A Neurosurgeon’s Rx for Violinists’ Back and Neck Pain: Optimizing Motion

May 22, 2023, 2:29 PM · For 85-year-old Paul, a decades-long section violinist, playing the violin was one of the greatest pleasures in his life. When severe lower back and leg pain made it impossible to sit through a rehearsal, Paul feared he’d reached the end of his performing years.

violinist back

He was offered "fusion" surgery, which would decompress the nerves and stabilize the spine, thereby providing pain relief. But this approach would also reduce his mobility to the point where playing the violin would likely have become impossible. And it would have meant a hospital stay, with all the risks inherent in major surgery, including blood loss and pain.

Paul’s options shifted dramatically when he found out about a new procedure designed not only to alleviate pain, but to preserve motion. Paul was able to undergo a multilevel, but less-invasive outpatient surgery, lasting a mere one-and-a-half hours, that allowed him to sleep in his own bed that night, and, more importantly, play the violin again.

This inspirational story was made possible at the skilled hands of neurosurgeon Dr. David Yeh. "The beauty of the motion procedure," said Dr. Yeh, "is it involves an implant that is flexible yet stable enough to allow for movement without the invasiveness and decreased range of motion associated with spinal fusion."

An Inspirational Neurosurgeon

Dr. Yeh is challenged on a daily basis to help patients continue doing what they love to do when their bodies cease to fully cooperate. It’s what he calls fighting against an aging machine that can’t be stopped. "The magic to life is to optimize movement," said Dr. Yeh. "And that is my ultimate goal, particularly for string players."

There’s another reason Dr. Yeh cares so much about motion, movement, and string players. He is a violinist.

I can attest to his musical abilities having heard him perform live and written about him in the past. He knows only too well that spinal degeneration is accelerated in us fiddlers due to the stress we put on our joints. His senior thesis, titled "Neurophysiology of Violin Playing," was a preview of where his thinking was headed even before his formal medical training began.

Dr. David Yeh
Dr. David Yeh, neurosurgeon and violinist.

Dr. Yeh, who performs several surgical motion procedures each week, compares these outcomes to traditional fusion surgery in musical terms. "A piece played one way is a caprice; another way, it’s an etude." And while spinal motion procedures may seem revolutionary, it’s basically the same technology that turned traditional hip and knee fusion of the past into the now-standard joint replacement procedures that allow for continued range of movement and mobility.

Dr. Yeh is quick to point out that when patients come to need a spine surgery, the choice between “fusion” and “motion” is a complicated clinical decision that requires extensive discussion with each individual patient. He wants to be an advocate for string players as they contemplate whether motion therapy might be an option when they require surgery. “There’s no question that fusion surgery is effective. It can decrease pain and increase nerve function and that’s no small feat. Over time, however, the areas above and below the fusion break down also, so it’s not necessarily the optimum fix. The motion procedures involve using spinal instrumentation that allows movement at the joint, thus preserving or restoring function as best as possible. My hope is that string players, with their very specific physical needs, will understand there may be other options that could help prolong their ability to play.”

Case Studies and the Case for Tele-Medicine

Paul’s experience is one of many such success stories for Dr. Yeh. A 52-year-old violinist with severe neck pain, pronounced left arm weakness, and multiple degenerative disks compressing the spinal cord and nerves, was offered fusion surgery locally. Again, it would have markedly decreased her ability to play the violin. She flew cross-country to see Dr. Yeh, who she describes as a "gifted and humble surgeon and human being." Two short days after a two-hour outpatient procedure, her left arm was full strength and she had gained dramatic movement in her neck.

Then there was the 71-year-old with herniated disks in the neck. She had been told that her options were either a major fusion surgery or a painful decompression surgery from the back of the neck. Dr. Yeh took a hybrid approach, which was to remove the deteriorated disk and then stabilize the area above a previous fusion with a flexible artificial cervical disk.

But you don’t have to fly to California to have a consult. "Covid has proven that tele-medicine works. It’s convenient, cost-effective, and allows patients to consult with doctors in different geographic areas." Dr. Yeh is one of many surgeons who consults with patients around the world about surgical options – patients who may well then have the procedure done in their home state.

Music As We Age

I ponder aging endlessly. I do understand the alternative, and it’s not a pleasant one. But I’m staggered by how many times I see the way a youthful body is capable of moving and I get the harsh slap in the face of knowing that I could no more do that than fly. I see young girls in my neighborhood practicing back flips on their lawn. I think, "How does a body even do that?" I see my adult son lace up a pair of hockey skates, speedily escaping body slams, and think, "No!" Thankfully, I’ve never once watched a violinist and thought, "I remember when I could do that." Because I still can do that.

But I’m heartened to know that if there comes a point when I start to experience back or neck issues, there are compassionate surgeons out there, like Dr. Yeh, who will give me as many options as possible to maximize my movement and keep the violin in my life.

Dr. Yeh’s compassion stems from his own experience as a musician. And he manages to keep music at the forefront of his life, as performer, audience member, and financial supporter. He’s fortunate that his college violin professor made sure he understood there were "many ways to have a rewarding musical life short of being a concert violinist." He’s been able to understand how important music is to those string players who come to him for help, be they professionals or amateurs. From his perspective, it makes no difference whether they play for a living or strictly for enjoyment. He understands that making great music is the desire of any musician.

Dr. Yeh says there is nothing sweeter to a surgeon’s ears then when a patient says he’s given them their life back, they are no longer in pain, they are active and enjoying life again, and they can resume playing their instrument. "It just doesn’t get much better than that."

He has made it his mantra to make sure there is movement, mobility, and music in his patients’ lives. "We are blessed to retain the movement and mobility that allows us to make music over the course of a lifetime. It’s worth whatever we must do to sustain it."

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May 23, 2023 at 01:48 AM · Wow!! What a fantastic article. Thank you for addressing this issue, I’m sure it speaks to many of us.

May 23, 2023 at 03:50 AM · Amazing article, Diana! I was beyond fortunate to work for Dr Yeh when he was just starting out in New Orleans almost 20 years ago. It was my first career out of graduate school and I never imagined that a doctor, much less a neurosurgeon, like him existed. Dr Yeh's compassion is unmatched. His surgical skills and musical abilities still leave me speechless. Dr Yeh is a true VIP - after all these years, I am grateful to call him a friend.

May 23, 2023 at 05:11 AM · Thanks for an excellent article, Diana, and Emmie for sharing your memories!

May 23, 2023 at 06:36 AM · I'm sure Dr Yeh is a good surgeon with many successes but all pioneering surgeons are risk-takers and risk-takers have failures too. Ideally one would like to see the results of cohort studies and long-term follow-ups, but statistical evaluation is seldom possible when numbers are small and every case is subtly different.

May 23, 2023 at 01:42 PM ·

Before ever risking back surgery, I would consult with a physical therapist who specializes in orthopedic rehabilitation. Years ago, I had lower back pains and spoke to my PCP about them. He ordered x-rays that were examined both by he and a radiologist. My PCP was an excellent physician who was educated at Stanford. But neither he nor the radiologist could detect a problem. So, I chalked it up to old-age.

Eventually, the pain got worse and extended from the lower back down into my legs along the sciatic nerves on either side. I spoke to my PT who indeed specialized in "OR", and he immediately diagnosed the problem. After about three weeks of twice per week treatment, and following through on home exercises, the pain was gone. It was like "magic," though there was a lucid explanation of what I was experiencing. My PT commented that, there are some skeletal/joint problems that physicians aren't trained to see. My problem was a case in point.

May 23, 2023 at 01:51 PM · Suzanne: Thank you so much! It is such an important issue for many of us (now or in the future).

Emmie: Lovely to hear of your personal experiences with Dr. Yeh!

Richard: I'm always so happy to hear from you!

Steve: Agreed on all counts. Thank you for reading and commenting!

Neil: Thank you for your comment and I'm so glad that things worked out for you! I agree that surgery should be one of the last options. And I'm personally glad PT is available!

May 25, 2023 at 05:31 PM · Excellent article, Diana. Surgeons are magicians who get in there and fix what needs to be fixed. But, being surgeons, they usually see surgery as the best option. What’s that saying, “if you’re a hammer, everything looks like a nail!”? When my hands developed arthritis, I was given the option of fusion surgery, which would have limited my ability to play the cello. I chose another route, thankfully. How great to know that there is a Dr. Yeh in this world who understands our need to keep playing this glorious music to feed our souls and those around us.

May 25, 2023 at 06:08 PM · Great to know that there are options!! Even better to know that there are surgeons who realize how important music is to the quality of our lives.

May 25, 2023 at 10:05 PM · David: Thank you for your comment and for sharing your personal story! I have to say that in my many discussions with Dr. Yeh, he is tends to look at surgery as the final option, after many other non-invasive options have been exhausted. I'm glad you are still playing the cello (as I happen to know that you are very good).

Teresa: I agree 100%!

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