Young man’s debilitating back pain a thing of the past

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Tyler Piotrowski isn’t one to sit still for very long.

But when a flareup with a spine issue he’d been experiencing on and off for years stopped him in his tracks in late 2022, the then 29-year-old knew he had to get help.

“I wasn’t able to stand up straight and couldn’t do the things I normally did,” said the former collegiate swimmer and pilates/boot camp enthusiast.

Over the course of the next year, Piotrowski consulted with a spectrum of doctors, physical therapists and chiropractors, each with a different recommendation for how to treat a herniated disc in the lower portion of his spine.

A herniated disc happens when a disc that cushions the vertebra in the spine weakens with age or injury, causing the soft, inner part of the disc to bulge out.

This herniated or bulging disc can press on nerves in the spinal cord and cause symptoms such as pain, tingling or weakness in nearby areas of the body.

Piotrowski’s MRI also revealed degenerative spine issues, also thought to be the result of his high school and college competitive swimming careers.

“Practicing 60 hours a week eventually took a toll on my spine,” said the Royal Oak, Michigan, resident.

Finding the right answer

Piotrowski’s herniated disc was pressing on spinal cord nerves, causing excruciating back pain and numbness in his legs.

When physical therapy, steroid injections and other treatment recommendations failed to help, Piotrowski sought the expertise of University of Michigan Health neurosurgeon Osama Kashlan, M.D.

“I found out that Dr. Kashlan specialized in degenerative spine symptoms as well as minimally invasive methods for treating them,” said the software operations specialist, who wanted to avoid more aggressive treatment options, if possible, due to his young age.

Piotrowski was happy to hear that Kashlan agreed with him, recommending lumbar microdiscectomy, a procedure that involves small incisions to remove portions of the herniated disc and ease pressure on the spinal cord nerves.

During the procedure, a small tube is inserted through the back, between the vertebrae and into the area of the herniated disc.

This is a phenomenal opportunity for patients to get University of Michigan Health care closer to their community.” 
Osama Kashlan, M.D.

Small tools are then inserted through the tube to remove part of the disc.

Unlike more invasive open procedures, a lumbar microdiscectomy doesn’t involve the removal of bone or muscle or the possible need for a spinal fusion.

Avoiding more invasive procedures is “something that's kind of a game changer for a young person like Tyler who's in super shape. It might not be the most robust approach, but for some patients, it can be the best option,” said Kashlan.

Convenience without compromise

Piotrowski was also happy to learn the procedure would be performed at Brighton Center for Specialty Care on an outpatient basis.

He would be the first patient to undergo the spine procedure at a U-M Health outpatient center.

“This is a phenomenal opportunity for patients to get University of Michigan Health care closer to their community,” said Kashlan of the Brighton Center for Specialty Care.

“It also means complex conditions can be taken care of in a more expedited manner as additional spine surgeons become available at the Center.

“Eventually, we’ll have five spine surgeons rotating at Brighton, but this is just the beginning,” Kashlan said of the growing outpatient spine care trend.

“This allows us to shift our resources, provide excellent patient care and get patients home sooner.”

Kashlan points out that for many patients, the convenience of a specialty center over a major medical center, with access to the same specialists, is an important consideration.

“There’s often less driving time for our patients, easy parking and no navigating a larger hospital, which can be overwhelming for some patients.”

All about quality of life

Even though Piotrowski may need additional surgery in the future, Kashlan says this less invasive technique gives him a chance for an improved quality of life without the risk of major open surgery at a young age.

“I'm still in the healing process, but I’m definitely able to stand up straighter and I notice much less pain in my left leg, so that's been a hugely positive thing,” Piotrowski said.

He’s looking forward to returning to cycling, Pilates and boot camp classes. “Just being able to do those without being debilitated for days afterward is a huge goal of mine.”

Still in physical therapy, Piotrowski reflects on his experience at the Brighton Center for Specialty Care fondly.

“It was wonderful and so easy. I was prepped for the surgery, stayed at the Center for a couple of hours and then was able to go home.” He’s especially grateful for the expertise of Kashlan and the entire Brighton staff.

From Kashlan’s perspective, Tyler will continue to improve and eventually get back to the activities he loves.

For now, he has strict orders not to bend, twist or lift anything heavier than 10 pounds until six weeks post-surgery.

“Once patients reach the six-week post-surgery mark, that's when they really escalate to the next step in terms of recovery,” said Kashlan. “This is what we anticipate for Tyler.”