By Heidi Lading Kiec
Some of you may recall a grandparent or elderly neighbor constantly stooped over and in pain after an open-back spinal surgery. Previously, patients having surgery to treat lumbar stenosis, essentially a spur or bony callus on the spine, had muscles cut and bones and ligaments removed in order for the surgeon to even begin addressing the pathology of the pain. Hospital stays were nearly a week, recovery time could be months, and up to eight-inch scars remained.
“When you remove all that bone and ligament it destabilizes the spine and leads to more degeneration and more chronic back pain and makes it more likely for a subsequent fusion,” says Jonathan Citow, MD, founder of the American Center for Spine and Neurosurgery in Libertyville and the chief of Neurosurgery at Libertyville’s Advocate Condell Medical Center. Luckily, significant advances in robotic technology and three-dimensional image-guidance systems allow today’s neurosurgeons and orthopedic spinal surgeons to perform minimally invasive spinal surgeries with far better results than surgeries in the past.
In the United States, 31 million people experience low-back—or lumbar spine—pain at any given time, and experts estimate that as many as 80 percent of Americans will experience a back problem at some time in their life.
Minimally invasive back surgeries are growing in popularity, especially for pain radiating down the leg (lumbar radicular pain), caused by pressure on the nerve from a herniated disc, a slipped disc (spondylolisthesis), or stenosis. To alleviate a patient’s pain due to compression of a nerve, doctors can perform a minimally invasive decompression surgery such as a microdiscectomy, where only the portion of the herniated disc that is pinching the nerve root is removed; or a laminectomy, in which the roof (lamina) of the vertebrae are trimmed or removed to create space for the nerves leaving the spine.
These surgeries, performed often as outpatient procedures, involve the use of a guide wire inserted through a small incision and placed with the assistance of a fluoroscope, a special type of X-ray machine. A series of tubes are placed over the guide wire to gently spread the muscular fibers and sequentially dilate the tissue down to the vertebrae. Then, the guide wire is removed, a tubular retractor is placed over the tubes, the tubes are removed, and a small microscope is brought into the surgical field to provide visualization for the doctor performing the surgery. Specialized instruments and microsurgical tools are inserted through the same port to perform the surgery. This all happens through an incision that, when healed, resembles a paper cut.
Beejal Amin, MD, a spinal surgeon at Loyola University Medical Center, specializes in minimally invasive spinal surgery. “Patients benefit tremendously due to decreased blood loss, less postoperative pain and shorter recovery time compared to traditional open operations,” he says.
Minimally invasive back surgeries go beyond spinal decompression. Cysts and tumors on the spine can be removed, spinal fusions can be performed, and treatment for deformity corrections, such as scoliosis, are also gaining in popularity.
According to Citow, if a patient is under the care of a surgeon with a good skill set, the risks of minimally invasive back surgery should be far less than the risks of open surgery. The latter risks, which occur in less than 1 percent of cases, include numbness, hemorrhaging, cerebral spinal fluid leakage, infection, nerve root injury, failure to improve and reherniation. But the benefits of minimally invasive surgery are smaller incisions, less anesthesia, shorter hospitalization, less operative trauma to adjacent tissues, faster recovery and less postoperative pain.
“Minimally invasive spinal surgery is not minimally effective,” Amin says.
One rainy day, general practitioner Mathangi Sekharan, MD, slipped and fell and injured her back. Yoga and physical therapy helped reduce her pain at first, but after several years, the pain got worse.
“It got to the point where I had severe leg and back pain, and I couldn’t stand for 10 to 15 seconds to check a patient’s blood pressure,” Sekharan says. “I was in pain all the time.”
She put off having surgery with Citow because she thought it would mean missing too much work. It wasn’t until her 80-year-old mother went to Citow for a minimally invasive hemilaminectomy and started traveling within two months that Sekharan changed her mind. She underwent a right-sided L5/S1 hemilaminectomy with partial discectomy on a Monday, was riding a bike that Friday and returned to work one week after her surgery.
Sekharan and her mother are, literally, walking endorsements for minimally invasive spinal surgery as a transformational approach to alleviating back pain. It’s not your grandparents’ surgery indeed.