend of mine about, “What should we do about this?”

 

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Uh, we obviously started with non-operative treatment.

 

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The muscle weakness was so bad and the pain was so bad that that

 

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just wasn’t working, and so I asked him to do

 

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what’s called a posterior foraminotomy or go in through the back to see if

 

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that decompression alone would be enough.

 

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Uh, the hope was that we could keep my motion by not having to do

 

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a fusion. So we did that and it made my pain a little bit

 

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better, but it didn’t solve the problem.

 

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So a couple of weeks later, we needed to go on and, uh, do an

 

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anterior cervical discectomy and fusion.

 

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And I’ve certainly done those surgeries and I’ve taken care of lots of people

 

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with that problem before, uh, but obviously, it got very

 

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personal. And the part that I wanted to share with

 

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patients and with my colleagues is that I learned a couple of

 

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things about helping in the recovery process.

 

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So number one, ice is your friend, and if you go on

 

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any web engine and, and search it, you can find a cowl-shaped

 

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ice gel pack that if you use that after the surgery, it really,

 

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really makes a difference. The second thing is that

 

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it’s not uncommon to have muscle spasms

 

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associated with surgery, and there’s a muscle called the levator

 

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scapulae which goes from the neck to the top of the shoulder blade.

 

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And I think when you have a C5 problem, which is what I

 

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had, that your shoulder sags and that little tiny muscle

 

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is trying to hold that shoulder up, and that results in a lot of

 

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spasm. And so there’s something called a Thera Cane that looks like a

 

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candy cane that allows you to do your own

 

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trigger point release type techniques, and it’s 15

 

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bucks or something like that.

 

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Mm-hmm. Mm-hmm.

 

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And so I, I think it’s very, very affordable.

 

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And then finally, the last thing I did which made the biggest difference was

 

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something called functional electrical stimulation.

 

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And so the goal of that is to help the muscle

 

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recover and maybe recover a little faster.

 

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The data, the scientific data is not compelling, but my

 

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personal experience was that that unit, using it twice a

 

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day, did more to relieve my pain than all of the different pain

 

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medications. And so I’ve now come to the point of just sharing

 

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with my colleagues, listen, you can go on the web and you can

 

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buy these things. For the functional electrical stimulation, you probably

 

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need to work with a physical therapist to figure out how to get the

 

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right settings and how to use it and place the pads

 

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appropriately, but if you do that, it’s very doable,

 

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uh, incredibly low risk. And if it helps you with your pain

 

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control post-op and accelerates your rehabilitation, then everybody

 

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wins. And so that’s been my message is to say these

 

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three little things that are

 

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over-the-counter, uh, and very safe kinds of

 

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things can really help the patients with their recovery.

 

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Yeah.

 

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Or at least they really helped me when I was a patient with my

 

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recovery.

 

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Can you explain to us, what does radiculopathy mean?

 

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When a nerve is pinched, there are a couple of things that

 

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begin to happen. It starts with numbness, and so for

 

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me, the C5 nerve compression gives you numbness

 

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in what we call the deltoid area or this part of your lateral

 

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shoulder. Uh, then that progressed to weakness,

 

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and the combination of numbness and weakness in a

 

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pattern of a nerve root is what a radiculopathy is.

 

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How do we differentiate between numbness and pain?

 

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Uh, you could take a pen and stick it here, uh, on me and

 

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even still, uh, and I wouldn’t feel it like a normal pen

 

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prick. Uh, but pain is, uh,

 

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described in a number of different ways.

 

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For me, it was a burning, stabbing sensation in that

 

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nerve root distribution.

 

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A lot of times, shoulder pain is coming from the

 

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neck. Sometimes it’s not, but a lot of times it is, and

 

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so differentiating where that pain is coming from is

 

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challenging sometimes.

 

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It’s a classic what we call crossover pain pattern, and it can

 

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come from the shoulder or from the neck.

 

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A simple way to try to help understand that is

 

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typically doing this. If it’s from the neck, that tends

 

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to lessen the tension on the nerve and that can help a little bit.

 

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If it’s the shoulder, that usually exacerbates it.

 

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That’s not 100% true, uh, but it’s good most of the

 

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time. And so I think sorting out where the pain is coming from

 

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before undergoing any sort of surgical intervention is really

 

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important. One of the things that I had done, uh, to make

 

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sure which level what the pain was coming from was I

 

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had something called a selective nerve root block-

 

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Hmm.

 

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… where a neuroradiologist under X-ray guidance put

 

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numbing medication around the C5 nerve root, and that gave

 

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me tremendous pain relief. It only lasted a few hours, but it

 

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was helpful to confirm that that was where my

 

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problem-

 

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Where

 

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the pain- … was coming from.

 

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Yeah. Dr. Polli is a giant in the world

 

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of spine, and, um, you know, it is

 

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remarkable to be able to be sitting next to you and talking

 

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about your own spine health journey.

 

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Um, as a spine surgeon…Did this catch you

 

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off guard?

 

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Well, I had had a wrestling injury in college a, a lot of years

 

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ago, and, uh, I knew my neck was not normal.

 

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But I’d been able to have a full career, and it, uh, came

 

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on so suddenly that that did surprise me.

 

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Uh-

 

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That’s interesting.

 

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… and, and it was, okay, this is what’s going on

 

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and needs to get taken care of.

 

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And, and Dr. Pauly had the knowledge, um, to know what

 

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was going on with, with his body. Um, a lot of times

 

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patients don’t know where to start, and, um, we talk a lot

 

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about having patients, um, figure out which

 

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provider, which kind of doctor they should see when they think they

 

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might have a neck problem. Um, Dr. Pauly, can you help

 

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us talk to the public about where do you go, where do you start

 

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if you think you’ve got a problem?

 

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It really probably depends a little bit on your insurance status and how

 

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you access healthcare. Um, in a perfect

 

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world, you have good access to your primary care doctor

 

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and you go to your primary care doctor and say, “I have this pain, it’s in this

 

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pattern, I have this weakness.” And then

 

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hopefully they will refer you to someone with specific subject

 

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matter expertise. That could, that could be a spine surgeon.

 

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Spine surgeons come in two flavors, either orthopedic spine surgeons, which

 

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is what I am, or neurosurgeons, uh, and that

 

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both of those specialties are well-trained to handle this

 

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problem.

 

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Mm-hmm.

 

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Uh, it’s also common to be referred to physical therapy.

 

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And my response to that is if physical therapy helps,

 

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then that’s a great answer. And so if you can get by and get

 

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better without having to have surgery, best answer there is.

 

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But if you can’t get by and you’re, uh, losing strength and

 

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having pain that stops you from being able to sleep at night,

 

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then those are the kinds of things that say that surgery may well

 

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be indicated.

 

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In many states in the country now, maybe all the states in the

 

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country, you no longer need a doctor’s referral to go to

 

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physical therapy. You can find a physical therapy,

 

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um, facility close to you and start there.

 

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You can go there and see a physical therapist and s- kind of start that course

 

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of treatment and see if that relieves, uh, symptoms.

 

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Yeah. So, uh, I have had spectacular physical

 

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therapist colleagues over the years, and I think one of the

 

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important things is almost all physical therapists are really good at, uh,

 

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knees and shoulders. Not all of them focus as much on the spine.

 

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Mm.

 

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So if you’re calling around, uh, you wanna

 

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say, “Do you do a lot of spine care at

 

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this physical therapy place?”

 

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Because if they give you a sheet and say, “Go in the corner and do these

 

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exercises,” that’s not what you need at the start.

 

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What you need is someone who will work with you, figure out what’s going

 

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on, start you on a treatment plan, and then see how you

 

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respond to it. And that’s very, very hands-on and

 

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time-intensive for the physical therapist to actually do that.

 

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Don’t be shy to ask about the, uh, experience

 

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that your provider has with your particular, um, you know,

 

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pain or, or symptoms. I think that’s a really good point.

 

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You wanna go to somebody who routinely treats neck and shoulder

 

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problems if, if you’re having a neck or shoulder problem.

 

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I like to tell my patients in the past that when you call up and

 

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say to the front desk people, “Do you do a lot of spine care?” And

 

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if they say, “Oh, yeah, we do that all the time,” you’re probably in the right

 

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place. If they say, “Yeah, we, we know how to do that,”

 

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maybe you wanna call another place.

 

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Sometimes experts will tell us that, um, you’ve gotta give it a couple

 

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of weeks and if you’re not seeing any progress

 

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after two or three weeks of really doing the, the treatment,

 

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then maybe that’s the time to think about changing course.

 

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Is that, is that right?

 

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If what you’re doing isn’t making a difference, then you need to

 

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think about doing something else.

 

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Right. And how long should you give that?

 

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Yeah. So that’s variable person to person.

 

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Mm-hmm.

 

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Uh, and that

 

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i- it’s not uncommon over my career that I had,

 

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um, surgeon colleagues come to me and say, “I have a

 

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severe radiculopathy with burning pain.” And I said, “Well, you know, most of the

 

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time that gets better in six weeks.” And they would say, “What are you doing

 

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Monday? Can you fix me on Monday?” (laughs)

 

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(laughs)

 

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So, so that’s a, a common scenario.

 

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And so the issue of being tolerant

 

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of pain and giving nature a course to allow things to get

 

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better is one of the hardest things that we ask people to do.

 

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If you’re having progressive weakness, that is a sign

 

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that we need to escalate, um, the level of care and

 

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potentially move on to a surgical intervention.

 

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You’re a spine surgeon, so you know a lot about, um, what

 

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kinds of symptoms, um, are indicating a problem

 

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in your neck, and you knew that as a young person you had

 

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had an injury from wrestling while you were at West Point.

 

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Um, so then many, many years later, so many years pass

 

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and you get this radiculopathy and weakness and

 

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numbness and you know, you think to yourself, “This is it.

 

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This is, this is happening.” You got some testing done, you had some

 

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imaging, um, you had some diagnostic tests

 

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done, and then the decision was made, “I’m a

 

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surgical candidate. Surgery will fix this problem.

 

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Now I’ve gotta go have that done.” Tell us about your surgical

 

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experience.

 

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Uh, obviously I came in with a biased perspective of-

 

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(laughs) … having the experience and it was someone who I’d worked with for 15 or 20

 

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years, and I asked for a particular procedure.

 

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In fact, my wife had had a posterior cervical foraminotomy.

 

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My wife is a retired physician as well.

 

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And that worked great for her, and so I was optimistic that maybe that would

 

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do it. Um-… and so I had that done as an outpatient

 

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procedure and it took my pain from a nine out of ten to maybe a four out

 

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of ten, but I wasn’t getting any recovery of my

 

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muscle strength. And there is sometimes

 

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sensitivity to when you lose muscle strength.

 

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The sooner you get it treated, probably the better the recovery will

 

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be, and so after a few weeks of just not

 

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getting any better, we repeated the imaging.

 

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The imaging suggested that the posterior foraminotomy had been done

 

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well, but there was still, uh, residual bone spurring

 

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that can’t be addressed with a foraminotomy.

 

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And both myself and my treating surgeon decided that

 

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e- e- we ought to go ahead with the, uh, anterior cervical discectomy and

 

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fusion. Wh- I would have loved to have had a cervical disc

 

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replacement, uh, but my arthritic change in the

 

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posterior part of the neck, uh, made that probably not a very good

 

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idea.

 

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And that’s- that’s a very interesting, um, topic you’ve touched on

 

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there, the decision between having a disc replacement,

 

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which is a motion-sparring, uh, procedure, versus a

 

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fusion. And that’s a very, um,

 

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important discussion for patients to have with their

 

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surgeon, to understand that that option exists

 

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and when it is or is not the right treatment for

 

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your particular condition. Um, I think many

 

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surgeons are looking at motion preservation as the- as

 

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the default that they want to be able to offer, but if the

 

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conditions within your body don’t allow that to be an option, then you

 

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move to a fusion. And I think it’s a reversal, a little bit, in the

 

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way that we used to be able to think about treating neck conditions.

 

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Could you comment on that?

 

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Well, the cervical disc replacement studies have been pretty

 

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compelling. Uh, it gets people back a little bit faster than a

 

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fusion does, uh, and that in a well-indicated

 

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patient, it h- has good results. Um, but it

 

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needs to be in a well-indicated patient.

 

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Mm-hmm. A well-indicated patient means a patient who has the

 

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right set of conditions in their anatomy.

 

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The- the bones are a- a certain configuration, if you

 

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will.

 

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Yeah, so the most common indication that makes sense is if you

 

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have what’s called a soft disc herniation.

 

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So if you have a disc fragment that’s blown back and putting pressure on the nerve

 

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root, going in and taking out that fragment that’s pressing on the

 

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nerve root and then replacing the disc with a mobile, uh, disc

 

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replacement is a great operation.

 

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If you’ve got a lot of arthritic change, not such a great

 

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strategy.

 

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Yeah. You had two surgeries in your journey.

 

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Do you think that, um, that was

 

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a result of your knowledge as a spine surgeon in

 

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directing your care, or do you think that’s a common thing for

 

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patients to have?

 

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That’s a little bit of a challenging question to answer.

 

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The foraminotomy was reasonably indicated for what I

 

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had, uh, but in any surgical intervention, there’s a

 

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batting average, and the batting average for the cervical

 

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foraminotomy is not as good as it is for an

 

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anterior cervical discectomy. But my hope, uh, was

 

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to try to maintain that motion, and it didn’t work out.

 

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You know, sometimes patients say, “Oh, if you have a surgery, you might have to

 

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have another, and maybe another.” And I- and I think there’s a

 

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lesson in there that that’s okay, that that’s- that’s gonna be

 

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okay.

 

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No surgery is absolutely perfect, and,

 

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um, what surgery does not do is stop the aging process.

 

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And so I like to use the analogy, if your right front car

 

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tire has worn out and you replace it, great.

 

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The right front car tire’s gonna be better.

 

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But that doesn’t stop the left front car tire from wearing out,

 

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and it probably has enough mileage on it if you got all the

 

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tires at the same time that it might wear out too.

 

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And so when the left front tire wears out, you ought to take care of it.

 

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That is a great analogy. I love that.

 

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That’s- that’s such a great metaphor, um, very easy to understand

 

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and think about in that way. Thank you for sharing that.

 

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Um, and then just sort of bringing your- your journey to conclusion,

 

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so, you know, we’ve had an awareness of a problem, got the

 

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right diagnosis, figured out a surgical

 

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correction, and then, um, headed into a

 

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recovery period. And that’s, I think, where, um,

 

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your experience as a patient in understanding some

 

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very basic, simple things that can help you feel better and help you

 

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recover, um, were really just, um, very

 

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enlightening, right, for- for you as a surgeon who

 

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maybe didn’t always experience the recovery side with your patients.

 

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Well, it’s obviously a very personal journey

 

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for everybody, and everybody experiences it a little bit differently.

 

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And how you handle pain is variable.

 

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Um, what is your home support network?

 

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What is your life circumstance? And then, what is

 

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it that your body responds to? And, uh, I had the

 

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advantage of knowing about the anatomy, knowing about

 

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strategies, and we did the usual things and they were

 

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somewhat helpful, but these other

 

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off-the-shelf things were, uh, more helpful than I had

 

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appreciated before, and it’s like, “Okay.”

 

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Ice pack, ice pack.

 

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Ice is your friend. I- I tend to tell my patients 15 minutes on and

 

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15 minutes off. Uh, and one of the things that I also learned

 

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is having two ice packs is helpful, because you melt the first one-

 

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(laughs)

 

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… (laughs) and it takes a while to get it chilled again, so.

 

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Yeah, and those are not expensive things to- to have, so.

 

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Right. Right, and it’s probably less than your insurance copay, so.

 

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(laughs) Dr. Polli, you look

 

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fantastic. You look amazing. I can’t believe what you’ve been

 

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through. Um, how are you feeling now?

 

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I’m about 80 or 90% back. Um, my surgeon

 

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let me go back to the gym at, uh, three months and I didn’t

 

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realize how important that was for my psyche as well as for my

 

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strength.

 

335

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Yeah.

 

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And so that’s been a big part of my recovery too.

 

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Yeah. Are there any things you cannot do any longer?

 

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Are there any activities you’ve been advised not to partake in?

 

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Unintentional inverted aerials on the ski slope.

 

340

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So I had to stop skiing for other reasons-

 

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Yeah. … a number of years ago.

 

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Yeah.

 

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But, um, it’s not stopped me from, uh, things that I was

 

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doing before the problem occurred.

 

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We, we like to say, you know, you get your treatment and you get back to it.

 

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You get back to your life. Um, one of the things that’s inevitable is the

 

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aging process. We can’t reverse aging, but we can help

 

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people live their best lives at whatever age and whatever stage.

 

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And I think that’s the, what I have discovered personally in my own

 

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treatment, is that that is the miracle of modern

 

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spinal surgery and modern spinal care.

 

354

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Um, Dr. Polley, do you have any closing words of wisdom or

 

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closing pearls for our audience?

 

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Figure out exactly the problem, have a good discussion with

 

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your, uh, treatment care team, and then do

 

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the thing that is, seems best to you, move forward,

 

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and, um, deal with things as they come, uh,

 

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and don’t look back.

 

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It has been an absolute honor and delight to be

 

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seated with world-renowned spine surgeon, Dr.

 

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David Polley, who has shared with us so openly and

 

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so honestly his personal spine

 

365

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journey. Um, we’re so honored to be with you today

 

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and we thank you for sharing your story.

 

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Um, it’s, it’s sharing stories of success like this that helps other

 

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people get the hope and knowledge they need to

 

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pursue their own treatment and overcome their own spine

 

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conditions. Thank you for

 

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listening.