In an area of western Colorado stretching from Durango to Wyoming and taking in Aspen and Moab, Utah, there are a lot of outdoors adventurers climbing mountains, skiing chutes, biking rocky trails and kayaking rapids. Those pursuits can result in spine damaging accidents. And the majority of the most serious of these injuries end up at St. Mary’s Medical Center where a group of four neurosurgeons share the expertise to cover nearly all maladies of the spine.

Neurosurgeons Basheal Agrawal, Robert Replogle, Edward Maurin and Brian Witwer make up the team at St. Mary’s Brain and Spine Surgery Center. The four neurosurgeons, all MDs certified by the American Board of Neurological Surgery, have been trained, and have the experience, to treat problems of the spine, from the more mundane like herniated disks to very complicated repairs of the most complex structure in the human body.

Each of these surgeons has distinct areas of special interest so that, as a whole, the group can now repair and treat nearly every spinal problem that turns up in emergency rooms and exam rooms in St. Mary’s large treatment area.

The medical quartet handles more complex brain and spine emergency and trauma problems than are seen at any other hospital between Denver and Salt Lake City. Only a handful of brain and spinal problems now need to be sent to specialists in those cities.

“We deal with tons of trauma,” said Dr. Replogle, who came to St. Mary’s from Rochester, N.Y., in 2016. “We are the only neurosurgeons taking trauma calls between Denver and Salt Lake City.”

As much as 80 percent of the Brain and Spine Surgery Center practice involves treating spinal problems.

Plenty of them result from accidents and trauma, but many are linked to common back issues. Nationally, more than 80 percent of the population has back problems at some time. By age 40 about half the population already has a back problem. By age 70, virtually everyone has something wrong in the spine.

National studies have shown those spinal problems have the greatest impact on the ability to work and on health care costs than any other musculoskeletal condition. Injuries to the spinal cord are considered the most physically and financially devastating.

The complexity of the spine and its link to virtually every other part of the body have a lot to do with the prevalence of spine-related problems.

Replogle describes the rest of the body as being “draped around” the spine. The spine is at the core of what is essentially a complex series of pulleys and levers that keep humans upright.

The discs that cushion the bones of the spine can be herniated, or what is sometimes referred to as “slipped.” The spinal column can grow narrow as it ages and impinge on the nerves that travel through it. Areas of the spine can become unstable, making the spine unable to maintain its normal configuration. Tumors can grow on the spine.

In the adventuring crowd, as well as in vehicle accidents, and in gunshot and knifing victims, spinal damage can cause death or paralysis.

The four St. Mary’s neurosurgeons are trained to surgically fix those problems and to stand ready to do so in traumas. That can mean surgery, but they say a large part of their practice is keeping people out of surgery. Only about one in 10 patients at the Brain and Spine Surgery Center undergoes surgery.

The remainder are treated with various therapies and lifestyle changes so they can avoid surgery. Sometimes, it is simply a matter of waiting out painful problems that will correct themselves.

“We are very conservative when dealing with elective spinal surgery,” said Dr.

Maurin, a graduate of Grand Junction High School who three years ago realized his dream of returning to Grand Junction to practice.

Maurin said an important part of the Brain and Spine Surgery Center is correctly choosing when to do surgery.

“It is all about proper selection of surgery candidates,” Maurin said.

When surgery is the best option, in the past decade minimally invasive surgery has become the gold standard for treating many problems. Tiny incisions are made alongside the spine to repair or replace discs, to fuse areas of instability and to remove tumors. To prevent damage to the many muscles that wrap around the spine, surgeons use a series of miniscule metal ‘straws’ that hold the muscles aside while they make these repairs.

The minimally invasive surgeries have a lot of pluses: less blood loss, less need for narcotics, and more rapid recoveries.

But when the problems are complex, the major surgeries that Dr. Agrawal specializes in can save lives and functioning, while enabling patients to remain on the Western Slope.

“Our goal is to take care of the whole spectrum of neurosurgical disease. We now have virtually every subspecialty represented in our practice,” Dr. Replogle said.

“We don’t want to have to send anyone out if we don’t have to.”

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