Genomic Prognosis

Genomic Spine Disorders
What Does The Future Hold
For A Patient?

For the most part a patient determines their future prognosis by their own willingness to commit to a spine health program. Number one on the list is not smoking. Number two is devotion to a daily self-administered health program of exercise, traction, good nutrition and the avoidance of repetitive injury. There are professional athletes out there with genomic spine disorders. In all fairness they devote a significant part of their day to health maintenance.

Meet Douglas Libby, as shown above he (and his family) have a classic example of the genomic spine disorder, juvenile discogenic disease (JDD). In 1983 Mr. Libby became neurologically impaired and required surgical decompression. He then did well until 1993 when he again became neurologically impaired and once again did well following additional surgical decompression. In 2006 he redeveloped lateral spinal stenosis at L5-S1 on the right and, once again, did well with surgical decompression. The point of this is that with the right type of surgery, which allowed this patient to continue to have MRI studies in order to make a specific diagnosis he has had an active life for almost 25 years. Mr. Libby is a non-smoker and has been diligent in maintaining good back health.

The patient to the left also has JDD. In addition to surgical decompression a posterior intervertebral titanium cage (green dot over cage shadow) was placed for the purpose of flexible stabilization at the time of surgery. In addition posterior free fat grafts (blue dot) , which have

now become normal fat, were placed at the end of the procedure to decrease postsurgical scarring and allow for future surgical decompression and decrease the risk of nerve injury. Note that the amount of metallic artifact is minimal allowing a satisfactory imaging study. If the back looks like a "junkyard" on imaging it is very difficult to know where the salvage surgery needs to be.

Shown here is a case involving a world class athlete with an underlying genomic spine disorder. Because of this he was at a higher risk for disc herniation and experienced a very large single fragment non-contained herniation. He has continued to be a successful world class athlete.

The Bottom Line

When one considers all of the potential birth liabilities that exist, having a genomic spine disorder really isn't so bad if you pick it up early, don't smoke, and start making deposits in your "spine savings account" on a regular basis. If you are a professional athlete one needs to make a greater investment in the rehabilitation process.

The next important consideration is the prudent avoidance of surgery that will create more problems than it will solve. Multi-level rigid instrumented fusions in individuals with genomic spine disorders provide only transient relief of back pain(a not very good reason to have back surgery in the first place). When progressive neurologic impairment produces the legitimate need for surgical intervention this must be appropriate to the problem and not prevent the patient having good imaging studies in the future.