Complex Spine Surgery at Tallahassee Memorial Gets Jack Back to Enjoying ‘Paradise’
As a native North Floridian, Howell "Jack" Smith always enjoyed nature and being outside. For 28 years, he was a Physician Assistant (PA) for the United States Army and the United States Department of Veterans Affairs. Jack had a passion for activity—he often spent his days biking, sailing or skiing with his friends before medically retiring.
Jack spends his time between Marianna, Florida and Highlands, North Carolina. He considers Highlands his "paradise" for hiking and gardening, which are his favorite hobbies in retirement.
"My favorite thing about gardening is watching the plants die and grow back to life, kind of like a resurrection," shared Jack.
Pain Interrupts Passion
Over the last few years, Jack’s 'paradise' hobby had become more and more restricted due to his chronic neck pain. 
Jack developed cervical myelopathy, a chronic condition that occurs when the spinal cord in the neck is compressed, resulting in problems with fine motor skills, pain or stiffness in the neck, loss of balance and trouble walking. His neck pain started in the early 1990's, and he underwent three separate spine surgeries starting in the early 2000’s to help with his pain.
But none of his surgeries permanently cured his pain, and it started to affect his quality of life. By 2012, Jack could no longer participate in activities he loved, like biking, sailing and skiing. As a result, Jack's groups of friends started to see him less, and he was starting to feel isolated. In 2014, Jack medically retired due to his neck pain and moved to Highlands, North Carolina.
His son, Ryan, noticed both the physical and mental toll Jack’s neck pain was taking on him.
“I started to see his quality of life decline significantly due to his chronic pain; he could no longer function normally,” shared Ryan. “He was very active, but those things started to dissolve overnight with the pain. On top of losing the things he enjoyed, the pain he experienced made life more challenging.”
A Growing Issue
In 2009, to help treat his myelopathy, Jack underwent a cervical laminoplasty, a procedure to relieve pressure on his spinal cord. The laminoplasty was successful and led to spinal diffusion, where the spinal cord spreads out in the widened spinal canal, but this resulted in limited movement. Jack developed a degenerative condition that affected the joint between his atlas and axis vertebrae in the neck – atlantoaxial osteoarthritis (AAOA) -- and a condition that affects the bones in the upper spine or neck under the base of the skull, atlantoaxial instability (AAI). Both his AAOA and AAI eroded Jack's C1 and C2 vertebrae, causing extreme pain and chronic spinal instability, a condition where abnormal movement in the spine’s vertebrae occurs. This led to radiating pain and inflammation that compressed nerve roots in his spine.
When Jack turned his head slightly, an electric shock would go through his body. He limited his movement due to his fear of the pain, which got so bad over the next few years that Jack turned to pain management, which included medication.
Jack sought help for his pain from a specialist in Gainesville in April 2024. The specialists suggested an approach to help with the shock through his body, but it would still leave him with chronic pain and limit his ability to swallow and turn his head. He left the visit with the specialist feeling discouraged.
Finding a Solution at TMH
Shortly after his appointment, his son Ryan, the Chief Clinical Officer at TMH, met TMH's newest spine surgeon, Griffin Baum, MD, MSc. Dr. Baum is a fellowship-trained, board-certified spine and neurosurgeon specializing in complex and revision spine surgery of the cervical, thoracic and lumbar spine.
Ryan heard Dr. Baum was accepting new patients and quickly set up an appointment for his dad. From his first visit, Jack and Ryan knew Dr. Baum could help with the chronic pain, and Dr. Baum echoed that sentiment.
With the complications that arose from Jack's previous surgeries, Dr. Baum knew the best approach would be to find a comprehensive solution to ensure Jack did not need any further surgeries.
"You wouldn't give someone insulin to treat blood pressure – the diagnosis matters," shared Dr. Baum.
Based on his previous scans and procedures, Dr. Baum knew the best approach would be to address the issues above and below the main problem, rebuilding and performing a multi-level fusion from Jack's C1-T3 vertebrae. With the surgery date set, both Dr. Baum and Jack began preparing.
Dr. Baum fed Jack's MRI (Magnetic Resonance Imaging), CT (computed tomography) scans, and X-rays into UNiD™ ASI, an Artificial Intelligence algorithm that predicts how the body will react to help surgeons achieve goals and improve patient outcomes. This tool allowed Dr. Baum to simulate the surgery and design specialized implants made from cobalt chrome rods to match Jack's post-surgery alignment.
During the surgery Dr. Baum executed his customized approach for Jack. He placed personalized spine implants, devices used to treat and stabilize the spine, and screws. He also completed bone grafting, a practice that transplants bone tissue to rebuild damaged bone in the spine, and inserted metal rods. Throughout the surgery, Dr. Baum used the O-arm surgical imaging system, an intraoperative 2D/3D imaging system designed to view vital structures and ensure implants are correctly placed during surgery, making the surgery more efficient.
After five hours in surgery, Jack was transferred to Vogter Neuro and Trauma Intensive Care Unit (ICU) for four nights while he recovered. 
"Around the clock, the care was amazing – the nursing staff, physical therapists and physicians were all remarkable," Ryan shared about Jack's time in the ICU. "Dr. Baum provided his number to check with us throughout the weekend. The care coordination and communication of the ICU staff was truly incredible. We could not have asked for a better experience."
Immediately after surgery, while still recovering in the hospital, Jack noticed the primary pain was already gone. After five days in the ICU, he was discharged. Jack spent six weeks recovering at his home in Marianna with Ryan's help for the first few days.
"During this recovery, he was self-sufficient," said Ryan. "I had to pull him back and say, 'Don't over-do it.'"
Now, Jack has fully recovered from his surgery. "I went from laying on the floor crying to walking two to three miles at a time," said Jack. "I'm living my life again."
Getting Back to Paradise
Jack says he can enjoy paradise again by taking small hikes with his fiancée. He has been able to return to his garden and admire his favorite perennials without worrying about his pain. Jack believes God placed Dr. Baum in Tallahassee at the right moment so he could perform his surgery.
"Mr. Smith is a good example of the importance of seeking care from the right healthcare provider," shared Dr. Baum. "If you have issues with blood vessels and blockage in your heart, you will see a cardiothoracic surgeon. When you have a complex spine problem and have had prior surgeries, you must see a person who has training in revision spine surgery."
Could You Need Spine Surgery?
Neck pain is the fourth leading cause of disability and affects 30% of adults in the United States. While medication can help with the pain, it usually indicates an underlying issue with your spinal cord. To learn more about spine surgery available at Tallahassee Memorial HealthCare, visit TMH.ORG/Spine.
