Minimally-Invasive Options for Spine Surgery
By Roger D. Sung, MD, Spine Surgeon at Colorado Springs Orthopaedic Group, Colorado Springs LIVING WELL Magazine
Eighty percent of the U.S. population suffers from back pain at some point in their life. While most back pain improves over time, many people need some type of intervention to relieve their pain. For patients with continual spine problems, there are many conservative options including physical therapy, medications, chiropractic, and injection treatments. When these options don’t work, many patients are offered surgery to address their spine problems.
Traditional spine surgery is usually an open procedure where the spinal muscles are moved in order to access the spine. This requires a large incision with increased pain and a prolonged hospital stay. Many patients requiring spine fusions are kept in the hospital for a week or longer. These surgeries have significant blood loss and often require a blood transfusion. The recovery times for these surgeries can be a year or longer.
Newer spine surgery techniques and equipment allow spine surgeons to access the spine through small incisions or portals. This is the same concept as arthroscopic knee surgery, laparoscopic abdominal surgery and robotic surgery. These minimally-invasive techniques achieve the same goal as open surgery, but with minimal trauma to the surrounding muscles. There is less operating time, minimal blood loss and recovery is much quicker. Patients requiring spine fusions often can have this done with an outpatient or overnight hospital stay and have better long-term outcomes.
Spine compression fractures are very common, affecting about 700,000 people per year in the U.S. These fractures can cause debilitating pain, lead to progressive spine deformities, and affect patients’ quality of life. Kyphoplasty, also known as vertebroplasty, is a minimally-invasive option to treat these fractures. Under X-ray, synthetic bone cement is placed into the fractured bone to stabilize and correct the spine deformity. This can give immediate pain relief. It is an outpatient procedure taking about 10 minutes per fracture level. It can be done with local anesthesia and sedation.
Lumbar disc herniations or spinal stenosis can cause compression on nerves resulting in sciatica or leg pain. Patients can also have numbness, tingling, weakness or heaviness in their legs. Surgery for this compression can be done through a one-inch incision or a tube. The compression on the nerves can be removed quickly as an outpatient procedure and patients often wake with complete relief of their leg symptoms. There are also interspinous spacer devices (e.g. X-STOP) that can be placed in the spine to make more room for the nerves. This can also give immediate relief of pain with minimal trauma to the spine.
Similarly, patients with disc problems in their neck can have spinal cord and nerve compression. This can cause arm pain and dysfunction, as well as problems with coordination and balance. Surgeries for this can also be done through a small incision to both remove the compression and stabilize or fuse the spine. This surgery can take less than an hour and can be done in an outpatient setting. Patients commonly awake with immediate relief of their symptoms.
Lumbar spine surgery is often needed when the spine is unstable and causes compression on spinal nerves. Traditionally, lumbar spine fusions were considered large dangerous surgeries with the potential for a lot of blood loss and extended hospital stays. Newer technologies have allowed spine surgeons the ability to successfully fuse the spine through minimally-invasive incisions or tube retractor systems. This provides safe access and visualization of the spine without large incisions or muscle trauma. Newer bone products allow for successful spine fusions without the need for a “bone graft.” This lessens post operative and long-term pain.
XLIF is a procedure where the spine is accessed from a one-inch incision in the patient’s side. Decompression and fusion of the spine can be achieved through this small incision with minimal blood loss and a short hospital stay. This and other techniques including facet screws and percutaneous screw options allow surgeons to perform these spine fusions in an hour. Patients can often have an outpatient hospital stay with a quicker recovery.
For patients considering spine surgery, an evaluation by an experienced spine surgeon is critical to determine if one of these minimally-invasive options is a viable alternative to traditional surgery. Patients are having better results with less operative time, shorter hospital stays, less blood loss and quicker recoveries. Overall, patients are much happier with their results both in the short and long term.
Roger D. Sung, MD, is a spine surgeon at Colorado Springs Orthopaedic Group and may be reached at 719-632-7669.
