Cleveland-area native Sal Fragapane was not surprised when he started experiencing back pain 15 years after having spinal fusion surgery. In fact, his surgeon, St. Vincent Charity Neurosurgeon John S. Collis, M.D., had warned Sal at the time of his first surgery in 2003 there was mild deterioration in the vertebrae above the fusion and chances were high that he would need additional surgery in the future.

“Dr. Collis said it would be 15 to 20 years before the vertebrae would go bad – and it ended up being 15 years to the month,” Sal said. “Because of his expertise, I knew what to watch for and what to do when I started experiencing pain again.”

Experiencing adjacent segment degeneration

Sal’s condition is commonly referred to as ASD, adjacent segment degeneration, in which the spinal segment above or below a fusion slowly deteriorates over time.  Typically, degeneration in the adjacent segment has already started at the time of a fusion, but is not severe enough for surgical intervention.

Dr. Collis, widely regarded as the “father of spinal surgery,” was at the forefront of the study of and raising awareness for the development of ASD in fusion patients.

“Only recently has this problem been widely talked about in the spine community,” said St. Vincent Charity spine surgeon Jeffrey F. Shall, M.D. “Dr. Collis has been talking about this condition for more than 30 years. His keen understanding of conditions of the spine – and how that knowledge helps prepare patient expectations – is why I sought out Dr. Collis as my mentor. He has long been the leader in the spine community.”

Because Sal was aware of the possibility of further deterioration, he began to take notice about a year earlier that he felt tightness and mild pain begin to return to his lower back. As the pain progressed into severe back pain that led down his left leg and he developed foot drop – caused by the compression of his spinal nerves – he knew he needed to take action.

And, there was no doubt it was Dr. Collis who he would reach out to for help.

Sal credits Dr. Collis for “giving him his life back” 15 years earlier and has worked to express his gratitude ever since. Every year on the anniversary of his surgery, Sal brings a variety of pastries to Dr. Collis and his team to say thank you.

“Over those 15 years, half of the time when I walked in I would get choked up,” Sal said. “It is important in life to take care of the people who take care of you.” Even though Sal has relocated to Charlotte, NC, he still makes his annual visit back to Cleveland to express his gratitude in person.

Returning to Cleveland’s spine experts

When Sal went into see Dr. Collis last year about his returned pain, Dr. Collis also brought in his colleague Dr. Shall to consult. The surgeons immediately put Sal at ease.

“They said, ‘we knew this moment was coming’ and reassured me that the initial fusion was still solid and good,” Sal said. “They were both surprised that I was working and functioning as much as I was.”

The surgeons presented Sal with treatment options, which included trimming the disc to buy him some time and relieve pain, or a second fusion to stabilize his spine. Sal chose the latter because he had confidence that it would provide long-term results with only one surgery. 

Back to triathlon training 

Dr. Shall performed the fusion with minimally invasive surgery, requiring a smaller incision and allowing for shorter recovery time than traditional surgery. Sal woke up from surgery with minor soreness and no pain. After therapy and wearing a brace for a short time, Sal is hoping to train and compete for another sprint triathlon. “I am pain-free again with an excellent prognosis for my future.”

Sal is, once again, grateful for the care he received from the team at St. Vincent.

“Dr. Collis and Dr. Shall gave me an immense amount of time at the initial consultation and combed through the MRI to truly identify the problem area,” Sal said.  “I trust this practice because Dr. Collis sets the tone with his rock solid approach. And, Dr. Shall embraces Dr. Collis’ philosophy. They are very authentic and sincere.”

John S. Collis, M.D., co-medical director of the Spine and Orthopedic Institute, is devoted to finding the right path to the best outcome for every patient. Widely regarded as the “father of spinal surgery” Dr. Collis has performed more than 17,000 major spinal surgeries, including 5,000 fusions. He chose to bring his six decades of surgical experience to St. Vincent Charity Medical Center to fully devote his skills and expertise to the practice of compassionate patient care. Believing that “you don’t have to operate on everyone,” Dr. Collis became not only a pioneer in surgical approach but he is also the inventor and discoverer of many non-surgical interventions. Contact his office at 440-746-1055. 

Jeffrey F. Shall, M.D., orthopedic spine surgeon, is devoted to healing the spine with advanced and minimally invasive procedures. Dr. Shall is a fellow of both the American Academy of Orthopaedic Surgeons and the North American Spine Society. A board-certified spine surgeon with three decades of experience in complex spine care, Dr. Shall specializes in minimally invasive procedures that reduce patient pain and recovery time and maximized mobility. Dr. Shall chooses the Spine and Orthopedic Institute at St. Vincent for the strength of its specialists and its compassionate approach. Contact his office at 440-746-1055.