Orthopedic spine surgeon now treating patients at Auburn Community, discusses spinal fusion surgery, other procedures
By Chris Motola
Q: What brought you to Auburn?
A: It was a sudden interest. My two long-time partners and I were working at St. Joe’s for 17 years. We got involved in some corporate downsizing and they closed our practice. I knew a PA in Auburn who had formerly worked at St. Joe’s and talked to him about spine surgery in Auburn. I knew they had done some in the past and had brought a couple surgeons up from Walter Reed Hospital. The PA said, “Well, I’m standing next to the chief medical officer right now, and we’re thinking about hiring a spine surgeon.” Next thing I know I’m talking to [Auburn Hospital CEO] Scott Berlucchi and the administrative team. One thing led to another and I started there May 1st.
Q: As an orthopedic spine surgeon, what kinds of conditions are you generally treating?
A: Generally speaking, I treat everything from the base of the skull to the pelvis. I treat mostly adult degenerative conditions, such as herniated disks. If there’s pressure on a nerve, we’ll take that off. I do spinal fusions. I also treat spinal deformities.
Q: Are we moving away from spinal fusions as an intervention, or are they still common?
A: We’re still doing a lot of spinal fusions, probably more than we were doing, say, 30 years ago. We do have better techniques now, though. Spinal fusions are used for conditions where there might be instability in a vertabrae where it’s slipping over the other vertabrae. We do spinal fusion when we need to do a very wide decompression. So if, in the lower back, the nerves are compressed both in the spinal canal itself and where they leave the spinal canal through what’s called the neural foramen, we have to take apart the foramen, which causes instability. So we have to do a fusion when that’s the case. When someone has a spinal curve that’s too large and you’re doing a laminectomy, the laminectomy ends up creating a greater curve, so we do a fusion in those cases. Spinal fusions are used for traumas. Someone breaks their back, breaks their neck, we do fusions. Spinal tumors that you take out can also cause instability, so we use spinal fusions quite a bit. Now, someone comes in with a simple herniation pushing on a nerve without spinal instability or simple spinal stenosis, we can often do those procedures without fusions. But we do use fusions in a lot of cases. For neck, for the right individuals, we are doing disk replacements instead of fusions. Usually the right individual is a bit younger, usually between 20 and 50, 55. And they don’t have collapse of the disk space or any instability or alignment issues. But in a lot of other cases we’re doing fusions.
Q: Other than age, what are the big causes of disk herniation that you see?
A: Disk herniations can happen to anyone. A lot of the time it’s overuse, sports injuries. Tiger Woods has had some back problems, a couple of diskectomies. So they’re putting a lot of force through their backs. Twisting a lot can damage the outer layer of the disk, causing it to tear. And a tear can lead to a disk herniation. As we get older, our disks don’t hold water as well and you get little tears on the outer layer of the disk which allows the “jelly” in the “jelly doughnut” to come out. That creates a disk herniation as well. So a lot of it is on a continuum of chronic degeneration as we go through life. Smoking can also accelerate the degeneration of disks because it prevents nutrients from getting into them. Obesity, inactivity can put excessive stress on the disks as well. So it’s multi-factorial, but it can be accelerated by certain activities.
Q: What are the outcomes of these procedures like? Are patients usually able to go back to the same activities and perform at a similar level?
A: If you do a simple diskectomy on, say, a professional golfer, you can go in and shave that disk down. After they rehab a bit they can go back to their regular activities. That disk is obviously damaged from the process, but many go back to regular activities. There was a Buffalo Bills football player this year who had to go into reserve because he injured his neck. He ended up having a spinal fusion on his neck. There was talk about him coming back in the playoffs. So you can have a one- or two-level fusion and come back and play professional football. Now if you do a big, multi-level, multiple vertabrae lumbar fusion on somebody, they’re not going to go back to playing professional football. But they can do things like exercise, ride bikes. Some can run, hike mountains as well.
Q: I noticed on your C.V. you have a doctorate in philosophy of anatomy from way back. What is that?
A: That was in the department of anatomy and cell biology. My late mentor had his doctorate in it as well. He and a local, retired orthopedic surgeon had a many-year investigation into limb deformities that they were developing. I did some work on the basic science side of that. So anatomy and cell biology, we’re the guys who teach gross anatomy in medical school. So they do a variety of research into general anatomy and cell biology. Most of it these days is on the cellular and sub-cellular level, but back when I was doing it I was doing some classic embryology and studying chicken embryos, checking them for limb deformities.
Q: Does having a deep understanding of spinal mechanics make you more cognizant of how you move?
A: Yeah, I mean, I’ve done a lot of impact sports over the years. I’ve had a disk herniation myself in my lower back. I didn’t need surgery for it. A lot of these things will get better without surgery if you give it time. I used to downhill ski race. I used to play rugby. Now I don’t do any of that stuff. It’s all low impact. Hiking, biking. But it is something I’m very conscious of because I do see the impacts of what happens when things aren’t going well in the back.
Lifelines
Name: Robert S. Nolan, M.D.
Position: Orthopedic spine surgeon at Auburn Community Hospital
Hometown: Liverpool
Education: Medical degree, SUNY Health Science Center at Syracuse (2000); orthopedic surgery residency, SUNY Health Science Center (2005); fellowship in orthopedic spine surgery, State University of New York at Buffalo (2006)
Affiliations: Auburn Community Hospital, SUNY Upstate University Hospital
Organizations: American Academy of Orthopedic Surgeons, North American Spine Society; American Board of Orthopedic Surgery
Family: Married, three daughters, two sons
Hobbies: Hunting, fishing, hiking