Your back puts up with a lot from you.

Whether you’re sitting, standing, slouching or stretching, it supports you no matter what. When it starts causing pain, your back is trying to tell you something. So why doesn’t everybody listen?

P. Ronjon Paul, M.D., a spine surgeon with and medical director of the Spine Center of DuPage Medical Group who performs surgery at Edward Hospital, says spine surgery has changed dramatically in the past 20 years, but still has a reputation for being a long, difficult process.

“Few people actually need surgery.  Many people are given misinformation about surgery regarding outcomes, length of recovery and how big the operations really are,” says Dr. Paul. “Sure enough, we do some very big operations. But, many people are good surgical candidates for minimally invasive procedures.”

Minimally invasive procedures have several advantages over more traditional back surgeries. When surgeons take a less invasive approach, Dr. Paul says patients experience reduced operation time, blood loss, scarring, post-op pain, hospital stays and recovery time.

Dr. Paul has performed an array of minimally invasive techniques for nearly seven years and has taught more than 200 surgeons in the U.S and United Kingdom.  In addition, surgeons throughout the Midwest frequently observe Dr. Paul in the operating room at Edward Hospital.

Before considering surgery as an option, Dr. Paul often prescribes pain management, such as cortisone injections for inflammation, and physical therapy.  Dr. Paul’s practice has three in-house board certified anesthesiologists and five highly specialized physician assistants who coordinate non-operative treatment and also educate patients about their condition.

If non-operative procedures aren’t successful, patients may be candidates for one of several minimally invasive procedures:

1.       XLIF (eXtreme lateral interbody fusion)

In an XLIF procedure, you lie on the surgical table on your side, and the surgeon makes two small incisions.  This allows the surgeon to remove a disc, restore disc height and realign the spine.  The procedure can be very effective for treating scoliosis or people who have had other back surgeries.  Dr. Paul typically places a state-of-the-art stem cell-based bone graft to help the bones fuse together. If your back is severely unstable, the surgeon may use screws, plates or rods to help hold the vertebrae together.  This approach does not require cutting or moving sensitive back muscles, bone or nerves, as is required with some traditional fusions.

Wayne Zaininger, 45, of Warrenville, had lower back pain for more than a decade before he asked his primary care physician about it. X-rays showed he had bone spurs and an MRI revealed he had a deformity and spinal stenosis – a narrowing of the spine that puts pressure on the spinal cord or nerves leading from the spinal canal. He couldn’t stand for more than 20 minutes without pain radiating down his legs.

“My legs were always tired,” Zaininger said. “I felt like I just got done running a marathon. I don’t run marathons, by the way. But if I did, I imagine that’s what it’d feel like.”

In March, Dr. Paul used the XLIF approach to grind off the bone spurs and fuse the problem vertebrae. In two days, Zaininger climbed 10 flights of stairs, nearly pain-free, and was able to go home. In two weeks, he returned to work at the St. James Farm in Warrenville, where his job as site manager often requires him to walk or drive the farm’s 600 acres.

“This is fantastic because it’s taking care of all the problems that I have,” Zaininger said.

Barb Sieja, 68, of Naperville, had three back surgeries in 20 years before meeting Dr. Paul: the first for a fusion with older screws and plates, a second to remove the plates and other hardware (“I have enough to make a clock!” she said), and a third for decompression. Her primary care physician and neurosurgeon both advised against more surgery when her pain returned a year ago.

“Sometimes I had to cut my walking short because of the pain in my hips or down my leg, and another day my knee would hurt, and other days my upper back,” said Sieja, a retired pediatric nurse. “It was never the same. I thought, ‘Maybe I’m just getting old.’”

With an MRI, Dr. Paul diagnosed Sieja with spinal stenosis and severe misalignment. He used XLIF to replace the old disc and fuse the vertebrae. Dr. Paul also removed all of the scar tissue from her previous operations.

It took her a year to recover from her first back surgery. This time, she felt better after two weeks. Sieja called Dr. Paul “a saint and a miracle worker.”

“I’m 20 years older than I was for my first surgery, and I feel 100 times better,” she said.

2.       Minimally invasive TLIF (transforaminal lumbar interbody fusion)

In a TLIF procedure, you lie on your stomach and the surgeon approaches the spine from the back of your body. The entire operation is done through two one-and-a-half inch incisions. This allows direct access to problematic nerves so the surgeon can place screws and rods in addition to performing an intervertebral fusion.

Tamas Takacs, 39, of Batavia, saw Dr. Paul for a stress fracture in his spine about five years ago. He returned last summer when a wrestling bout with his nephew aggravated a herniated disc caused by disc degeneration.

“Most of my life I’ve done construction work,” he said. “And, I’ve been in manufacturing a long time – bending, heavy lifting – so over time it took a toll.”

Four hours after his surgery in February, Takacs was up and walking. He expected to need his wife’s help at home for two or three months, but he said it was more like two or three weeks. He returned to the office of his own construction company in March.

“I know people who had (back surgery) 10 or 15 years ago, and they were laid up for six months, recuperating for two years,” he said. “This felt like outpatient surgery.”

3.       ILIF (interspinous lumbar fusion)

In an ILIF, you lie on your stomach so the surgeon can access the spinous processes through a small two-inch incision in your back. The surgeon uses minimally invasive techniques to decompress and fuse the bones. The procedure takes about 40 minutes, and patients often go home within 24 hours.

Rolande Michael, of Lisle, a 68-year-old retired nuclear medicine technologist, already knew osteoarthritis was affecting her back. Pinched spinal nerves and vertebral slippage caused a constant stabbing and burning sensation down her left leg. A couple of friends recommended Dr. Paul, and he recommended surgery.

“I had become a prisoner in my body,” she said. “Prior to the surgery, I could not even climb my own stairs. I was going on my floor like a 2-year-old baby.”

In October 2009, Dr. Paul performed a fusion and decompression – a process Michael said he made easy by explaining exactly what to expect.

“I was a new person,” she said. “The following day I was walking in the hallway, and it was unreal.”

4.       ALIF (anterior lumbar interbody fusion)

In an ALIF procedure, your spine is approached from an incision in the abdomen. This approach spares trauma to the back muscles but requires the surgeon to maneuver around major blood vessels that lie in front of the spine. The surgeon removes the damaged disc and replaces it with a metal cage filled with a bone graft to help the bones fuse together. If your back is severely unstable, the surgeon may use screws, plates or rods to hold the vertebrae together.

At 38, Cheryl Gilsdorf, of Bolingbrook, ruptured a disc in her spine. The injury was radiating pain from her lower back to her leg, making it impossible for her to work full-time. But she thought she was too young for back surgery.

For five years, she tried to control the pain with shots, nerve burns and pain patches. The chronic physical pain also weighed on her emotionally. She had been diagnosed with depression before her injury; afterward, her depression worsened.

Gilsdorf and her husband talked to Dr. Paul about how surgery could increase mobility and decrease pain. In February, Dr. Paul performed the ALIF procedure.

Three months later, she started working in an office full-time again. Now 42, she can run errands, ride a motorcycle and go boating without pain. She’s also back to managing her depression and says Dr. Paul cared about things like that – her whole lifestyle.

 “I had seen three other surgeons over the years, and they were just all about the surgery,” she said. “He was all about the impact on your life before and after the surgery.”

Dr. Paul has one of the leading minimally invasive spine practices in the region.  He is one of only a few spine surgeons in the Midwest who perform the XLIF procedure, more of which are performed at Edward than any other hospital in the Chicago area. Dr. Paul often takes referrals from neurosurgeons and orthopedic spine surgeons for their more complicated cases.  His patients have come from all over Chicagoland, downstate Illinois, northwest Indiana, Wisconsin, Louisiana, California, even Taiwan.

For more information, visit the Edward Spine Center at www.edward.org.