He survived ejection from an F4 Phantom jet over the Pacific and, later, wars in Kosovo, Afghanistan and Iraq, but Gen. James Amos was no match for the pain that followed a fall down a steep flight of stairs and open-back surgery.
“It was all I could do to even get into the car to get to the Pentagon,” said Amos, a retired four-star general who served as commandant of the U.S. Marine Corps from 2010 to 2014. Amos joined the Novant Health board of trustees in January. "I wasn't sure I'd ever be normal again.”
Military doctors surgically repaired a bulging disk in his back in 2012, but recovering from the surgery was harder than Amos expected. And after he retired, his pain returned, radiating from his lower back to his left leg. Last fall, things got even worse. Repairing the dock at his lakefront home in Charlotte, Amos gave a stubborn board a hard jerk with his pry bar. His back popped.
The pain was incredible. Amos had trouble simply walking, let alone working in the yard or on projects, like the dock. He hobbled into one doctor’s appointment leaning heavily on his wife, Bonnie, because that was the only way he could get around.
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He landed in the office of Novant Health neurosurgeon, Dr. Adam Back, who explained that with minimally invasive spine surgery, a team could straighten a curve (scoliosis) in Amos' spine and replace the deteriorated disks that were causing his pain without performing open-back surgery, which Amos had been through before.
This new approach relies on smaller incisions, minimizing damage to nearby muscle so there are fewer side effects and less pain, which means a shorter hospital stay and a speedier recovery.
The 71-year-old general's case is a textbook example.
Amos’ surgery, on Oct. 12, was over in about three hours, and he was up and walking by suppertime. Three days later, he was home with Bonnie, his wife of 47 years. At the six-month mark, Amos' prognosis is, as a Marine might say, “outstanding.”
“His leg pain was gone almost immediately after surgery,” said Back, whose team included orthopedic surgeon Dr. Anthony Kwon. “His back pain is essentially zero. He's doing extremely well.”
Back, who also does traditional open spine surgeries, is one of a handful of Charlotte-area specialists who perform minimally invasive back surgeries. So far, he's done about 800, including those during his residency at Duke University Medical Center in Durham, North Carolina.
Most patients are unaware minimally invasive back surgery may be an option for them, Back said, but demand is likely to grow as the population ages, old backs wear out, and more people learn about it. But it’s not for everyone with a bad back. Patients with severe or complex problems are probably not good candidates.
Amos’ surgery had two goals: treating his degenerative disc disease and correcting the deformity in his spine.
In traditional surgery, a doctor would make a 5- to 6-inch-long incision down the patient's back, move major muscles out of the way and make repairs.
Amos' team, however, worked through five small openings on his side and back, with microscopes and real-time X-ray images guiding their work.
First, they made a 2-inch incision on his right side. Through it, they inserted a skinny tube called a retractor.
Through this pathway, they cleared away remnants of three disks in his lower back so deteriorated that Amos' vertebrae were grinding together, squeezing key nerves. One by one, they replaced those disks with synthetic ones (“a little smaller than a hockey puck,” Amos said).
Then, with Amos lying face-down, surgeons got to work on his scoliosis.
Watching their work on the X-ray screen, they placed eight titanium screws into bony projections along Amos' spine called pedicles. Then, using a removable guide, they positioned a pair of titanium rods and locked them into place, straightening the general's crooked spine.
“The rods don't hinder me at all. I don't even feel them,” Amos’ marveled. “The physical therapy team has done wonders in restoring my body's nimbleness and flexibility.”
Doctors lifted limits on his activity eight weeks after surgery. But Amos is careful. He particularly avoids heavy lifting, mindful that it will take about a year for his implants to fuse with the bones around them, completing what should be a permanent fix.
Soon after, he plans to celebrate by strapping on his skis and heading to the slopes.
He’s already resumed much of the active life he loves, working out daily on the treadmill, elliptical and bike in his home gym, playing golf, tending his yard and casting for fish on Lake Wylie.
“The degree of difficulty and the danger with this surgery compared to the first was tenfold, but the recovery has been a walk in the park,” Amos said. “I have had zero pain associated with this surgery other than the normal discomfort of incisions healing.”