Joseph Mishkin, 78, a real estate agent from Delray Beach, was an active father and grandfather with a passion for golf before finding himself trapped by debilitating pain that stole his mobility and his independence.

His story, however, would take a sharp turn on a path to a remarkable recovery thanks to a breakthrough procedure that offered him a second chance at a pain-free life. The surgery — or “facet arthroplasty” — was led by Frank Vrionis, M.D., Ph.D., neurosurgeon and chief of surgery at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health.

Dr. Vrionis is one of a few surgeons in South Florida providing this alternative to the more traditional spinal fusion procedure. It uses a system approved by the U.S. Food & Drug Administration (FDA) just five years ago under an expedited approval process for products that target serious or life-threatening conditions, and offer substantial improvement over existing options

The Weight of Excruciating Pain

Mr. Mishkin's struggle began with sciatica, a familiar ailment for many. For years, he managed it. “I've had sciatica pain for maybe a few years,” he recalls. “Tried shots, tried everything – physical therapy -- couldn't get rid of the sciatica pain, but I lived with it.” But then, the pain intensified and migrated, becoming an unbearable force that brought his life to a halt.

“Then I got the pain on the right side and front side, and that was even more excruciating and basically debilitating,” Mr. Mishkin explains. The vibrant real estate agent who once thrived on activity could no longer perform the simplest tasks. “I'm a real estate agent and I couldn't do my job. I couldn't drive. It was just a very bad situation. I hunched over. I used a walker. So, it was to me a very dire situation and I knew I had to take action.”

A Glimmer of Hope in a Phone Call

Traditional solutions often point toward spinal fusion, a procedure that permanently joins vertebrae to stabilize the spine but sacrifices natural movement. This option felt like trading one limitation for another. The turning point came unexpectedly, during a conversation with a friend.

“When you have this kind of pain, you sort of tell everybody,” Mr. Mishkin says. His friend mentioned a new type of surgery, an alternative to fusion that preserved motion. “The concept is — instead of a fusion, they put in a device that actually goes between the vertebrae, instead of cages. And it actually flexes and moves with you. So, you're kind of hopefully back to somewhat of a normal life without the stiffness of a fusion.”

This new procedure was facet arthroplasty. Intrigued and desperate for a better option, Mr. Mishkin sought out one of the few surgeons in South Florida skilled in this innovative procedure: Dr. Vrionis, at Marcus Neuroscience Institute at Boca Raton Regional Hospital

The Breakthrough Procedure: Facet Arthroplasty

Dr. Vrionis diagnosed Mr. Mishkin with spondylolisthesis, a condition where a vertebra slips forward, and associated spinal stenosis, a narrowing of the spinal canal. These conditions were the source of his intense back and leg pain. While other physicians had only presented fusion as a solution, Dr. Vrionis offered a path toward motion preservation.

“This type of diagnosis essentially leads us to two paths,” Dr. Vrionis clarifies. “One path is fusion, and the other path is motion preservation and facet arthroplasty.” He notes that many patients are unaware this alternative exists. “The unique part about Joseph, is that he was not given any other option other than fusion before coming to us... I see that every day in the clinic.”

Facet arthroplasty involves replacing a damaged facet joint—the small joints that connect vertebrae and allow the spine to bend and twist—with an artificial one. This system is the first and only such device approved by the FDA for the lumbar spine. It stabilizes the spine while preserving its natural range of motion.

“Facet arthroplasty is a new procedure,” says Dr. Vrionis. “It received a breakthrough designation by the FDA because it's not only an innovative procedure — but also that it was superior to a fusion.” The pivotal clinical trial for the device demonstrated significantly higher rates of clinical success compared to fusion, with patients reporting better outcomes in pain, disability, and overall function.

A "Miraculous" Recovery

Mr. Mishkin, who had embraced the new technology with an open mind, underwent the procedure. The result was nothing short of life-changing.

“I came out of surgery from going in with excruciating pain to absolutely no pain in almost seven weeks now,” Mr. Mishkin says, his relief palpable. “I have my life back. Yesterday and the day before I drove to Miami, I couldn't get in a car for that long before. I was in a car for hours with a client and no pain. I was able to be myself again and be able to resume most of my activities.”

The recovery itself was remarkably swift, a key benefit of the procedure. “It was rather extraordinary to me that you can recover this quickly,” Mr. Mishkin remarks. “The process of recovery is two to three weeks faster because you don't have to deal with this extra idea of bone having to go over the cage.” Without the need for bones to fuse, patients can regain their mobility and strength more rapidly.

This swift return to normalcy is a testament to the procedure's design and the precision required to perform it. Dr. Vrionis emphasizes that accuracy is paramount. “Like any type of motion preservation procedure, it needs to be extremely accurate,” he states. “This is in contrast, to some degree, with fusion procedures which have more versatility as far as where to place things.”

Looking Ahead to the Golf Course

Today, Joseph Mishkin is a man transformed. The walker is gone, the hunch has straightened, and the excruciating pain is just a memory. He is back to work, driving clients, and living a full life. While he hasn't returned to the golf course just yet, it's a goal that is now well within reach. “Golf? Not yet. But we're working on that one,” he says with optimism.

Dr. Vrionis shares this goal for his patient. “Right now he's doing great, and I believe he will continue to do great in the future. Our goal is to have him hit some golf balls very soon.”

Mr. Mishkin’s story is a reminder that medical innovation continues to push boundaries. For thousands suffering from debilitating spinal conditions, the choice is no longer limited to living with pain or sacrificing motion with fusion. As Dr. Vrionis says, “There is a need to educate the public about new and effective procedures that would have better results for the patients in the long run.”

For Mr. Mishkin, this education came at just the right time. His journey from a debilitating condition to a restored life highlights the profound impact of matching the right patient with the right technology and procedure. As he puts it: “I don't know what to say except — it's a bit of a miracle.”