MINIMALLY INVASIVE SPINE SURGERY
One of the goals of surgery has always been to minimize trauma to normal tissue and improve the recovery of patients postoperatively as rapidly as possible. In recent years with the advances in technology, it has become possible to target the surgical approach more accurately with appropriate imaging modalities in order to minimize associated trauma to normal tissue. Although cosmesis is not the prime indication for minimally invasive surgery, it is one of the byproducts of using a targeted surgical approach.
Significant advancements have been made in the field of spinal surgery. Today, patients of all ages are benefiting from new technology that allows surgeons to perform complex operations on the spine.
What is Minimally Invasive Surgery?
Minimally invasive surgery is a type of surgery that is performed through several small incisions (less than 1 inch in diameter), or puncture sites. An endoscope, a thin, lighted tube similar to a microscope, and surgical instruments are passed through these incisions. The endoscope enables the surgeon to view the problem area without having to make a large incision.
By completing the operation through small incisions, the surgeon can safely work on the spine without disturbing normal tissue. As a result, patients are less likely to develop complications, recover sooner, and can quickly return to normal activities. Many of these procedures can be performed as outpatient surgery. Controlled studies have proven that these procedures are safe, very successful, and cost effective.
Currently, minimally invasive spinal surgery is used to treat:
Patients who have a herniated disc typically complain of severe pain that radiates down the leg or arm. This pain is caused by a pinched nerve. Nerve damage may cause numbness, weakness, or partial paralysis. Candidates for surgery usually have pain that has failed to improve after at least 6 weeks of non-surgical care and have noticed little or no improvement in their condition. Often, they are unable to work or care for their families because of severe pain that requires the use of strong pain medicine.
Ruptured disc material (nucleus pulposus) in the spine is most commonly responsible for this pinched nerve. Minimally invasive spinal surgery allows the surgeon to remove the ruptured disc material using an endoscope along with special small instruments, including a laser. The surgery can even be performed under local anesthesia and most patients leave the hospital within 23 hours. Ninety-five percent of the patients leave the hospital with little to no nerve pain after surgery.
Spinal stenosis is a condition that results from degeneration and arthritis of the spine. Thickening of the bone and ligaments of the vertebrae narrow the spinal canal, which contains nerves. Nerve damage can produce severe pain, numbness, weakness, bowel and bladder problems, and in severe cases, partial paralysis. Patients typically feel better if they sit or lean forward. They have difficulty walking any distances without their legs going “dead” and many patients cannot shop for groceries without “hanging onto the cart.”
As with herniated disc surgery, minimally invasive spinal surgery allows the surgeon to remove the offending bone or tissue microscopically, thereby removing the pressure on the spinal nerves and improving the patient’s condition. Most patients leave the hospital within 23 hours and start physical therapy shortly after.
Spinal fusion is a process in which a number of vertebrae are made to grow, or “fuse” together. The surgery is performed for spinal instability, certain types of deformities (such as scoliosis), and for painful spine degeneration. The operation consists of placing bone between two or more vertebrae and using an agent to promote the growth of bone between the vertebrae. Over time, the vertebrae fuse together and can no longer move.
The surgery eliminates painful and damaging abnormal motion, reducing pain and increasing function in most patients. A special laparoscope (a type of endoscope), surgical instruments, and spinal cages (hollow, metal cylinders) can be placed between the vertebrae through puncture incisions in the abdomen to fuse the spine. Most patients having this surgery can leave the hospital in one day.
Spinal deformities such as scoliosis (curvature of the spine), kyphosis (hump back), fractures, and tumors require major surgical procedures from two approaches: the front and the back. Today, surgeons can use minimally invasive surgery techniques to work on the front and back simultaneously, in many cases eliminating the need for two separate surgeries. This approach has proven to be safer, to have fewer complications, to allow quicker recovery, and to be more cost effective in today’s managed health care environment.
What Patients Are Candidates for Minimally Invasive Spine Surgery?
First, the patient must be evaluated by a spine surgery specialist. This evaluation includes a detailed history and physical exam. At the initial visit, patients are asked to bring with them all previous information, test results, letters from physicians and surgeons, and any previous X-rays or imaging studies. Patients may also be asked to complete a spine information form.
Additional testing may include:
In our center, we perform minimally invasive surgery whenever possible and whenever it is safe to do so. For example in a lumbar discectomy, we routinely use either a microscope to perform a microdiscectomy or an endoscope to perform a surgical endoscopic discectomy. We also use percutaneous vertebroplasty or kyphoplasty to treat osteoporotic vertebral compression fractures of the spine. These procedures are performed quite often under local anesthetic.
In cervical surgery, a very small transverse skin incision enables a wide range of procedures to be performed including cervical disc replacement, anterior cervical fusion, and decompression to be performed effectively.
To achieve the required outcomes, meticulous preoperative planning, modified positioning of the patient on the operation table, use of image intensifier and the use of specialized instruments are all required.