Only ten years ago if you had spine surgery, you could expect a long recovery, in some cases, as much as a year. Now, thanks to minimally invasive surgery (MIS), what used to result in a week long hospital stay has been reduced to a few days or less. Recovery time has decreased from a few months to a few days and while there used to be long incisions, now it consists of a few small scars. Minimally invasive can mean faster recovery, shorter hospital stays, less blood loss during surgery, reduced pain and the need for pain medication postoperatively.
Minimally invasive surgery utilizes techniques that decrease injury to the muscles and other soft tissues. The surgery performed under the skin is very similar to that which is performed by traditional techniques. To perform these surgeries safely, we utilize varying technologies to visualize the spine including the naked eye, microscopes, radiography, and endoscopes.
Orthopaedic surgeons have used minimally invasive surgery in other parts of the body since the 1970s. General surgeons pioneered laparoscopy for abdominal surgery to minimize the trauma caused to patients. Now the majority of gall bladder surgery and many hernias, appendectomies and some intestinal surgeries are performed through the scope. Cardiothoracic surgeons use smaller incisions to harvest a vein during open heart surgery. All of these improvements are done to minimize tissue damage and incision scarring to ultimately improve the patient's outcome resulting in the patient's return to daily activities and employment.
MIS can not be used with all forms of spinal surgery nor is it appropriate for all patients. Although we continue to improve the field of minimally invasive surgery, it is continuing to rapidly evolve. We now can repair herniated discs. We can perform spinal fusion, which is used on degenerative discs and we can perform some deformity corrections such as for scoliosis. Finally, we can restore a fractured vertebra with a procedure called Kyphoplasty. MIS is on the move, all to the benefit of the patient. Let's be specific about some of these procedures.
Minimally Invasive Fracture Reduction (Kyphoplasty)
The majority of vertebral compression fractures are a result of osteoporosis. Now there is a way to restore the height of the vertebral body as well as eliminate the pain of the fracture. Through two small incisions, we can create narrow pathways into the fractured bone and insert two tiny balloons. The balloons are inflated to restore the bone to its original shape. Once this has been done, the balloons are deflated and removed and bone cement is inserted. The pain from the fracture and surgery is gone within a few days.
Kyphoplasty can be performed on compression fractures that have not fully healed in their current position. The procedure is usually done under general anesthesia, takes about 30-45 minutes and an overnight stay in the hospital. The next day you can fully resume your normal activities.
Minimally Invasive Spinal Fusion
Spinal fusion surgery is performed in an attempt to decrease pain caused by arthritis or painful degenerative discs. Most of these surgeries are performed via a midline incision in the area of concern. The surgeon lifts the spinal muscles off of the bone and proceeds to bone graft the area followed by placement of screws and rods. Recovery from this type of surgery can take several months.
Minimally invasive fusion utilizes smaller incisions located over the area of the screw and rod placement. Under the skin, screws, rods and bone grafting are performed; however, the injury to the muscles is significantly reduced. Blood loss is significantly less as well as the need for pain medication. One can return to full time employment within weeks compared to much longer recovery times with traditional fusion surgery.
Similar to minimally invasive fusion surgery, we can now decompress pinched nerves from spinal stenosis with MIS. When spinal fusion is not necessary, it's possible to have the surgery with minimal tissue injury and be discharged the same day as surgery. This can also be performed in conjunction with the minimally invasive fusion. Again, pain is minimal with this approach.
The discectomy is now commonly done using this approach as well. Muscle injury is reduced by making the skin incision directly over the herniated disc. During the surgery, the portion of the disk that is irritating the nerve is removed. Patients are usually discharged the same day of surgery. The standard discectomy and the minimal approach both yield excellent results in 90% of patients.
Expertise at the Sonoran Spine
Not all surgeons are trained in minimally invasive surgery. There is a steep learning curve for these procedures and although there are distinct advantages of these procedures, it is important that your surgeon be totally skilled at these newer techniques. MIS is certainly bringing an exciting future to spine surgery as this field continues to evolve.
The physicians at the Sonoran Spine pride ourselves in being leaders in the field of spinal surgery. We are actively involved in the development and teaching of these minimally invasive techniques. Dr. Crandall has been involved with Kyphoplasty since its inception in this country. He has published several papers about the outcomes of our patients at Sonoran Spine. We are also involved with the development and teaching of minimally invasive fusion surgery for one and two level degenerative disc disease. We are active recruiting surgeons to Phoenix to learn this technique. We are committed to continually improving outcomes from spine surgery. Ask us if these minimally invasive techniques can be utilized in your particular situation.