It is estimated that 80% of the population suffers from back pain at some point in time during their lifetime. Patient’s seeking treatment for back pain is one of the most common reasons for doctor’s office visits.
Pain interferes with every aspect of life’s daily activities; including sleeping, standing and working. Recent advancements in technology have made vast improvement in treatment options and can help reduce the negative effects of back pain.
Conservative treatment options include physical therapy, chiropractic adjustments, exercise. When non- surgical and conservative treatments fail, surgery may be required.
Traditionally, treating conditions such as sciatica, bulging or herniated discs, stenosis, disc degeneration or spondylolisthesis have required extensive and invasive surgical procedures. Recovery for certain types of spine surgery would require a week, maybe more, in the hospital, yield lengthy incisional scars, and require perhaps a year recovery time.
Minimally Invasive Spine Surgery (MIS) has evolved with the desire to minimize muscle trauma and shorten recovery time. MIS represents a major change in the way spine surgery is being done. MIS minimizes disruption of surrounding tissues through the use of tiny portals or incisions, thereby reducing blood loss, anesthesia time, post-surgical pain, hospitalization and healing time.
A disc herniation occurs when the soft spongy portion of the disc bulges or ruptures outside of its normal location. This results in pressure and irritation of a nerve root producing sciatica. Patients may report severe, disabling pain, numbness, and weakness in the extremity. When surgery is performed a18-mm incision is made over the disc space involved and a small window in the bone is made with a high speed drill. The nerve root is carefully moved and the disc fragment is evacuated. The procedure lasts 30-45 min and the patient is discharged within a few hours of the operation. Patients generally report significant improvement in their pain almost immediately.
For some patients with spondylolisthesis, degenerative disc disease, or back pain associated with nerve root compression fusion surgery may be the treatment of choice. Fusion requires the healing of one bone to the next, in this case one vertebra to the next. Numerous techniques exist and fusion can be performed via the front of the spine or the back. When addressing this from the back this can be done via a transforaminal lumbar interbody fusion (TLIF). The advantage of a TLIF is that it addresses fusion in the front of the spine as well as the back of the spine all with one procedure. It is performed through the foramen of the nerve root (nerve tunnel) which avoids working within the canal which may damage the nerve or create scar tissue around the nerves. Using the small tubular retraction system the disc is removed and an implant is placed between the vertebra to restore disc height and to provide a means for fusion (interbody fusion). Then screws and rods are placed with the use of x-ray through two very small stab incisions. Blood loss is usually small and one to two days in the hospital are all that is needed.
Spinal stenosis is a condition that most often arises as a result of an arthritic narrowing of the spinal canal. This creates a condition causing buttock or leg pain which may be worse with standing or walking and improves with rest. For those needing surgery for this condition several possible procedures may be available. Using x-ray to localize the incision site the contributing bone spurs and lamina are easily visualized and removed with use of a high speed burr. This opens up the nerve tunnels allowing in relief of buttock or leg pain. The entire spinal canal is visualized from one small portal and multiple levels can be addressed. Some patients may require fusion for their condition and this would change their course of treatment. Patients can be discharged same day depending on their age and tolerance of pain.
These are just a few of the spinal disorders treated well with minimal access techniques. It is important to point out however that not all conditions can be treated with minimal access techniques. Please be sure to discuss these options with your surgeon.