Spine reconstruction restored his life

Spine surgery strikes fear in many people, especially as they get older. But Dominick Maggio, 73, who has had seven spine surgeries in the last 14 years, has a different story to tell.

After his sixth surgery in 2022, Maggio thought he was done. His ability to walk was restored and he was free of chronic pain. But by early 2024, he was walking hunched over again. Getting around became progressively more difficult and soon he couldn’t stand for long because his legs were so weak.

Many X-rays and MRIs later, Maggio sought out the head spine surgeon at a prestigious institution who told him he did not have a problem with the implants used in his previous fusion surgeries and there was nothing more to be done.

Feeling hopeless, he talked with his community pain management doctor who suggested that he see Dr. Nitin N. Bhatia, chief of spine surgery at UCI Health.

Looking at his X-rays, Bhatia immediately identified a loose screw securing the first sacral (S1) vertebrae at the base of his spine and a snapped stabilizing rod. Because of Maggio’s many previous surgeries, Bhatia referred him to UCI Health orthopaedic surgeon Dr. Sohaib Z. Hashmi, who specializes in complex revision and reconstructive spine surgery.

“Dom’s experience is not uncommon, being told by certain surgeons that they’ll just have to live like this,” says Hashmi. “That’s just not true. My entire clinical practice is revision surgery — 90% of my patients have had one, 15 or even 20 previous surgeries. They do not have to accept that standard.”

A history of back pain

Maggio’s spine issues began at age 59 with a neck fusion to correct a pinched nerve. The cause was diagnosed as severe spinal stenosis, a narrowing of the spinal column that put pressure on his nerves.

Next came surgery on three vertebrae in his lower back (lumbar or L3, 4 and 5) then another for his L2. A few years later, he had surgery to fix a loose screw at L2, then a surgery spanning the lowest thoracic vertebra (T10) in his upper back to the S1. Later, he needed a repair of the S1 vertebra and additional surgery on his T4 vertebra.

After so many surgeries and the amount of metal in his back, his family affectionately dubbed him the “Tin Man” and even gave him an oil can for Christmas one year.

“By the time Dom came to see me, he only had eight remaining segments of his spine that were mobile, and that was basically his neck and his upper back. The majority of his thoracic and all of his lumbar spine was totally fused, about 13 bones in total,” says Hashmi, who also is the director of spine trauma at UCI Health.

Along with the stenosis, Maggio had adult degenerative scoliosis which is a sideways spinal curve that develops due to age-related wear and tear, disc collapse and osteoarthritis.

“It was a complicated case, but I knew we could help him.”

Rebuilding a spine

The complexity of Maggio’s condition required Hashmi to assemble a team of experts in plastic surgery, interventional radiology and anesthesiology to strategize and plan his surgery.

“It gave me such hope to hear that something could be done for me,” says Maggio, who works as a business consultant in Huntington Beach. “I also liked that Dr. Hashmi brought in a team of specialists and developed a plan tailored just for me.”

Hashmi ordered a CT scan contrast study to better understand how many of the Maggio’s symptoms were related to potentially broken hardware or pinched nerves after previous surgeries.

“Because so much of Dom’s spine had been fused, we needed to take out all the previous hardware, undo the previous fusions, basically deconstruct and reshape the spine by performing a three-column osteotomy,” he says.

Intricate planning

The team spent weeks planning every aspect of Maggio’s reconstructive surgery, even bringing in software engineers to consult and custom-design spinal rod hardware for him.

“We needed to understand how many degrees of correction to make in part of the spine, how much to resect for proper alignment and where to place the new hardware,” says Hashmi.

“There are five basic spine shapes, and we analyze each patient to determine their ideal S-shaped curve based on their anatomy and pelvic tilt. Using artificial intelligence to analyze 25 unique angles, we can map a patient's original anatomy and fabricate new rods and hardware specifically for them.”

Such advanced planning and analysis using the latest technology is rare, time-consuming and usually only available at academic health systems like UCI Health.

"All patients deserve the highest level of spine-specific planning. It’s the most important part of spine surgery,” says Hashmi. “My team and I are committed to offering our patients the most durable spine treatment." 

Surgery success

Maggio’s surgery was on July 31, 2024. To calm his nerves, he focused on thoughts of his life improving so that he could continue to have adventures with his wife, Kathi, and enjoy their nine children and eight grandchildren.

Hashmi and his team deconstructed and rebuilt Maggio’s spine in 14 hours. An integral member of the team, UCI Health plastic surgeon Dr. Eric D. Wang, spent the final 90 minutes meticulously performing a multilayer closure.

“Reconstructive techniques create tension-free layers that better protect deep bone grafts and hardware from the skin surface,” says Wang. “They also can reduce the risk of wound complications, eliminate dead space where fluid can collect around the hardware and help improve blood supply.”

For Maggio, not only was the reconstruction successful, “having a plastic surgeon handle the closing ensured that all layers joined up perfectly. That was a wonderful surprise!”

Rehabilitation takes time

Hashmi warned him it could take six months to a year to get back to normal and that the nerves in his legs were “going to go nuts” for a while,” Maggio recalls.

After six months of serious physical therapy and pain medications, little by little, the strength in his legs returned. Eventually, he was walking completely upright and pain free.

“In some ways, the easy part is having the surgery done and finished,” Hashmi says. “Then our patients must re-engage all those muscles to feel like themselves again. Dom understood the goals and achieved all those milestones.”

New lease on life

Maggio marvels that two years after surgery he walks normally.

“I’m able to enjoy life with my amazing wife, wonderful children and beautiful grandchildren. I even walked seven miles without a cane, walker or cart at Universal Studios. And I walk at least a mile a day and ride a recumbent bike for 20 minutes.”

Each patient’s experience is unique, says Hashmi. “But that’s what is so interesting about our spine innovations — we can now customize each person’s treatment for their best possible outcome.”

Maggio agrees. “From Dr. Bhatia’s expert diagnosis to the intricate surgery that Drs. Hashmi and Wang planned and performed — I have the highest recommendation for the care afforded me at UCI Health.”

Call 714-456-3300 or schedule an appointment online with one of our specialists at the UCI Health Comprehensive Spine Center.

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