Eight years after Susan Smith’s 2015 spinal fusion surgery, her mom needed the same surgery. Over time, technology has evolved to drastically change the procedure.

Story by: Nick Picht; Reviewed by Jeffrey L. Gum, M.D. on May 3, 2024

Susan Smith’s back pain started as a teenager.

“I was 19, a sophomore in college,” Susan said. “I started having pain in my hip and couldn’t figure out what was causing it.”

She bounced from doctor to doctor, looking for answers. Several months later, her right leg was paralyzed. She needed a MRI, which confirmed she’d ruptured a disc in her lower back. It was compressing her nerve roots, and she needed to have surgery immediately.

“[The doctor] said, ‘I don’t want to fuse your spine; you’re too young,” Susan said. “But he also told me, ‘this won’t be your only surgery.’”

The recovery was arduous. She was directed to stand up straight or lie flat on her back for 30 days. From then on, she battled chronic daily pain, derived from a combination of arthritis and spondylolisthesis, a condition when one vertebra slips in front of the other.

“It wasn’t severe most of the time, but I always knew it was there,” she said. “And as I got older, it started getting worse and worse. And I usually had one to two bad weeks per year, but I always dealt with it.”

In 2015, the pain became insufferable.

She couldn’t perform daily tasks, like bending down to tie her shoes. She went to see Jeffrey L. Gum, M.D., orthopedic spine surgeon with Norton Leatherman Spine, who — in June of that year — performed a successful lumbar fusion of Susan’s L4 and L5 vertebrae.

During the nearly three-hour, “open-technique” surgery, Dr. Gum made a roughly 6-inch incision in Susan’s back and removed bone spurs and disc fragments that were pressing on her nerve roots. Then, he took pieces of bone from Smith’s hip and placed them between vertebrae in her spine, then fused the bones together using screws and rods. She spent three nights in the hospital and started her recovery, which compared to her first surgery, was night and day.

“When I went home, it was no lifting, bending or twisting,” Susan said. “But Dr. Gum told me to live my life and we’ll check in in 30 days.”

But she didn’t even need that long. After just two weeks, she was cleared to return to work.

“I have not had pain since the day of my surgery,” Susan said. “Everyone tweaks their back every now and then, but I have not had back pain for almost nine years.”

‘Like daughter, like mother’

Sharry Waldeck has a theory.

She believes her back pain is derived from the day she fell off a horse when she was 10 years old. Though the riding accident didn’t impact her severely at the time, she’s had some back pain from then on.

Fast forward roughly 60 years, and that pain began to worsen.

“Probably for the [last] two years, I have had quite a bit of pain that last year became intense,” Sharry said. “And the last few months was to the point that I could hardly do my household chores or get dressed.”

Luckily for Sharry, her daughter Susan had some experience and knew who to call.

In 2023, Susan connected her mother with Dr. Gum, who diagnosed Sharry with the exact same conditions — spondylolisthesis and arthritis. Sharry also was dealing with slight scoliosis, or sideways curving of the spine. She needed surgery to correct it.

“She had a lot of voices telling her it might not go great,” Susan said. “And I knew better. And I knew Dr. Gum would never have suggested surgery if he didn’t think he could improve her quality of life. So my role in all of it was to counteract the negative [stigma] around back surgery.”

In November, Dr. Gum performed the same surgery on Sharry as he did on Susan — a lumbar fusion of the L4 and L5 vertebrae. And while the premise of the surgeries was the same, Dr. Gum was able to perform Sharry’s procedure as minimally-invasive surgery, with the help of a robot.

The robot — called the Mazor X Stealth Edition— helps expedite surgery time and get patients into the recovery room quicker. It uses imaging software and GPS capabilities to help surgeons map out a plan before surgery, increasing the accuracy of screw placement and improving the overall efficiency of the surgery. Because the robot guides the screws, the size of the patient’s incision decreases to less than 2 inches. Even more, the new surgical technique also affects how surgeons manage pain. Dr. Gum used a preoperative nerve block, helping reduce the need for opioids to manage pain post-surgery.

“I love it,” Dr. Gum said. “I always want new technology that can help us do things better, and I love proving that it adds value to our specialty. For me, it’s like seeing what’s not just available now, but what can be available in two years, five years or 10 years; that’s what gets me excited about what I do. When you decide to go into a surgical specialty, you’ve checked the box of being a lifelong learner and always being receptive to new technology or new techniques. So I think it’s one of the most exciting things we get to do.”

Sherry’s recovery was just as advertised.

Just hours after surgery, she was sitting in a chair and had already walked the hospital floor without issues. After an evaluation from Dr. Gum, she was cleared to go home. So, Susan helped her mother get dressed and walked her out of the hospital that same night.

“It is truly amazing to see,” Susan said of her mother. “I was waiting to go back to recovery, and it was taking pretty long. And finally they came out and said, ‘She wants to go home.’ It’s crazy to think here I was 30 years younger and in the hospital for three nights, very long incision, with drains and ports and the whole bit,” Susan said. “And here she is, 30 years older, with no hospital stay. And I only stayed with her one night, and that was it.”

‘I get goosebumps talking about it’

Now five months after surgery, Sharry is back to normal, living her life without restrictions. Susan is still doing well too, eight years after her procedure.

They compare scars from time to time and have the usual mother-daughter discussions about their procedures. But, they don’t give too much thought to the gravity of it all, until you ask.

“When I had mine done, I knew it was going to be better than my first surgery 20 years before that, but I didn’t appreciate the difference in the two,” Susan said. “To go from my first surgery to what I had done [in 2015] is amazing. But that was 20 years, and so it makes sense. But then to think, ‘Oh, in nine more years there’s going to be a robot that’s going to do this surgery, and you’re going to have this tiny incision and you’re not going to have to stay in the hospital, that didn’t cross my mind. And I definitely didn’t think [the example] would be my own mom.”

The same can’t be said for Dr. Gum, who continues to push the limits of what is technologically possible, while looking ahead to what the next advancement might be, and how that may make patients’ lives even better.

“I almost get goosebumps talking about that,” Dr. Gum said. “Every day you enter that operating room, you need to understand how you can do better the next time you go in. And so part of that learning or critique process is asking yourself, ‘Why are we doing it this way?’ If there are techniques to do it better, we need to learn those techniques. So to me, every day is an evolution of how I look at the [operating room]. I want to walk out of there learning something new or better. And when you take a step back and put it all together, I think it’s beautiful and awesome that we’re seeing robots in the OR. There’s all this new technology that’s evolving that’s going to make it easier and safer for what we do.”