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Joe Esposito in an exam room at Connecticut Neck and Back Specialist, LLC. with Dr David Bomback. Esposito recently had ground breaking back surgery, the first one done in the state, to fix a herniated disc, by Dr David Bomback. Friday, July 9, 2021, Danbury, Conn. Esposito was attending his first follow-up appointment.

Joe Esposito talks Friday with Dr David Bomback during a follow-up to his back surgery. Esposito recently had groundbreaking back surgery, the first one done in the state, by Bomback.

Joe Esposito looks at an x-ray, that shows the device implanted in his back, with Dr David Bomback during a follow-up to his recent ground breaking back surgery. Friday, July 9, 2021, Danbury, Conn.

Joe Esposito looks at an x-ray, that shows the device implanted in his back, with Dr. David Bomback.

Joe Esposito talks with Dr David Bomback in his office after a follow-up to his back surgery. Esposito recently had ground breaking back surgery, the first one done in the state, by Dr Bomback. Friday, July 9, 2021, Danbury, Conn.

A model of the device Dr David Bomback implanted in Joe Esposito's back during recent ground breaking back surgery, the first one done in the state. Friday, July 9, 2021, Danbury, Conn.

Joe Esposito waits in an exam room at Connecticut Neck and Back Specialist, LLC. Esposito recently had ground breaking back surgery, the first one done in the state, to fix a herniated disc, by Dr David Bomback. Friday, July 9, 2021, Danbury, Conn.

Joe Esposito talks with Dr David Bomback during a follow-up to his back surgery. Esposito recently had ground breaking back surgery, the first one done in the state, by Dr Bomback. Friday, July 9, 2021, Danbury, Conn.

Joe Esposito talks with Dr David Bomback in his office after a follow-up to his back surgery. Esposito recently had ground breaking back surgery, the first one done in the state, by Dr Bomback. Friday, July 9, 2021, Danbury, Conn. Bomback is showing a model of the device he implanted in Esposito's back.

DANBURY — On a Thursday in mid-June, Dr. David Bomback scrubbed-in for surgery and prepared to do what no Connecticut surgeon had done before.

He was performing a groundbreaking lower-back surgery on 36-year-old Joe Esposito, a physical therapist from Sandy Hook, to insert a new device that could help prevent Esposito’s spinal disk from re-herniating.

“We've been looking at this problem for years and years and we said, is there any way that we can repair the defect?” Bomback said.

The lower-back implant, called a Barricaid Anular Closure Device, has been in development since the 2000s, but only received Food and Drug Administration and premarket approval in March 2020.

“We were in the unique position of getting our final FDA approval about 72 hours before elective surgeries shut down,” said Maddox Kay, a senior marketing associate at Intrinsic Therapeutics, Inc., the company that makes the device.

As a result, initial rollout and sales were slower than expected, but have since started to gain momentum, Kay said.

Now, Esposito is Connecticut’s first resident to get the implant.

“No one else [in Connecticut] has attempted to do it,” Kay said.

Despite the event’s novelty, the doctor-patient duo have history.

As health care professionals working in complementary fields, Esposito and Bomback have known each other for several years, having referred patients to each other for surgery or physical therapy. So when Esposito needed help with his back, he knew where to go.

“We’ve referred so many people back and forth. I never thought I'd have to refer myself to him,” Esposito said.

On Friday, Esposito returned to Bomback’s office at CT Neck and Back Specialists in Danbury for his two-week, post-operation checkup.

“Everything went really great,” Esposito said. “They just did an X-ray to make sure the device was in a good place.”

Four days after surgery, he was able to stop taking pain medications. On day five, he was able to walk a mile.

Now, the husband and father of two young children said he’s feeling good and will be able to return to work six weeks post-operation.

The spine is a strong, yet finicky, structure, made up of a collection of bones — or vertebrae— stacked on top of each other with round disks of padding between each. With a tougher outer shell and a jelly-like substance on the inside, these essential cushions, or disks, protect the vertebrae and spine as you walk and run and move, acting as shock absorbers.

When someone herniates a disk — a result of a gradual wearing down, weight gain or physical injuries — the inside jelly leaks out through the disk’s outer layer and can press on surrounding nerves. Bomback gave the analogy of an oozing jelly doughnut.

Herniations are more common in men than women, and often occur between the ages of 35 and 55, according to the Cleveland Clinic. Intrinsic Therapeutics estimates about 350,000 to 480,000 lower-back disk surgeries, or discectomies, are performed every year in the United States.

This procedure removes the inner disk jelly that has leaked out of place.

Regardless of how it happens, herniated disks can sometimes result in intense and chronic pain, depending on location and severity.

For Esposito, his herniated disk was so painful it took him 45 minutes just to get out of bed one morning. That was when he knew something had to be done.

The new device Bomback inserted, made of titanium and mesh, looks a bit like an open car jack when implanted. By anchoring the titanium into healthy bone by the herniated disk, the device is able to remain steady while also covering the tear in the disk’s outer layer.

“Think about filling a pothole,” Bomback said. “Sort of like digging out the pothole, freeing it up and then we’re kind of filling it.”

Since Esposito’s job is highly physical, it was important to be able to get back to work and not worry about re-herniation, which could lead to another back surgery and more wasted time.

He talked with Bomback and did his own research, watching surgical technique videos and presentations on the device, “just to see exactly how they do it.”

For some patients with large tears, the chance of re-herniation of larger disks can be as high as one in four. That’s where the device comes into play.

Bomback said results have shown the new technology reduces the chance of re-herniation to about 10 to 11 percent. If a patient’s herniation is large enough, it makes sense to try to reduce the re-operation odds.

“Twenty-five percent is a pretty large number,” he said. “If we can knock that number down from 25 percent to about 10 or 11 percent, that's a pretty significant reduction.”

Since that successful first procedure, Intrinsic has reached out to Bomback to see if he would train other surgeons to perform it.

So far, Intrinsic has virtually trained more than 100 surgeons, and Kay estimates the device has been used in more than 30 states. Over 8,000 implants have been placed worldwide, with roughly 250 in the U.S., he added.

When Bomback told Esposito about the new surgical option, he explained that while he had performed thousands of disk operations, or microdiscectomies, and implanted thousands of metallic devices, he had never performed this particular surgery on a patient.

But he wasn’t nervous to be the first.

“I’ve been doing spine surgery for 17 years, and I do implants that are way more complicated and surgeries that are way riskier than this,” Bomback said.

Esposito also trusted that Bomback wouldn’t recommend a surgery unless he thought it appropriate.

“Dr. Bomback is not someone who's very knife-happy, which I really appreciate,” Esposito said. “He likes to go through all the other routes before doing surgery.”

Leading up to the surgery, Esposito said he was a little nervous, but mostly excited. He felt secure knowing that his doctor was confident with the device, but he also knew they wouldn’t be able to tell — until they opened his back during surgery — if the device would work for him.

A disk tear must be between six to 12 millimeters wide and four to six millimeters high to use the implant. Only about one in three patients who go in for surgery have tears large enough to accommodate the device, Bomback said.

This was not the first time Bomback had tried to implant the device.

“I tried this on somebody about six months ago,” he said. When I got in there, the defect was not the right size to accommodate the implant, so we had to abort the procedure.”

That was the first thing Esposito asked about when he woke up from surgery, Bomback said.

“Hey doc, were you able to put it in?” he asked.

Currie Engel covers health issues and the towns of New Milford and Brookfield for the News-Times. A graduate of Princeton University and Columbia Journalism School, she has worked for publications like The Houston Chronicle, Harper's Magazine, and TIME. When she's not reporting, Currie is usually reading, running, and singing, but usually not at the same time.