There’s a widespread belief that once you reach a certain age, you may have to tolerate a certain amount of back pain. Some orthopedic surgeons are hesitant to operate on octogenarians or nonagenarians.
But Dr. Mark Lyerly isn’t one of them.
The neurosurgeon, who’s done over 6,000 procedures on patients 55 and older and 2,400 procedures on patients 70 years and up, recently returned to the Triad after four years in Martinsburg, West Virginia, and Bangor, Maine. The siren song of grandchildren – he has one grandson and two grandchildren on the way – lured him and his wife back to their old home in Lewisville, North Carolina. Their four sons still live in the area, as do both sets of parents. He joined Novant Health Brain & Spine Surgery - High Point in early June.
"Some doctors say that just because Patient X is 80 years old, they don’t want to operate,” Lyerly said. “But, Patient X might (have the physical fitness) of a 60-year-old. So, age isn’t the best delimiter. I've seen a lot of older people who are busy all day long, and some of them still work. They’ve got good muscle tone. They have well-controlled chronic conditions – maybe a little hypertension – but there's no need for those people to be relegated to pain and less activity if something can be done with a reasonably low risk rate."
Back pain? We can see you same-day or next day.
Risk rate: That’s probably the biggest concern for surgeons when it comes to operating on seniors. Lyerly takes that into account, too.
“It’s not that I’m bold and unafraid to do these surgeries,” he said. “The team and I approach each one cautiously. But we've operated on a lot of people in their 70s, 80s and 90s, and a significant number of those do very well – especially with a smaller surgery.” Most of his procedures are outpatient.
“By the time you hit 80, you might have a lot of issues,” he added. “We don’t need to fix all of them with a huge procedure. We can generally address 80% of the pain with a minimally invasive procedure.”
Lyerly hopes, whenever possible, to eliminate the most pain with the least amount of risk. "Sometimes, people feel pain throughout their back, but it’s originating in a small area – a single level or maybe two levels, such as vertebrae L4 and L5 (situated around your beltline),” he said. All of their spine may look bad, but it's really just one or two levels causing the problem, so we can do a much smaller procedure. If you do [that] and take away 50, 60, 70% of the pain and give them the relief they need, that’s often preferable to a big procedure that’s attempting to fix 90% of their pain."
Lyerly values the security that operating at Novant Health offers: “When you’re operating on older people, you need to be in a hospital that offers all the ancillary services. We take on a lot of responsibility when we perform surgery. If a patient has pneumonia or a heart attack or a stroke or anything else while in our care, we’re in an environment with an extensive support structure. This kind of surgery can’t take place just anywhere. But it can … at Novant Health."
Be alert to the signs of spinal stenosis
Since spinal stenosis is common – and if you’re 65 or older – could you have it? And how would you know?
There are simple indicators that can help seniors determine if they might have the condition. According to Lyerly, you should see a doctor if:
- When you walk around a grocery store, you find your most comfortable position is leaning over your cart.
- Your legs get tired from walking, but when you sit down, they get refreshed pretty quickly.
- You find yourself, when walking, leaning forward at the waist a little and having trouble standing up straight.
Are there things younger people can do to stave off conditions such as stenosis?
Yes, Lyerly said. “Don’t do things that are going to lead to a weakened spine. The biggest one is to quit smoking, (which) keeps (doctors) in business. The nicotine leaches out calcium, which can lead to osteoporosis.”
“There are things you may not be able to control,” he added. “If you’re doing a heavy labor job, that can lead to stenosis, although it’s not a guarantee. If you're laying bricks or using a jackhammer all day long, you're more likely to have some degenerative change that leads to stenosis.”
‘Know your options’
Lyerly said most patients make their way to him after other surgeons tell them they’re not good candidates for surgery.
“I get a lot of referrals from patients who know I operate on people in their 70s and up,” he said. “The vast majority are relieved, hopeful, grateful. They’ve been in pain and are often willing to do anything to alleviate it. Nearly all my patients come with an open mind and want to know what’s available that can make them feel better. They want to know their options and then decide."
Just because Lyerly performs surgery on many seniors doesn’t mean surgery is right for every senior he sees.
“We offer a small procedure that’s likely to help alleviate pain for many people,” he said. “Neuromodulation – a spinal cord stimulator – may be helpful, and patients can have a trial where we – here in our office – put a wire in their back through a needle. They use it for a week, and if they're no better, we just slip the wire out. That’s about as minor a test as you can do. And if it didn't work, it's one more checkbox we use to consider: Should we do a considerable surgery or not?"
‘No reason to suffer’
His motto: “There’s no reason to suffer just because of your age.”
He means it, too. Lyerly has operated on older people who spend most of their time in a wheelchair. While most of the surgeries he performs are outpatient, someone who’s a wheelchair user would need to be admitted to the hospital and have post-op physical therapy in the hospital before going to rehab or back home with skilled-nursing care.
It’s especially gratifying for him to see how surgery changes the lives of those patients. “We’ve had patients who needed a wheelchair full time be able to walk with a cane or a walker after surgery,” he said.
Several years ago, he operated on a man who was a few days shy of his 102nd birthday. “He had spinal stenosis and regained his mobility after surgery,” Lyerly said. Spinal stenosis is a degenerative condition in which the spinal canal narrows and pinches the nerves, resulting in back and leg pain – or numbness and tingling.
“Lumbar spinal stenosis typically results from degenerative changes in the spine associated with aging,” according to JAMA, the Journal of the American Medical Association.
Lumbar spinal stenosis affects about 11% of older adults in the U.S. Studies show that about 20% of adults over 60 show evidence of spinal stenosis on imaging scans, but more than 80% don’t have symptoms and therefore don’t need treatment.
Surgery for spinal stenosis, which involves removing some of the bone, ligament or disk tissue pressing on lumbar nerve roots, is simple and straightforward, Lyerly said. It’s one of the smaller, low-risk surgeries that offers a big return.
But it’s not all he offers: “I’ve done bigger surgeries, including spinal fusions, on people in their 90s.”
After a TV doctor restored someone’s vision, a young Mark Lyerly’s path was set
As a fourth grader in Salisbury, North Carolina, Mark Lyerly saw an episode of “Ben Casey,” in which Casey, a brain surgeon, helped a woman regain her eyesight. His reaction: “I want to do that!”
He didn’t want to be any other kind of doctor. He wanted to be a brain surgeon who helped people regain something they’d lost.
Most kids go through an "I want to be a doctor/nurse” phase, but only a fraction of them pursue it. And Lyerly might not have either – if he hadn’t had Mr. Peck, his science teacher at East Rowan High School, encouraging him.
“I did well in school, but no one in my extended family had gone to college, and I had no idea what happened there, how you got there or anything else,” he said. “My parents, who worked in a mill, were always very supportive. They didn’t push me, nor did they hold me back.”
Mr. Peck took him and several other East Rowan classmates, including Novant Health’s Dr. Ronnie Barrier, to visit UNC Chapel Hill. “Had Mr. Peck not taken a few of us guys under his wing and dragged us up to Chapel Hill for a weekend, I may have wound up in the mill," he said.
Mr. Peck later wrote something in Lyerly’s yearbook that he still remembers: “You’re a true academic.”
It was – and remains – true. Lyerly, who earned his medical degree at Duke University School of Medicine and did his residency at Wake Forest, said, “This stood out to me because he appreciated the fact that I love to learn.”