Standing tall

SPONSORED: Reconstructing the spine through robotic surgery

It happened in an instant. Ray Urrea was in the walk-in cooler of the restaurant he managed when he went to pick up a box of lettuce. As he twisted his body in the tight space to lift the heavy package something happened in his spine that would go on to define the next 13 years of his life.

The injury required a fusion of a few of his vertebras. As time wore on, the neighboring vertebras weakened and also needed to be fused together. In the years that followed, he had so many surgeries he lost count — “I think six or seven,” Urrea said — his posture became severely pitched forward, to the point that he was perpetually imbalanced, and he was in constant, agonizing pain.

“My doctors tried everything under the sun, but nothing really helped,” Urrea said.

Urrea’s story isn’t unique: Dana DeBernardi runs Moose Mama’s, a moose calf rehabilitation nonprofit organization, and also experienced a series of tears, herniations and bulges in her spinal area after years of lifting plywood and orphaned calves. She too had had back pain for years and a prior surgery that didn’t offer the relief she needed.

“I was in so much pain that if someone told me kicking a wall for an hour would help, I would have done it,” DeBernardi said. “I was so desperate.”

Both found a solution in Dr. David Paulson at Innovative Neurosurgery Associates.

A GPS for spine surgery

Dr. Paulson specializes in complex deformity correction — treating patients who have been operated on multiple times, but who haven’t seen relief.

“It’s an opportunity to problem solve and try to understand exactly why someone has reached the point that they have,” Dr. Paulson said. “I’m trying to arrest that continued progression downward and find somewhere that’s better than where they have been.”

Usually, that means treating the patient as a whole, not just the one problem they’re in for.

Often, Dr. Paulson said, surgeons will focus on a discrete issue. For example, if a patient comes in with a herniation, that solitary problem is treated. When that same patient comes back with increased back pain, which can happen after surgery, the surgeon offers a spinal fusion. While the spinal fusion addresses the problem, it can make the spine straighter than before. The new positioning alters the biomechanics of the body and causes the patient to lean forward slightly, making their spine more prone to wearing out. Dr. Paulson, on the other hand, tries to evaluate the whole spine and see where improvements can be made overall. His passion is reconstruction.

Dr. Paulson uses a spine robot and the O-arm for reconstructive surgeries, a tool that, in Anchorage, only Alaska Regional Hospital has access to.

Think of the O-arm as a GPS for spine surgery, Dr. Paulson said. Surgeons can use the O-arm and the spine robot to navigate the placement of screws and put them in the right location, as well as take an image similar to a CT scan in the middle of the operating room to confirm that all screws and hardware are in the ideal spot.

“It allows you to place screws with a high degree of reliability,” Dr. Paulson said. “Which lets you maximize the screw length and diameter so you can improve outcomes with better fusions.”

The technology allows Dr. Paulson to step back and rework a spine that’s been operated on previously, and address the overall solution rather than the immediate fix.

“[Urrea] was a classic example of somebody who has been operated on again and again with worse results each time,” Paulson said. He decided the best option wasn’t to fuse more vertabes, but rather to separate them to put a curve back into Urrea’s spine. In doing so, it would draw Urrea’s head back into the position it should be, where his ears are over his shoulders which are over his hips.

Arriving at relief

For the first time in 13 years, Urrea’s pain diminished.

“The injury had adversely affected my whole life,” Urrea said. “I was always trying to hold my pain and it showed up on my face. My staff always thought I was mad at them. But now, after [the reconstructive surgery], I don’t have that problem. I have peace.”

Meanwhile, on August 12, 2021, DeBernardi underwent her reconstructive surgery with Dr. Paulson.

“I was really sad, because I had to rely on so many other people to help [with my nonprofit],” DeBernardi said. “But Dr. Paulson got me to the point that I was able to run the program again. I was able to release two moose back into the wild.”

Having such a fast recovery time was particularly good for DeBernardi, as autumn is when her organization releases the rescued moose calves back into the wild.

“He really took his time to pinpoint what was wrong with me and took the time to explain it to me ahead of the surgery,” DeBernardi said. “By the end of September, you couldn’t even tell I had surgery. I can bend over and touch my toes now!”

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with the Sponsor. The ADN newsroom was not involved in its production.