For one very active patient with debilitating back pain, artificial disk replacement by Yale Medicine physicians changed her life.
Some people might consider lugging around 25-pound bags of mulch the worst sort of punishment—but not Danette Guay. The 49-year-old Middletown resident says that the day she spent last spring spreading mulch in her garden was a joy, and she was grateful she could do it.
Guay is relieved that she has regained the ability to do hard physical work. She had spent decades suffering from back pain that made tasks such as gardening and carrying heavy objects impossible. A lively and vibrant woman who enjoys kayaking, cross-country skiing and playing golf, Guay describes the back pain she had lived with since her 20s as “excruciating.”
Her episodes of back pain were frequent, agonizing and unpredictable. After exertion or, at times, after no apparent provocation, she’d be suddenly laid out and unable to move without suffering. When her back “went out,” as Guay puts it, “it would throw everything out of alignment.”
Staying pain-free wasn’t a simple matter of avoiding specific activities, either. “Something as basic as going out of town and sleeping on a strange mattress could ruin a vacation,” she says. “I pushed through it and forced myself to do things anyway—but there were always consequences.” The after-effects of a back pain episode lingered for weeks, sometimes even months.
Not entirely sure what caused her injury, Guay suspects she must have done something to her spine during the years she studied martial arts in her younger years. Eventually, she says: “I was diagnosed with L4 and L5 disk degeneration with a slight protrusion. The vertebral bodies were almost bone on bone.”
Living with ‘constant fear’
Guay was determined to power through the pain and live the way she wanted to. But one day she realized that anxiety over her condition was dominating her life. Fearing the consequences of her activities, she’d started to make decisions about what she could and couldn’t do based on avoiding pain. “The problem wasn’t that I was in constant pain,” Guay says. “More like I was living with constant fear of pain.”
The medical diagnosis for Guay’s problem is degenerative disk disease. Disks are pillow-like layers of collagen fibers, which are meant to serve as shock absorbers between vertebrae. Without the disks to provide cushion, some movements produce agonizing pain.
The go-to treatment for this problem has long been spinal fusion, a surgical procedure using a bone graft to essentially “weld together” several disks. "For some patients, spinal fusion is necessary and remains an effective treatment, says Peter G. Whang, MD, an orthopaedic surgeon with the Yale Medicine's Department of Orthopaedics & Rehabilitation, and a specialist in back pain. “But there are some downsides to it, including limited motion.”
For patients who are appropriate candidates and who want to stay active, such as Guay, artificial disk replacement can be a highly effective treatment. During the surgery, the worn and damaged disk is removed and replaced by an artificial one, typically made of metal and plastic, that is designed to move naturally with the spine. A key advantage over spinal fusion is that full range of motion is restored, allowing the patient to once again enjoy activities that had been impossible because of back pain.
To learn more about treatment options for back pain and patient care locations, click here.
Choosing replacement over repair
Guay first heard about artificial disk replacement more than a decade ago from the orthopaedic surgeon she was then seeing. “He told me he thought this might help me,” she says. But the procedure was new, and she decided against it.
As time went by and her condition worsened, Guay found herself returning to the idea. Disk replacement seemed her best option for returning to the active life she wanted.
Guay found her way to Dr. Whang and says she felt an immediate connection. “He’s young and dynamic and he does a lot of these procedures,” she says. “I immediately felt very confident in him.”
Guay is a prime example of the type of person who can benefit from disk replacement surgery. “She is young and active, and it’s important to her that she stays active," Dr. Whang says.
It was also important that Guay’s overall health was good and she had no other back problems. Guay and Dr. Whang felt confident that the procedure would be a success.
Guay’s disk replacement surgery was performed on Sept. 29, 2014. “I was in the hospital for four days, and I have to admit, the pain immediately afterward and for several days following was excruciating,” she says. Disk replacement patients are encouraged to move and walk right from the start, and though it hurt to do so, she found this activity helped a lot.
“Within a few days of getting home, I was able to go outside for walks,” says Guay, who took a six-week medical leave of absence. “I felt fragile at first, but I was actually walking three and a half miles toward the end of my medical leave and any pain I had left was from the incision scar, not my back,” she says. “My back pain was gone very soon after the surgery.”
‘Like a normal person’
Guay’s recovery included four and a half months of physical therapy, mostly focused on core strengthening exercises. “I still do a lot of them,” she says. “You’re told that full recovery will take six months after you finish physical therapy, but that winter I was cross-country skiing with no problems. I got the green light to go ahead and do whatever I felt I could do. I’d say I was totally recovered nine months after the surgery.”
Now nearly two years after her operation at Yale New Haven Hospital, Guay feels like a “new person with a new back.” “My back hasn’t gone out once since the surgery,” she says, noting that in terms of sports and activities (such as hauling bags of mulch), she has no limitations.
“Dr. Whang has always told me that if I do something that bothers me, I should listen to my back and stop,” Guay says. “There have been a couple of instances when I’ve pushed hard at the gym and come home and felt a little bit achy—but it’s not a back problem."
Dr. Whang emphasizes that artificial disk replacement is not an optimal treatment for every patient with back pain.
“If you have arthritis from stem to stern, disc replacement is not the right approach,” he says. “We can only treat one level of adjoining disks this way, and some patients have pain at several levels. Ms. Guay’s pain was isolated on one level, the rest of her back is healthy and she is young and active. So, for her, this is the ideal treatment.”
Because her procedure was so successful, Guay says she has become an advocate for artificial disk replacement. “It changed my life. Every day that I do something I couldn’t do previously, where my back doesn’t even enter into the equation, I find myself saying: ‘Wow! This is amazing!’”