Triathlete turns to surgery
to get back on the trail

Broken Triathlete's online posting says it best: "Very active male, triathlete for 12 years, competitive in age group. Symptoms began four years ago with very stiff and sore back. Began doing yoga and Pilates, which seemed to control the problem. Then two years ago, it began again with a vengeance. Had to stop running altogether."

Benjamin Zerbey, a commercial airline pilot living in Manheim Township -- AKA Broken Triathlete -- posted those words last November on Spine-health.com in a discussion forum for people dealing with spine pain. Readers share stories and meet others in similar situations through the site.

A native of Tucson, Zerbey grew up in the national parks of Arizona, Massachusetts, Michigan, New Jersey and Pennsylvania, because his father worked for the U.S. Park Service. Those surroundings gave him a lifelong affinity for the outdoors and for fitness.

"I started to access my options," Zerbey's online posting continued. "One: stop doing triathlons and assume my position on the couch. Two: just continue with swimming and biking. Three: consider back surgery. Initially I felt my world was crashing around me, I was loosing the life style that I loved. When my 17-year old said, 'Dad, you're such a drama queen,' I realized that I have a lot to be thankful for and if I could find some way to get this back fixed, I would give it a try."

First, he learned what the diagnosis was -- spondylolisthesis of the L3 and L4 vertebrae, very little disc left, with spurs on L4. What that means: forward slippage of one vertebra on another, with narrowing and pinching of their nerves.

Zerbey also learned about a less-invasive surgery called X-LIF from his family doctor, Charles Mershon, M.D., of Cornerstone Family Health Associates in Lititz. Dr. Mershon recommended that he talk to neurosurgeon Chris Kager of Lancaster NeuroScience & Spine Associates.

X-LIF may sound like a new TV series, but what it stands for is extreme lateral interbody fusion. The surgery treats lumbar degenerative disc disease for patients who experience severe disabling pain that occurs at two levels. Fusion of the spine is accomplished by eliminating motion around a disc space by creating a bone bridge from one vertebra to the adjacent one. The X-LIF differs from traditional fusion in that the surgeon gets at the problem disc through the side of the spine. It avoids an incision across the abdomen, or cutting and disrupting back muscles.

Zerbey learned that Dr. Kager, who was fellowship-trained in spinal surgery at The Cleveland Clinic, had undergone specialized training for the X-LIF surgery and had successful patient case histories with the procedure. "Dr. Kager explained about how very little soft tissue damage is done with X-LIF, " Zerbey said, "and how recovery time and scar tissue is reduced. He told me that X-LIF is one tool in his toolbox, that it's a nice tool but has its limitations." A marathon runner himself, Dr. Kager understood Zerbey's passion for motion.

Zerbey decided to have the surgery and he shared the news online with others who felt his pain. "I had the X-LIF fusion L3-L4 done on November 20," he simply stated.

In the weeks that followed, Zerbey described his surgery and recovery experience online -- the initial euphoria, the setback of muscle spasms that made him second-guess his decision, the realization that he needed to look at the long term. "You want a good back for the next 30 years, not for the next six months," his physical therapist told him.

According to Dr. Kager, X-LIF is not radically new, but a refined approach to fusion for certain patients. "It allows me to approach the spine laterally, which means a quicker recovery than a traditional fusion, less surgical time, and less cost," he explained. "It's an alternative we have for people predominately with severe pain or tingling, which signals disc degeneration or collapse."

Dr. Kager found that to be the case with Benjamin Zerbey. "He had an area where one vertebra had collapsed on top of the other, bone on bone," he explained. "One had started shifting forward on the other. We begin by cleaning out the disc, and then installed a cage between the vertebrae, so they won't keep collapsing or sliding forward. We actually got that vertebra back in alignment, like one fist on top of another," he said.

Three months after surgery, Zerbey believes he made the right choice. He's back to work, he's doing everything by the book for physical therapy, and he's back at the gym regularly, working at about 50 percent his usual level, but gaining on it. He's eager to learn about how the bone fusion is progressing around the cage, saying he'll be much more comfortable as the fusion progresses.

A lover of running, swimming and biking, he looks forward to getting back to all three. His flight assignments take him to many points around the globe, and he is anxious for the next open swim in the Caribbean, and biking the Pacific Coast highway, among many favorites.

His last online comments to those asking about the surgery sum it up: "I'd say yes, I'd do the X-LIF, if the surgeon says you meet the protocol. As Lance Armstrong says, 'As long as I'm moving, I'm living'."