Youngsoon Hong, 81, was a little girl in North Korea when her family was targeted for their religious beliefs. Several of Hong's relatives were executed during the Korean War for being Christians. Hong endured a weekly punishment called "self-judgment" where she had to stand in front of her classmates and explain why her faith was “wrong.”

Even as the war raged around them, the family and their church community decided they had to escape. They navigated around bombed-out bridges and swam through lakes dotted with bodies to make their way toward freedom in South Korea.

All seven of the Hong siblings eventually immigrated to the United States. Two became pastors, while Hong moved to North Carolina in 1984 and opened a convenience store in Winston-Salem with her husband. The store supported her family of four, including her daughter, Khrystyne, and her son, Dr. Kyung Soo Hong, who worked at the store full-time before enrolling at Wake Forest University School of Medicine. America had given Hong a chance for a good life, and she was grateful.

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She had earned the right to live her later years with as little discomfort as possible. But for two decades, starting in her early 60s, she struggled with back pain that radiated down her legs. By 2022, she had to walk with her back hunched over. Hong couldn’t tolerate “more than five minutes of standing up or even extending her back to stand up straight,” said her son, Kyung Soo. She had difficulty sleeping and was often out of breath.

Dr. Kent Cochran

The situation might have seemed hopeless given her age. It wasn’t to Dr. Kent Cochran, a specialist in pain medicine at Novant Health Spine Specialists - Bermuda Run. He suspected Hong might not need surgery to relieve her suffering.

A collaboration to reduce pain

It turns out that Hong’s pain, which started in the lower back and extended to the knees, ankles, and feet, is a common problem. Cochran estimates that of the 350 patients he and his colleagues see in their office each week, about a quarter come in with similar pain. “Within the low back, we have a lot of wear and tear with bulging discs and arthritic changes,” he explained, which can affect nerve roots exiting from the spine.

Hong’s pain was mild when it began, and she figured it was caused by all the lifting that running her business required. She didn’t retire until 2018, at age 76, because she enjoyed being active and didn’t want to fade into the background during retirement, as some friends had.

When Cochran first saw Hong in 2019, he diagnosed her with spinal stenosis. Hong tended to hunch over to ease the pain because there wasn’t enough space around the nerves in the base of her spine.

In Hong and other patients with the condition, “That space where that nerve root exits just isn't big enough. It's constantly being inflamed, because that nerve is hitting up against changes in the spine that occur over time,” Cochran said.

Hong had been receiving lumbar epidural steroid injections from another physician since 2012 to reduce inflammation and lessen the pain. Cochran continued that treatment. The injections worked for years, but over time, their effectiveness can wane. Eventually, they gave Hong relief for six months, then three months, then six weeks. She couldn’t continue to receive injections that frequently. They needed a better solution.

Cochran consulted colleagues at Novant Health, including Dr. William Bell (now retired), a neurosurgeon, and Dr. Chase Bennett, an orthopedic spine surgeon. The collaborative approach helps ensure “we’re performing the correct procedure that will decrease the patient’s time in the doctor's office,” Cochran said.

The team ruled out surgeries that would be more invasive, cut muscle, and change the anatomy of Hong’s spine. They agreed on a treatment that wouldn’t require surgery.

“It feels great to stand again”

Cochran would insert a Vertiflex (see video) device. Its tiny prongs wrap around a portion of the spine to lift the area and open the space. The device is small enough that it doesn’t place excessive pressure on the spine. Made of titanium, it would still allow Hong to safely receive CT scans or other imaging in the future.

Cochran would use X-rays to guide him on the placement, and the incision would be small. Some seven years’ worth of data on the device indicated that patients enjoyed sustained relief from their pain, Cochran told her. The entire process was an outpatient procedure.

Hong was ready to try it. She trusted Cochran, and if it didn’t work, Cochran said the device was simple to remove. The treatment is typically recommended for patients in their 70s and older who might be poor candidates for surgery. Those who could benefit have “the shopping cart sign,” Cochran said. “Their back and leg pain feels better when they’re bending over to put groceries in their cart at the store.”

They also may feel better sitting down, he added. “Both of these movements create additional space within the spinal canal and can relieve the constant pain or pressure that these patients feel as a result of their spinal stenosis.”

Hong had the procedure in August 2022. She began physical therapy soon after to gain strength and flexibility, and to work the muscle groups she had avoided using for so long because of the pain. Cochran lives with her son, and he was heartened to see the progress she made. “It feels so great just to be able to stand straight again,” Hong told Cochran at her follow-up appointment.

Cochran is not 100% pain-free. But she has much of her life back. She visits her sister’s home where they prepare meals together and goes out to dinner with her family. She gardens in her front yard. She even walked to her grandson Evan’s graduation from middle school.

“I’m grateful for the mobility she gained back, and her ability to take part in her grandson’s life,” Kyung Soo said. Before the procedure, she would have needed to be in a wheelchair.