"I turned," says Brian Ganton Jr., "and immediately knew I shouldn't have."
The 51-year-old advertising executive and North Caldwell resident has been working out for a long time. He knows how to lift weights safely. So when he got distracted in the middle of a lift during a workout last December and felt something snap in his back "like a rubber band," he realized right away that something was wrong.
"There was no pain," he recalls, "but I said to myself, 'Uh-oh!' The pain soon arrived, and within a week it grew more and more acute, spreading, along with numbness, from his lower back to his left hip and from thigh to knee. Ganton went to see a pain management specialist, who prescribed an ever-escalating series of pain relievers that included oral steroids, steroid injections and finally strong narcotics. "They didn't do anything," he says.
In late January, however, he got a referral for his problem from an unlikely physician, his ophthalmologist. Ganton has glaucoma, and at a regular checkup his eye doctor, Michael Harris, M.D., took one look at him and asked what happened.
"The pain was written all over my face," Ganton says. "He told me he had once injured his back and required surgery and knew just the guy for me." That guy was Joseph Koziol, M.D., a neurosurgeon at Saint Barnabas Medical Center.
"When Mr. Ganton came to see me, he was in so much pain he couldn't sit," says Dr. Koziol. "He almost had to lie down." a magnetic resonance imaging (MRI) scan revealed the problem, a far-lateral herniation of the disk between the lumbar 2 and lumbar 3 vertebrae of his spine. This type of disk herniation, in which the disk slips out beyond the canal, is rare, accounting for no more than 10 percent of all disk herniation, he says. "The more common herniation is within the spinal canal, more centrally."
Far-lateral herniation can be especially painful. "If the disk stays within the canal, the nerve can move out of the way," says the doctor. "Here, the disk pushes the nerve into bone. It can't get out of the way." Ganton's disk hernia "was pretty dramatic," Dr. Koziol says. "He also had an artery wrapped around the nerve like a noose, preventing it from moving."
The only option was surgery. "We needed to remove everything that had come out of position and then go into the disk space and remove whatever was loose, so that it wouldn't come out later," Dr. Koziol says.
Thanks to an opening in his schedule, Dr. Koziol was able to perform surgery on Ganton the next day. "At this point he was on narcotics but was not feeling better, so there was no point in waiting," he explains.
Back surgery, like many other procedures these days, is much less invasive than it used to be. Dr. Koziol makes a small, two-inch incision in the side and slips his surgical instruments between muscle fibers, rather than actually cutting the muscle, until he reaches the site and "teases out" the disk fragment. In Ganton's case, a microscope revealed the offended nerve. "It was red and angry," he says. "The nerve root is right there, and it is very sensitive. It takes a while to recover."
When he woke up from surgery, Ganton discovered that his pain was almost completely gone. "The change was incredible," he says. He went home the next day. There was still some residual discomfort, which he managed with pain medication and muscle relaxants. "I had trouble sitting for a long time," he says. He worked out of a home office for the next week while recuperating with his wife, Joan, and their children, Sarah, 21, and Daniel, 18. He then spent more and more time at work. He also started physical therapy to regain his strength and flexibility.
As of mid-May he still felt some numbness in his thigh. "I'm told that should improve, but it may never come back because the damage to the nerve was so severe," Ganton says. He is back to most normal activities, though he has altered his exercise regimen to ensure spine-neutral positioning in which his back stays straight at all times. "I do planks now instead of crunches," he says. He also has added cycling, walking and elliptical training to his routine to reduce the frequency and impact of running.
Though he attributes his back problems—he has had other, far less severe back issues in the past—to a lifetime of aggressive physical activity, Ganton reports that "Dr. Koziol said I could have done this same thing reaching to the back seat of the car." He plans to keep working out, but from now on he'll pay closer attention to his form.