Spondyloptosis is an uncommon condition, which means not many surgeons have experience in treating it. Lou Keppler, M.D., co-director the Spine and Orthopedic Institute at St. Vincent Charity Medical Center, is one of few surgeons who have experience performing the procedure done to treat the condition. Dr. Keppler trained under the surgeon who pioneered a procedure to treat spondyloptosis. He performed the complicated Gaines procedure on a Cleveland-area woman, who has since made a strong recovery.
An article about the surgery ran in the hospital’s online monthly newsletter. Below is the full text of the article.
She Thought She Would be in Pain Forever. But Her Doctor Didn’t See it that Way.
Angela Wyatt of Gates Mills never thought years of cheerleading, tumbling and tackling could become crippling in her later years, until she developed an uncommon condition called spondyloptosis.
“It was getting progressively worse. I had numbness in my feet,” she said.
After trips to many surgeons, she was referred by her neurologist to Dr. James Anderson, a neurosurgeon with the Spine and Orthopedic Institute at St. Vincent Charity Medical Center.
Dr. Anderson suspected she had cracked her L-5 vertebra on both sides as a teenager. Now 47, the West Geauga teacher’s vertebra slid off the sacrum. The slip was pinching the nerves in her bowel and bladder.
Her condition called for unique expertise, so Dr. Anderson turned to his colleague Dr. Lou Keppler, who is the co-director of The Spine and Orthopedic Institute. The Gaines procedure is a difficult surgery and not many people have performed it because it has a high complication rate and involves a sacrum pelvic fusion. “It is rare, but I have experience with this procedure,” said Dr. Keppler.
“The procedure, which lasted more than 10 hours, involves an anterior (front) and posterior (back) approach. We take the L-5 out from the front and put the L-4 back on the sacrum from the back,” he said. Using screws and rods, they were able to pull her back into alignment.
The first surgeon to do this procedure was Dr. Art Steffee in 1986. He was a surgeon at St. Vincent Charity and made his name as the inventor of the pedicle screw for spine surgery. Dr. Keppler trained under Dr. Steffee. “We used to put people in body casts and they would have to be in bed for months,” he said. “Once he developed the pedicle screw, we became able to fuse the spine into a more stable state.”
Though it was a long surgery, going well into the evening, Dr. Keppler was happy with result. “Because we rearranged the nerves, her foot was weak for a while. Her muscles need to find new alignment and her bone will take about a year to solidify. She will gradually build up her endurance, but once it’s healed, it’s healed for good.”
It was a year in March and Wyatt is feeling strong again. She is grateful for the attention both she and her family received from St. Vincent Charity. “Dr. (John) Bastulli (anesthesiologist) talked to my family and was there all night. Once Dr. Keppler was in there, he was able to straighten my spine better than it ever was before.”
While she was expected to stay in the hospital 10 days, Wyatt credits Ernestine Javorik, physical therapist, with getting her out in six days. “Ernestine is the reason. She got me up and moving. I firmly believe that if she had not been there, I would have been in the hospital for weeks.”
As for Dr. Keppler, he has never been one to shy away from a difficult surgical case. He will routinely go over and over an operation in his head prior to surgery. “It’s not fair to the patient to say you can’t help them. You’re obliged to help, even if it’s a tough case. You’re in it together, as a patient and a surgeon. If it’s what the patient needs you do it,” he said.
St. Vincent Charity Medical Center is a ministry of the Sisters of Charity Health System.