Ask the Doctor

What is minimally invasive Spine Surgery?

Minimally invasive surgery attempts to accomplish the same treatment goal as with traditional surgery, but to do so with much less trauma to muscle and other tissues. Reducing such trauma generally leads to a shorter time to return to activities. Minimally invasive spine surgery is performed through small incisions and frequently uses specialized x-ray techniques in surgery to localize the areas to be worked on instead of opening the area for direct inspection. Some of the types of surgery that can be done using minimally invasive techniques are discectomy, fusion and the placement of screws and rods in the spine. Minimally invasive surgery techniques are sometimes used in conjunction with other spinal procedures to treat spondylolisthesis herniated disc, degenerated disc and possibly other conditions. However this method can not be applied to all patients.

I have recently heard about artificial disc replacement (ADR). What is involved and what types of patients benefit from the procedure?

Artificial Disc Replacement is the most significant advance in spine surgery in recent years. Artificial disc replacements are designed for the treatment of disabling pain from disc degeneration in either the neck or low back. They provide pain relief while preserving motion. Low back ADRs are designed to be used for low back pain, while neck ADRs are designed to be used when there is a pinched nerve from a damaged disc. A patient is generally not considered for lumbar (low back) ADR surgery unless they have failed to gain relief from active therapy with or without medications or injections for a period of at least six months and are being considered for a lumbar fusion. These artificial discs are put in through a small incision in the abdomen. Patients with previous abdominal surgeries in the area of their lower spine, patients with too large of an abdomen or patients with pain primarily coming from the joints in the back part of spine may not be candidates. An evaluation by a trained surgeon is necessary to make that determination. Cervical (neck) ADR may be appropriate if a patient has not responded to a minimum of six weeks of treatment with medication, therapy or injections and is being considered for a fusion. Patients with osteoporosis are generally not candidates.

I have off-and-on episodes of back pain, sometimes mild and sometimes pretty bad. I've put off seeing a doctor because I'm not sure what to expect and I don't want to have surgery. What are my other options?

Many patients are hesitant to see a spine surgeon because they are afraid they will need to have surgery. The truth is that very few back pain patients go on to have surgery – in fact, only a small percent need to have an operation. Generally the doctor will examine you and take your history. If serious problems such as tumor or infection, which are very rare, are ruled out, most patients receive care in the form of medication, physical therapy, and education about activities to reduce and/or prevent back pain. For many patients, this course of treatment provides acceptable relief. If significant pain persists, the doctor may order an MRI or other diagnostic tests to help determine where the pain is coming from. Injections into different areas of the spine may provide relief. If you have significant leg pain, one or more epidural steroid injections may be done to reduce painful inflammation around nerves in your back that pass into your legs. These injections can be done as an outpatient with sedation and x-ray (fluoroscope) guidance. Often patients can return to normal activities the next day. Surgery is generally not considered an option until after non-operative treatments have failed. It is always your choice whether to have surgery, and only after you and your doctor have discussed options and potential risks.

 

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