01 Nov 2011
By Valerie Lee
Lynette Koh’s moment of truth came one day when she was on holiday with her family. “We were sightseeing and I told them to go ahead and I sat it out because of my pain. When I looked at them walking away I felt pretty miserable. It felt like I wasn’t part of the family.”
Ms Koh was diagnosed with degeneration in her spinal discs one year before a holiday with her extended family, including her parents, nephews and two teenage children. She had been grappling with her fear of spinal surgery even after several consultations with doctors and friends had put her in touch with Singapore General Hospital orthopaedic surgeon Associate Professor Yue Wai Mun, a pioneer in minimally invasive spine surgery.
Like most people, and as the condition wasn’t life-threatening, Ms Koh had postponed having to decide whether to go ahead with surgery or not - for almost a year. Instead, she sought out alternative, ”non-invasive” ways of dealing with her pain, signing up for physiotherapy and massages.
But the annual family holiday was literally the last straw that broke the camel’s back. “After that incident when I felt all alone, sitting there and looking at the family, I went to see Dr. Yue and asked him for his earliest available slot, which was in two months,” Ms Koh said. “I thought: I am only in my 40s, I don’t want to be living my life like that!”
She did not regret that decision. “(The surgery) was like a miracle. It was the best decision I had ever made and gave me my life back.”
The head of regional marketing based in Singapore for a US listed company, Ms Koh was one of the many patients who had gained from Assoc Prof Yue’s skills in the use of minimally invasive (MIS) or keyhole surgical techniques for dealing with conditions of the spine or in medical terms, minimally invasive transforaminal lumbar interbody fusion (TLIF).
She is testament to the findings that Assoc Prof Yue has published in an award-winning study on the MIS method, comparing it with the more traditional open surgery methods. His findings were that MIS, being less invasive, cuts down on recovery time as well as pain and blood loss, making the immediate benefits of that procedure superior to open TLIF.
Spinal fusion surgery, using either method, is a procedure where two or more vertebrae are “welded” together to prevent the abnormal movement that is causing pain.
“Outcome scores for the MIS method are as good. The fusion rates are just as high but the benefit is in the early phase of recovery and that, to many patients is already very significant,” Dr Yue said.
“Patients go back to work faster, pain medication is less and there is 10 times less blood loss. If the patients are young, they can get back to work earlier, and for old patients, they are able to tolerate the surgery better.
“I have operated on patients who are 83 and 86 years of age. In the past, even if the spine condition merits the surgery you may not do it as the attempt could possibly kill your patient. With MIS there is less of an assault to the patient’s body.”
But Dr Yue hastened to add that while MIS has increasingly been advertised by medical institutions in Singapore and elsewhere, it is only with continued practice at the procedure that a surgeon can say he is comfortable handling it with any patient in need of it.
“My guesstimate is that it takes around 40 to 50 patients to get really good,” he said adding that the surgery requires new surgical techniques, instruments and a steep learning curve. He has operated on over 300 patients in the course of the last six years.
‘I belong to the first generation of MIS surgeons. We were the guys who were exploring how to do, how to execute this kind of surgery. It took me a while but I developed a way to do it safely and reproducibly, so I teach others how to do it this way.
“It was not like there was one great guru master who taught everyone. Someone came up with the instrument and then various places started exploring how to do it. I stuck with it, although initially I had some difficulties and kept at it.”
And as his patient, Ms Koh is glad that he did. “The procedure was excellent. I stayed three days in hospital after the surgery but felt very independent, very well. I could go to the bathroom by myself.” After a month of physiotherapy, which she reinforced by “diligently doing home exercises”, Lynette moved back home from her mother’s home where she was staying and has never looked back since.
She has resumed cycling, brisk walking on the treadmill, travelling, work and more importantly, going on annual holidays with her family. “I am 100 per cent myself,” she declared.
Click here for JPEG format Pg 1 & Pg 2
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