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Minimally invasive spine surgery
The overall goal of spine treatment should be to get at the root of the problem, causing the least amount of disruption to the patient’s lifestyle. Spine surgery is typically a choice of last resort, after all nonsurgical methods have been exhausted, or when problems like severely herniated discs or damaged vertebrae simply will not respond to nonsurgical treatments.
However, when surgery is the right course of action, it is essential for you to play an active role in selecting the best spine surgeon for you. You should look for a surgeon that specializes in spine problems rather than one that spends time treating patients with other needs, such as head, knee and shoulder injuries. As with anything else, practice makes perfect. The more a person does something, the better they get at it. The ideal spine surgeon is one who is fellowship-trained, spine-specialized and proficient in minimally invasive techniques.
About 200,000 Americans undergo fusion surgery each year in order to relieve pain from serious degenerative disc disease and spondylolisthesis. The outcomes from these surgeries are often unpredictable, and there is no guarantee of success. New developments in minimally invasive techniques have introduced improved ways the surgeon can access the spine, therefore making the recovery process smoother and easier. These techniques are expected to eventually replace conventional surgical approaches.
Traditional, “open” spine surgery can involve a three-inch long incision, in which muscles and tissues are separated for optimal access to the injury site. Due to the resulting trauma to surrounding tissues and the amount of blood loss involved, a several-week recovery period may be required for the affected tissues and muscles to heal.
Minimally invasive surgical techniques provide the opportunity to successfully treat back problems with minimal interruption to the patient’s regular, active lifestyle. Results achieved from these methods have been proven to match that of conventional “open surgery.” The surgeon makes smaller incisions, sometimes only a half-inch in length. Through these tiny incisions, the surgeon inserts special surgical instruments and probes in order to access the damaged disc in the spine. By using minimally invasive techniques, access and repair to the damaged disc or vertebrae is achieved without harming nearby muscles and tissues. Other benefits of minimally invasive techniques include shorter surgery duration and recovery time, less visible scars and reduced pain and blood loss.
Minimal access spinal technologies (MAST)
The development of minimal access spinal technologies (MAST) enables spine surgeons to create the least amount of invasion possible, while at the same time achieving identical results as open spine surgery. The use of these tools creates a smaller surgical area in which to work because of the acute accuracy they provide.
Types of Minimally Invasive Surgery
Microdiscectomy / Minimally invasive discectomy
Discectomy is the removal of the herniated portion of a disc to relieve the pressure on nearby nerves as they exit the spinal canal. Contrary to myths, the disc does not slip out of position like a watermelon seed. Instead, the disc is like a jelly donut, acting as the functional shock absorber between two bony vertebrae. An injury, damage from a lifting incident, or a twist may cause the jelly center to break through the wall of the disc. When a disc herniates, the jelly center can press on nearby nerves. This causes back or leg pain when the hernation is in the low back, and arm pain if the disc is in the neck area (see "cervical spine/neck").
In a lumbar discectomy, the surgeon typically only removes the portion of the disc that is causing a problem, not the entire disc. If you have a herniated disc, keep in mind that a disc has a purpose. When you remove a disc, it may cause instability in the joint, and a surgeon may recommend a fusion to re-stabilize the area.
The surgeon can remove the damaged piece of disc through a traditional incision in the back. However, at Spine Colorado, the surgeons typically use a microscope to minimize incision size, tissue trauma and recovery time. In addition, in some cases, minimally invasive discectomy can provide an even less invasive approach.
Depending on the nature of your disc problem, your surgeon will recommend the most appropriate type of surgery for you.
Interspinous Process Decompression
There is now a new device that helps correct spinal stenosis. Interspinous process decompression is the first minimally invasive alternative to conventional lumbar spinal stenosis (LSS) surgery approved in the United States. The interspinous process decompression implant has been clinically proven to greatly improve the most common symptoms of lumbar spinal stenosis, including symptom severity, physical function and patient satisfaction. LSS is a degenerative disease that is often associated with the narrowing of the spinal canal. The implant is designed to limit extension of the lumbar spine and therefore maintains the spine in a neutral or slightly flexed position, which increases the area of the spinal canal and decompresses the nerves. The interspinous process decompression procedure is performed under local or general anesthesia and has a low rate of complications. This procedure offers a less invasive option that was not available until now. Before this technology, common stenosis treatments included non-surgical therapies such as NSAIDs or injections to invasive procedures such as lumbar laminectomy, the most common surgical option.
Anterior lumbar interbody fusion (ALIF)
In this type of spinal fusion surgery, back muscles and nerves remain undisturbed. The space between discs is fused by approaching the spine through the abdomen. This procedure is used when the spine is relatively stable, when there's a significant amount of disc space collapse, and in cases of one or two level degenerative disc disease. The surgeon will approach the abdomen through an incision (minilaparotomy) or by using an endoscope.
Posterior lumbar interbody fusion (PLIF)
This spinal fusion surgery is very similar to the anterior lumbar interbody fusion, except that the surgeon approaches the spine through the low back. This method is used when there is a greater amount of instability in the patient's spine. An advantage to this surgery is that it can also provide anterior fusion of the disc space without having a second incision.
Lateral lumbar interbody fusion (XLIF)
This minimally invasive procedure is performed with by making small incisions on the patient's side. It is typically performed to treat leg or back pain due to degenerative disc disease. Making the incision on the side avoids major muscles of the back. Two incisions are made, the incisions are much smaller than traditional spine surgery. A probe is entered through one incision and instruments are guided throught the second incision. The probe is used to help detect and avoid interrupting nerves.
Dilation tubes are used to help create a larger incision for the probe. A retraction device may be used to access the spine and move aside muscle tissue.
The damaged disc is removed through the channel created by the surgeon. In order to realign the bones, an implant is used to fill the empty disc space. The implant may be filled with bone graft and helps relieve pressure from the pinched nerve roots. The bone graft forms a bridge connecting the vertebral bodies above and below the implant, this is known as a fusion.
Posterior Cervical Foraminotomy / Discectomy
For some herniated discs or bone spurs in the neck affecting only the nerve roots, a posterior discectomy and foraminotomy can be performed. This avoids spinal fusion, and with a microscope or a minimally invasive technique, can minimize recovery time and speed a patient back to work or activities.
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