Spinal Surgery: Advances
What are minimally invasive surgery and microsurgery?
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 with an attached camera) and surgical instruments are passed through these tiny 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.
Microsurgery is performed through very small incisions, using an operating microscope, and specially designed instruments. The microscope allows surgeons to perform delicate operations through an incision of 1 to 1½ inches in length. Traditional surgical methods for delicate operations require incisions from 6 to 10 inches in length.
Which types of spinal problems can minimally invasive surgery or microsurgery help?
Patients who have a herniated disc typically complain of severe pain that runs down the leg or arm. This pain is caused by a pinched nerve. Nerve damage may cause pain, numbness, weakness, or partial paralysis. Candidates for surgery usually have pain that has failed to improve after at least 6 weeks of nonsurgical care. 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. Microsurgery allows the surgeon to remove the ruptured disc material from the spinal canal using a microscope along with special small instruments. The surgery is often performed under spinal anesthesia only, and most patients leave the hospital within eight to 12 hours. Ninety-five percent of the patients report excellent pain relief after microsurgery.
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, microsurgery allows the surgeon to remove the offending bone or tissue microscopically, thereby relieving 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. An anterior fusion consists of placing bone between two or more vertebrae to promote the growth of bone between the vertebrae. Over time, the vertebrae fuse together and can no longer move.
The surgery eliminates painful, abnormal motion, reducing nerve irritation and increasing function in most patients. A laparoscope (a type of endoscope), special surgical instruments, and spinal cages (hollow, metal cylinders) are placed between the vertebrae through puncture incisions in the abdomen to fuse the spine. Most patients having this surgery can leave the hospital in two or three days.
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 than traditional surgical approaches.
Which 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:
Consulting with the patient, a spine surgery specialist will review this information and discuss options for surgical treatments, including minimally invasive spine surgery.