Car crash survivor avoids paralysis after less invasive spine surgery

A demand for training in spine endoscopy is rising in the United States

5:00 AM

Author | Noah Fromson

daughter and dad smiling and selfie in bed
Moore and his daughter on Christmas 2022 (left) and Moore in the hospital (right). Photos courtesy of Ralph Moore

After surviving a rollover crash due to an intoxicated driver in August 2022, a Michigan landscaper avoided paralysis – and a long, costly recovery – thanks to a minimally invasive spine surgery that is gaining popularity.

The car came from several lanes over. Ralph Moore, 42, remembers sticking out his arm to shield his wife before they spun out and flipped.

Allison Moore only suffered minor injuries, some whiplash and seatbelt bruising. But in the center of US-10 near Ludington, Mich., Ralph Moore felt numbness on the left side of his body. A disc that protects his thoracic spine had ruptured and entered his spinal canal.

“I couldn’t feel my leg and would fall when I tried to walk,” said Moore, who has owned a landscaping company in Hart, Mich., for 18 years. “Any time of the day, the pressure on my spine caused me to lose all power and feeling in my left side.”

SEE ALSO: For kids with severe scoliosis, growth-friendly surgeries cause more complications than single spinal fusion (michiganmedicine.org)

Many patients with a herniated disc in their thoracic spine don’t require surgery and can instead be treated with rest, anti-inflammatory medications and physical therapy. But for Moore, the quickly worsening symptoms represented a ticking clock.

“Patients with this condition who go untreated with aggravating symptoms can progress rapidly,” said Osama Kashlan, M.D., a neurosurgeon at University of Michigan Health. “The thoracic spinal cord does not do well with pressure from the herniated disc. If Mr. Moore had waited longer, he could have been paralyzed.”

 

car crash stressed couple
The Moores in their car after the crash (left) and a look at the damage (right).

Moore sought several opinions from hospitals on the west side of the state before arriving at U-M Health. They all recommended the same surgery, a discectomy and fusion, to remove the ruptured disc. The two traditional methods for such a procedure involve either cracking open the ribs to move the lung and reach the spine, or to get access through a large incision in the back that requires screws and rods.

“They wanted to bust me open and cut it out, but I really did not want to be in a walker,” Moore said. “So, I went to get another opinion.”

After an evaluation at U-M Health, neurosurgeons saw Moore’s condition worsening and recommended the same operation. But before the procedure, a team member thought to connect with Kashlan, who, in 2018, spent time overseas learning a minimally invasive operation to treat the condition from which Moore suffered.

A less invasive surgical option

Spine endoscopy is not new outside of the United States. The procedure involves sticking a small scope through a sub-centimeter-long incision, using X-Ray to find the herniated disc and water to break up the pieces before removing them.

Research into thoracic spine endoscopy shows that it carries a high success rate with reduced morbidity compared to traditional approaches. At U-M Health, where he is currently training a second neurosurgeon to perform the operation, Kashlan says his endoscopy patients have faster recoveries and shorter hospital stays.

“Traditional methods see a recovery time of three to six months, and spine endoscopy can have patients feeling recovered in four to six weeks — sometimes as early as two weeks,” he said.

Endoscopy will one day be the standard of care in neurosurgery. There are so many potential applications with endoscopy beyond thoracic disc herniations.”

- Osama Kashlan, M.D.

As someone who spends his life and career moving, Ralph Moore was ready get up and walk out of the hospital the day after his procedure in December 2022.

SEE ALSO: Back Pain: A Thing of the Past (michiganmedicine.org)

“They told me four to six weeks, but I’m one of those people that always wants to do more,” Moore said. “I felt great – I would pick that over any surgery. Before this, I thought there was no way I could’ve continued in the landscaping business that I’ve owned for years.”

Gaining popularity

The successful operations and speedy recoveries for patients like Moore have Kashlan looking to the future for a procedure that is gaining popularity in the U.S.

“Endoscopy will one day be the standard of care in neurosurgery,” he said. “There are so many potential applications with endoscopy beyond thoracic disc herniations. It can be used to treat cervical disc herniations, any type of stenosis, certain nerve pain issues and, recently, spinal fusion. Soon the traditional methods will feel outdated in many of these conditions.”

The challenge of growing spine endoscopy: limited training opportunities. Kashlan is an instructor through one of the companies that supplies devices for the procedure. The demand for learning how to provide this type of care, he says, is steadily rising.

“I have a lot of colleagues in southeast Michigan who are waiting for me to be able to train them,” Kashlan said. “As soon as that happens, we will hopefully have a lot of surgeons in different health systems in the area who can serve this population. People all around the country are wanting to learn about spine endoscopy. I am blessed to have trained under giants in the field and am honored to spread this knowledge and skills to others all around the nation.”


More Articles About: Spine, Back & Neck Neurology Bones and Muscles and Joints (Orthopaedics) Orthopaedic Surgery Spine Surgery
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories brain drawn
Health Lab
Gene therapy for rare epilepsy shows promise in mice
Dravet syndrome and other developmental epileptic encephalopathies are rare but devastating conditions. Research from Michigan Medicine takes aim at variant in SCN1B, which causes an even more severe form of DEE.
brain drawn
Health Lab
ALS survival may be cut short by living in disadvantaged communities 
Living in a disadvantaged community may decrease the length of time a person can survive with ALS by over 30%, a Michigan Medicine-led study finds.
mom and son and dog in front of the survival flight helicopter
Health Lab
Therapy dog supports teen through recovery after serious dirt bike accident
Evan Sanders had a dirtbike accident which left him with fractures across the left side of his body. During his hospital stay, service dog Barney helped Evan with his rehabilitation goals, including a visit to the Survival Flight helicopter.
red spot in shoulder pulsing red with circle around it on black background and see-through to shoulder bone and joint
Health Lab
How do you treat rotator-cuff tears?
Rotator-cuff tears appear most in adults over the age of 40. These injuries are typically treated with physical therapy and surgical intervention as a last resort.
Minding Memory with a microphone and a shadow of a microphone on a blue background
Minding Memory
Understanding Dementia Risk Factors with Helen C. Kales, MD
In this episode, Matt & Lauren have the unique opportunity to talk with Dr. Helen C. Kales, a geriatric psychiatrist and health services researcher who has participated in the previous Lancet Commissions on Dementia Prevention, Intervention and Care – including the most recent one released in 2024. Dr. Kales discusses how the commission puts together all the evidence to make recommendations that can play a crucial role in dementia prevention. Dr. Kales is the Chair of the Department of Psychiatry and Behavioral Sciences and Joe P. Tupin Professor of Psychiatry at the University of California at Davis and has dedicated much of her career to improving the lives of patients living with dementia.
brain drawn
Health Lab
The brain in balance
In a recent study, using network neuroscience, investigators found a way to objectively determine the balance of integration and segregation in fMRI-measured brain signals during wakefulness as well as during sleep and anesthesia.