Life often throws you curveballs. This is what Kevin Izzo discovered when he first met with Dr. Andrew Casden in 2008. Dr. Casden, now Chief of Orthopedics and Spine Surgery at White Plains Hospital, was a spine surgeon at Mount Sinai Hospital in New York City at the time.
Izzo, a 30-year-old fitness buff who worked out frequently — his routine included long runs and completing dozens of push-ups a day — appeared the picture of strength and health. But a diagnosis of congenital stenosis (narrowing around the spinal cord) in the cervical, or neck, region of the spinal column led him to Dr. Casden. It was the beginning of a journey that lasted roughly 15 years.
When he first began having symptoms, in 2008, Izzo thought it was mostly due to fatigue, convinced that he was overdoing it at the gym. “I didn’t think it was anything serious at first,” recalls Izzo. But then he woke up one day with severe “foot drop,” which is an inability to lift the front part of his foot.
After a week, he noticed some other concerning symptoms, including a hitch in his walk and severe weakness throughout his body. He could barely do two push-ups. In addition, his right hand had become “claw-like,” and he couldn’t manipulate it properly.
His primary doctor referred him to a local neurologist, who ordered an MRI that showed severe congenital narrowing around the spinal cord in the cervical region of Izzo’s spine, which controls movement of the arms and legs. If he didn’t have surgery soon, the neurologist told him, he could be paralyzed.
Izzo was referred to Dr. Casden who, given the progression of his condition, felt surgery was the only option. Dr. Casden says spinal stenosis is typically seen in older patients and develops gradually over time, so having a young patient like Izzo with such severe narrowing and rapid onset of symptoms was a cause for concern.
“The pressure on the spinal cord due to the congenital narrowing was causing his spinal cord to function improperly. It could not transmit the impulses from his brain to his arms and legs,” Dr. Casden says.
Izzo felt comfortable with his surgeon right away. “Dr. Casden has this cut-and-dried way of explaining things,” he recalls. “He did not sugarcoat the severity of my case. He told me I had to make decisions in real time because the changes for me were so rapid.”
A Series of Surgeries
Dr. Casden performed Izzo’s first surgery in 2008: a cervical discectomy and fusion, which is a type of neck surgery that involves removing damaged discs and spurs of bone to relieve spinal cord pressure. To do this, Dr. Casden made an incision through the front of the neck and, after removing the discs and spurs, replaced them with a titanium cage and plate, causing the bone above and below the discs to grow together. Izzo had significant improvement of his preoperative symptoms and resumed his lifestyle.
Three years later, with the compression again progressing, Izzo underwent another procedure with Dr. Casden, allowing him to regain his strength and mobility once again.
The story unfortunately doesn’t end there. In 2019, Izzo was hit by a car while walking in a crosswalk at a local shopping center, and his painful spinal journey began anew. He was taken to a local hospital for preliminary X-rays, but the pain was everywhere, he recalls: in his back, hips, head, and legs. He underwent physical therapy, as well as acupuncture and spinal injections, but nothing helped.
Izzo was in constant pain every day — so severe that he couldn’t even pick up his newborn daughter. He was in need of another surgery, this time lower on his neck, near his shoulder blades.
Thinking he had to have the procedure at a major New York City facility, Izzo had another surgery in 2020 at a Manhattan hospital with a different surgical team. Unfortunately, almost 18 months later, he was still in constant agony and was once again developing weakness in his legs and difficulty walking. Desperate for relief, the Long Island resident reconnected with Dr. Casden at White Plains Hospital.
From left: Dr. Andrew Casden, Dr. Kaushik Das, and Kevin Izzo
Finding World-Class Care at White Plains Hospital
Izzo could hardly walk when he saw Dr. Casden again in March 2022, in the Center for Orthopedic and Spine Surgery at White Plains Hospital. He needed complex revision spine surgery, and Dr. Casden quickly assembled the expert colleagues needed to handle Izzo’s complicated case, including neurosurgeon Dr. Kaushik Das, who joined the Hospital as Director of Neurosurgery in January. “I had this whole team of superstars in the system, providing me with personal attention,” explains Izzo.
Drs. Casden and Das determined that residual compression from the last surgery was causing Izzo’s pain and weakness. They performed a laminectomy, removing some of the bone covering the spinal cord in the back of the neck while also revising the existing screws and rods. “Extensive preoperative imaging was necessary to completely understand the anatomy of his previously treated spine, so we could safely accomplish our surgical goals,” explains Dr. Casden.
“There was still significant compression of Kevin’s spinal cord,” adds Dr. Das. “During surgery, we were able to identify the key area and successfully decompress the spinal cord.”
The Hospital’s state-of-the art technology helped ensure a successful outcome. Intraoperative computer guidance (the “O Arm”) identified the area of Izzo’s residual compression, explains Dr. Casden. The team also used a surgical microscope to “tease off ” bones and ligaments from the spinal cord, so it had more room to function properly. In addition, they utilized intraoperative neuromonitoring (IONM) to perform surveillance of Izzo’s spinal cord, which was at risk during the surgery. “Any changes in the IONM during surgery would necessitate swift action to prevent permanent spinal cord damage,” says Dr. Casden. At the surgery’s conclusion, a plastic surgeon expertly closed the incision, minimizing Izzo’s pain at the incision site.
Almost a year post-surgery, Izzo says he “feels amazing and stronger,” thanks to the care he received at White Plains Hospital. “Kevin traveled from Mineola to White Plains Hospital; that says a lot about the level of care you’ll find here,” notes Dr. Casden. “We are doing complex revision spinal surgery that used to be done only at major university hospitals.”
In 2022, The Joint Commission, the nation’s leading and largest independent accrediting body in healthcare, recognized White Plains Hospital as a Spine Center of Excellence.
Izzo is grateful for his entire experience at the Hospital, especially considering how bad his condition had become. “The whole process, from the lead-up to surgery through discharge, instilled about as much comfort and confidence as a patient could possibly have in a team and a hospital,” he says.
To learn more about White Plains Hospital’s Orthopedic Services, visit wphospital.org/services/orthopedics.