In neurosurgery, a passion for preserving motion keeps patients thriving

Orthopaedic patients in the high country often have one thing in common: Their top goal for treatment and recovery is to return to an active lifestyle. Helping patients get back to doing their favorite activities is something that drives Dr. Ernest Braxton, a neurosurgeon at Vail-Summit Orthopaedics and Neurosurgery. Research shows that residents in Summit, Eagle and Pitkin counties, where many of Dr. Braxton’s patients reside, live longer on average than anywhere else in the United States. 

“The fountain of youth is really activity,” Dr. Braxton said. “Surgery should be restorative — it should improve your quality of life and allow you to live your life to your fullest ability.” 

Awake spinal fusion reverses a grim outlook 

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Mike Shell is a Frisco resident who has been skiing for 42 years, mostly at Arapahoe Basin. Throughout his work in the motorcycle business, he spent a lot of time flying, sitting at a desk and standing on his feet for long periods of time. 

When he felt lower back pain, he figured some physical therapy and maybe some injections to calm his nerves would be sufficient. A minor skiing accident compounded his back troubles, worsening his symptoms. One day while hiking with a friend, he felt numbness from the waist down that eventually led him to Dr. Braxton. 

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Shell’s spinal cord was almost totally pinched. If he were to fall down, he was facing the risk of losing control of everything below his waist. 

Dr. Braxton wanted to do the surgery for his condition, spondylolisthesis, as soon as possible, but there was one caveat: he wanted Shell to remain awake for the procedure. 

This awake spinal fusion procedure is done with local anesthesia, allowing Dr. Braxton to communicate with his patient throughout the surgery in an outpatient setting at Vail Health. 

Spondylolisthesis is a common disorder of the spine in which a vertebra slips out of place and keeps moving, creating a deep ache at the base of the spine. As Dr. Braxton decompresses nerves during surgery, an awake patient can respond to help identify nerves so Dr. Braxton knows he’s not injuring or damaging them. 

The awake surgery allows Dr. Braxton to examine the patient’s neurological condition during the procedure, which makes the operation safer. It also eliminates the need to use intravenous narcotics and decreases the overall cost of the hospital stay. 

Shell remembers the surgery and said he communicated with Dr. Braxton and the anesthesiologist quite a bit. Everyone in the operating room kept him up to speed on the progress of the procedure, and only once did he feel a little pain, nausea, which he said was taken care of right away. He walked out of the surgery center at 2 p.m. that day after heading in at 6 a.m. Recently, about nine weeks after surgery, he said he’s walking about three to five miles per day and expects to be skiing again in a year. “It’s nothing short of remarkable and I’m just so thankful that someone of Dr. Braxton’s caliber was right here in my neighborhood,” Shell said. “I couldn’t imagine having this procedure down in Denver and having to do follow-ups down there.” 

Motion preservation 

Dr. Braxton sees a lot of spinal fractures during ski season, while disc herniations and degenerative conditions are more common in the summer and spring, especially among golfers rotating the spine as they try to accelerate their swing. 

Before joining VSON, Dr. Braxton served as chief of Neurosurgery at San Antonio Military Medical Center, the Department of Defense’s largest

medical treatment facility. Turns out, goals for patient outcomes among athletes and active duty military are quite similar. 

“The transfer from the military to Vail was actually a lot easier than I thought. The emphasis in the military is return to duty — to do surgery that allows them to return to the fight as soon as possible. In Vail, it’s a return to performance,” Dr. Braxton said. “When can I ski, golf, hike, bike and get back to my active lifestyle?” 

Minimally invasive procedures 

With these goals in mind, minimally invasive treatments are preferred. By minimizing anesthetics and doing awake procedures whenever possible, and minimizing incision sizes to disrupt as little of the muscle as possible, 

Dr. Braxton has a patient’s future lifestyle at the heart of most procedures. “When you make a larger incision, you injure the core muscles because they get detached from the spine. By minimizing incisions, we protect the body’s core muscles, which are the innocent bystanders,” he said. “We need to be more precise with our surgical strike to take care of the bad guy and protect the innocent bystanders.” 

For example, the anterior lumbar interbody fusion is a procedure done from the front of the body in order to protect the core muscles — those innocent bystanders — in the back. 

Patient Lindsey Christian, of Eagle, does Crossfit and works on her feet most of the day. She had just had a baby in 2017 when she needed a fusion and other surgeons who had examined her were suggesting a posterior approach. She saw Dr. Braxton and he recognized her need to return to physical activity and was confident the surgery could be successful from an anterior approach. 

“I had the surgery and was only on pain meds for like a week, which is unheard of, so I was still able to nurse my baby,” Christian said. “I was back to work in three weeks. For a fusion, that just blew my mind. I had such a good experience. Dr. Braxton really took time to explain everything — you can tell he really cares about his patients.”

Another procedure, an artificial disc replacement in the lumbar spine, is also done from the front of the body for this same reason. One of Dr. Braxton’s patients, Laura Cardwell, said he was the first doctor who sat down with her to truly understand what her goals were. “He gave me reasonable expectations and so I could take everything into consideration,” she said. “This anterior approach doesn’t cut through the back or stomach muscles, and I was back to work in two weeks, back to hiking in two months, and I skied within three months. It was a quick recovery.” 

That was a big deal for Cardwell, who relies on physical activity as a mental outlet. 

“Movement and exercise, for me, is the biggest component to my mental health. It’s not just about physical well being, it’s sanity in life,” she said. “I love new challenges and trying new sports. I started mountain biking this

summer — something I never thought I would have been able to do given how much pain I was in a few years ago.”