Spinal cord compression is often missed in seniors. But when a previously active and healthy Janet Kunkle turned up at UCI Medical Center with no feeling from the waist down, doctors considered all possible causes and treatments, including spine surgery.
At age 80, Janet Kunkle still tackled the household chores, even cleaning the rain gutters from atop a tall ladder.
Suddenly, what began as numbness in Kunkle’s toes quickly progressed to the loss of all sensation below her waist. She couldn’t stand let alone walk on her own.
Could being wheelchair-bound and living in a nursing home be far behind, she thought.
Severe spine compression
“I was in trouble and I knew it,” says Kunkle. “I wasn’t fully capable of taking care of myself.”
Dissatisfied with the slow pace of diagnosis at a community hospital, Kunkle and her daughter, Cherie Turner, contacted UCI Medical Center in Orange and were advised to get to the emergency department right away.
They were met by a team of physicians, including UCI Health neurosurgeon and spine specialist Dr. Michael Oh, who quickly determined that a spinal disc had slipped or collapsed, causing a severe compression of the spinal cord, a condition called myelopathy.
Missed in older patients
“They said it was literally crushing her spine,” recalls Turner, adding that immediate surgery was advised.
“I thought ‘immediately’ meant in the near future — because hospitals don’t usually treat anything that urgently. But they really meant immediately, like now.”
Myelopathy is often missed in older patients due to their age and other accompanying health concerns, says Oh, a member of the UCI Health Comprehensive Spine Program.
For example, many seniors with bowel and bladder issues are referred for nutritional counseling or other specialties — leaving the root cause, spinal cord compression, undetected, Oh says.
“Physicians usually don’t approach these types of symptoms in older patients through the lens of either neurosurgery or orthopedics,” Oh says. “But as an academic medical institution, UCI Health is less biased and more open to different possibilities.
“That is one of our many strengths. Whether we’re your first choice or your last hope, we’re here for you no matter your age.”
Surgery to relieve spine pressure
Oh proposed a thoracic laminectomy and transpedicular discectomy. The procedure involves removing a section of the bone over the spinal cord, allowing access to any protruding and damaged nerves in order to alleviate pressure on the spine.
“Even with the best surgery, things can go wrong,” he cautions. “But if you start with the wrong diagnosis, even the best surgery won’t be effective.”
In fact, Kunkle had had spine surgery five years earlier at another hospital.
“They nicked her spinal cord, and she had a cerebral spine fluid leak,” Turner recalls. “It was supposed to be an overnight stay. She ended up in ICU in excruciating pain for over a week.”
Kunkle was understandably worried given her past experience.
“Dr. Oh talked to me before the surgery and explained everything that was going to happen," she says. "He made me feel like I had nothing to worry about.”
At the pre-operative check-in, everyone on Oh's neurosurgical team introduced themselves to Kunkle and her daughter. “It felt more like a social event, which put us all at ease,” Turner recalls.
Oh and his team were also realistic and cautious in explaining what Kunkle could expect, saying that the objective of the surgical procedure was to prevent further damage to her spine.
“They told us they could not guarantee that it would reverse the damage that had already occurred,” Turner says.
After the three-hour procedure, Oh told Turner and other waiting family members that the surgery had gone well and that he had “very high expectations that some of the damage could be reversed.”
Within six weeks after surgery, Kunkle was walking on her own, undergoing follow-up care and physical therapy under the direction of Dr. David Majors and the UCI Health Physical Medicine and Rehabilitation Services team.
“He’s a star, too,” beams Kunkle. “And so is his staff. I can walk. I can feel my legs. I can feel my abdomen. That’s major.”
She was able to recover comfortably in her Santa Ana residence of more than 40 years — not in a nursing home as she had feared. She’s able to garden, shop with her daughter and generally enjoy life.
She does, however, leave the rain gutter cleaning and ladder-climbing to others.
“I truly believe everyone here at UCI saved my life,” she says. “They gave me back my life.”