Surgeon performs unique surgery

LINCOLN JOURNAL STAR (also appeared on the AP newswire and Nebraska newswire)

OMAHA – At age 30, Anna Lundmark is as fearless as they come. Some people also might call her lucky.


The former competitive skier once hit a tree while traveling 45 mph. A few years later, she landed on her head after flipping off a jump.


After 14 years of suffering from chronic debilitating back and neck pain, the Stockholm woman took a new risk – a procedure offered by Dr. Ake Nystrom, a fellow Swede and a surgeon at the University of Nebraska Medical Center.


The procedure is aimed at easing pain for people suffering from whiplash and similar neck and upper back trauma.


But experts in pain management and related fields say they are skeptical about the procedure, which is believed to be done on a regular basis only by Nystrom.


“On the surface it sounds a bit outrageous, but one can’t categorically say there isn’t anything to it,” said Dr. James Campbell, a neurosurgeon and pain specialist at Johns Hopkins Hospital in Baltimore.


During the three-hour procedure, the patient is awakened after a vertical incision is made on the back of his or her neck. Patients don a sterile glove to reach into the wound and point out pain points in their upper back and neck.


Nystrom then cuts away the connective tissue from the nerve at that site. He said he must work slowly, and carefully, since the wound is not anesthetized. Nystrom said he needs patients to be able to differentiate between their old pain and pain they would be feeling from the surgery.


Two months after the unique form of trigger-point surgery, Lundmark says she had the same results she did the week following surgery – a normal range of motion and minimal pain in her neck. That’s a change for a woman who once took six prescription pain pills a day, was forced out of competitive skiing and could turn her head at most a few degrees to each side.

“It’s like a miracle – it’s amazing,” she said.


Campbell said it is difficult to gather reliable data in the pain field because of a possible placebo effect.


Dr. David Apple – an orthopedic surgeon and medical director of Atlanta’s Shepherd Center, which specializes in pain management – shared Campbell’s sentiments.


“If a patient thinks you’re doing something that is going to help them, the mind over matter sort of takes over,” Apple said.


“It’s sort of an old adage – you can’t cut out pain,” he added.


Both Campbell and Apple say more structured research is needed to better understand the procedure’s level of effectiveness.


Nystrom’s patients undergo tests to their range of motion once before and once after the procedure, said Dr. Glen Ginsburg, medical director of the Munroe-Meyer Institute at UNMC, who helps conduct the tests.


“Every patient is statistically significantly better,” Ginsburg said.


Nystrom has been at the medical center since 2001. He came to the United States in 1994 and performed several hundred of the surgeries at the University of Pittsburgh, he said.


Most of Nystrom’s patients are Swedish, something Nystrom attributes to heavy media attention in Sweden.


He doesn’t actively pursue those patients, he said.


In 15 years, Nystrom has seen more than 600 patients for the surgery, though it didn’t become his focus until the mid- to late ’90s, he said.


Nystrom plans follow-up testing for some of the patients. Such testing has been hampered because of the large number of international patients, he said.


Nystrom has no plan to use an independent researcher to study the surgery – something that Campbell said is important in validating Nystrom’s findings.


But Nystrom said he is open to the idea if someone expressed interest.


Some medical insurance plans have covered the procedure, although a majority of Nystrom’s overseas patients pay for the procedure – generally between $15,000 and $17,000 – themselves, he said.


Celann LaGreca, a spokeswoman with Blue Cross and Blue Shield of Nebraska, said the company is reviewing the procedure before deciding whether to begin granting patient coverage requests.

Why the surgery appears to be working is unknown, Nystrom said.


“I don’t know that any better than anyone knows why operating on a tennis elbow relieves pain, and no one knows that,” he said.


Campbell said sometimes surgeons discover the rationale after getting an idea and finding that it works.


“But for every one of those ideas there are 99 where it just ends up being snake oil,” he said.

A car accident several years ago left Nina Andersson, 36, also of Stockholm, to deal with whiplash and pain that radiated into her arm, leaving her fingers numb. She was referred to Nystrom after seeing a hand surgeon in Sweden.


After the surgery, Andersson said she immediately noticed her pain was gone and tried to refuse the standard wheelchair ride out of recovery.


Martina Johansson, 28, who lives just outside Stockholm, said her mother read about the procedure in a Swedish women’s magazine. Johansson, who had been suffering since a 1998 car accident, said she had a few friends who tried to change her mind about having the surgery.


“I think it is difficult for anyone without chronic pain to understand that you have to take the chance,” she said in an e-mail.


Thirty hours after her August 2002 surgery, Johansson drove across the country on vacation. Today, she is back in Sweden, where she works as an engineer and has not relapsed, she said.


Nystrom recommends patients rest following the surgery. He says therapy usually is not needed.

He emphasizes that the procedure is not a cure-all. Like any surgery, there are risks, he said.


Lundmark had two hematomas, or collections of blood, in her back that were drained within days of the surgery. She was the only of his patients to have such a condition, and Nystrom said he suspects she has a blood-clotting disorder unrelated to the surgery.


He said it’s good that there are skeptics out there, but he stands behind the procedure and its ability to give people their lives back.


“What we do is not experimental surgery. We provide routine health care and we do that rather successfully,” he said.

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