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Last Updated: Saturday, 24 February 2007, 03:03 GMT
'Back operation has me flying again'
By Jane Elliott
Health reporter, BBC News

Joanne Linton in a 747 plane
Joanne is now able to enjoy a game of polo
This year Joanne Linton returned to the skies after a revolutionary new procedure to repair her spine.

Joanne, 36, from Horsham, West Sussex, is a long-haul jumbo jet pilot who spends a minimum of nine hours each flight sitting in the cockpit - flying to Australia, Africa and America.

From her teenage years Joanne had occasional niggles with her back, but about three or four years ago the pain became much worse.

Joanne started to see an osteopath for twice weekly manipulation, but her problems continued.


Although she was comfortable sitting in the aircraft, she had to start taking time off sick because standing and walking were too painful.

Cabin crew had to help her carry her bags and on a bad day she felt unable to cope with the pain.

I wish I had had the operation sooner
Joanne Linton

Joanne was referred to leading spinal surgeon Andrew Quaile at the BMI Hampshire Clinic, in Basingstoke. At first she was prescribed a course of cortisone (steroid) injections, but this failed to ease her pain.

A special X-ray, a discogram, showed that Joanne's lowest spinal disc was badly damaged and that she was in need of surgery.

So Mr Quaile performed on Joanne the UK's first minimally invasive spinal surgery - an Axialif, which allows fusion of the spine through a very small incision.

Within two days Joanne was walking again with the use of crutches.

A bout of sciatica delayed her return to work by about five months, but Joanne said she now feels in top form.

She has even taken up the energetic sport of polo as a means of keeping fit.

"I would recommend this sort of treatment. It has been brilliant for me. I am still sometimes a little sore, but that should go soon. I wish I had had the operation sooner.

"My back is so good."


Mr Quaile explained that the surgery, currently only available privately, is already proving very popular.

He and his team are training up NHS doctors in the procedure and expect it to be available on the NHS soon.

Mr Quaile said the technique meant a shorter operation time of 45 minutes, compared with the traditional two-and-a-half hours. It also involves a smaller incision of just one inch (2.54cm) and these improve recovery times.

"Typically, spinal fusion surgery requires a six inch (15.24cm) incision in the back and retraction of the back muscles and tissue to gain access to the surgery site.

"The advantages for minimally invasive spinal surgery are: reduced operating time and hospital stay, minimal blood loss reducing the likelihood of transfusion, reduced post-operative pain, rapid mobilisation and rehabilitation, due to less muscle damage, and reduced complications such as nerve injury."

It is not a magic wand, but it is a useful tool
Andrew Quaile

"Also the novel approach is through a different area than the traditional ones further reducing the risk."

Mr Quaile, said the operation, which in some countries is carried out as day case surgery, involves the fusion of two vertebrae and the removal of the lower disc.

Currently the operation can only be carried out on the bottom of the five lumbar discs, but Mr Quaile hopes it could be adapted to suit all disc fusions.

But he warned patients not to expect the operation to provide a miracle cure and stressed that other avenues of pain relief should be explored first before surgery.

"It is a very successful technique, but the people who have this surgery should have had physio and other treatments first. It is not a magic wand, but it is a useful tool."


Retired spinal surgeon and trustee of the BackCare charity Alan Gardner said the technique could provide a useful option, but agreed surgery should not be a first response.

"Surgery for low back pain is a controversial area as we are treating a symptom - pain - rather than any objective disease entity.

"There is no blood test for pain and it cannot be directly imaged an any scan, although as an electro-chemical reaction in the nervous system, this must be possible before long.

"Success therefore depends on identifying the pain source through clinical examination and other investigations such as MRI scanning.

"Once the pain source has been identified with a reasonable degree of probability, then, if suitable, a surgical technique can be recommended, usually with the intention of stabilising the offending disc or joint on the principle that abnormal movement of over-sensitive tissues is the cause of the problem.

"Any co-existing nerve compression can be dealt with at the same time. Traditional spinal fusion with bone grafting can be highly effective and is still sometimes necessary, but it is a major intervention with some complications and four to six months' recovery time.

"New techniques such as Axialif can be dramatically more patient-friendly when skilfully performed on well selected individuals."

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