Minimally Invasive Spine Surgery

What it is:

Minimally Invasive Spine Surgery is conducted through a small incision, usually with the aid of microscopes or other endoscopic visualization, such as small devices or cameras designed for viewing internal portions of the body.

 When needed:

Minimally Invasive Spine Surgery is intended to treat disorders of spinal discs with minimal muscle related injury and to allow rapid recovery. Traditionally, surgical approaches to the spine would generally necessitate a longer recovery period. Prior to the use of microscopes while operating, a large incision was needed to visualize the herniated lumbar disc; thus, large sections of the back muscles were detached from their spinal support. 

Conventional surgery, with the larger incision, is responsible for the majority of the post-operative pain and delays return to full activity. The degree of post-operative pain directly affects the dosage of pain medication, and an increase in dosage which can lead to an unwanted increase in side effects. 

Second, by dissecting the paraspinal muscles from their normal anatomic points of attachment, the muscles are required to heal through the process of scarring. The various layers of individual muscle scar to one another, causing them to lose their independent function. In addition, it has been discovered that this type of dissection may result in the muscle’s loss of innervation, or nerve stimulation, with subsequent atrophy. A permanent weakness of the back muscles may result either as a symptomatic dysfunction or as a hindrance to the patient’s overall function. 

With such significant muscle injury associated with traditional surgical approaches to the spine, there is an undeniable need for the development of a less invasive surgical technique. The newer minimally invasive procedures are intended to offer several major advantages, including:  

v     Reduced surgical blood loss and complications

v     Reduced use of post-op narcotic pain medicines

v     Reduced length of hospital stay

v     Quicker return to daily activities 

Success rates of minimally invasive microdiscectomy surgery for herniated discs now range from 88% to 98.5% in various series. 

Our approach:

Dr. Joseph Maroon has preformed on over 3,000 microdiscectomy procedures. With an intimate working knowledge of the microsurgical approach to lumbar discectomies, Dr. Maroon remains firm in his belief that such a technique is the gold standard against which other procedures must compare. 

Our patients are positioned — an x-ray is used to confirm the correct disc space.

Once prepared, a 1 to 1.5 inch (about 20 mm)skin incision is made, and an operating microscope is brought into use. Using high speed drill a small window is made in the bone. Disc fragments are removed and pressure is released from the nerves which go to the legs for lumbar surgery or arms for cervical surgery.  If the surgery in done in the cervical spine the bone opening is fused.  Finally, sterile strips and a band-aid are applied to the wound. 

Patients are urged to ambulate immediately and are discharged within 23 hours, either the same day, or the following morning in 95% of the cases. Since our earliest reports, our results have stayed consistent. The average operating time is under an hour, and approximately 90% of our patients obtain good to excellent pain relief. Complications, such as dural tears, nerve root injury, and infections are under 1.5%; and long term reoperations remain under 5%.  No transfusions are required for this procedure as general blood loss is under 5 cc’s.   

Conclusions:

 

Proponents of MED (micro-endoscopic technique) assert that the primary differences with the microsurgical approach are: a smaller skin incision, muscle splitting rather than a separation, less postoperative pain, faster hospital discharge, and a quicker return to employment.  Once exposure through the tubular endoscopic system is obtained, the endoscopic technique for ligamentum flavum removal, discectomy, and foraminotomy are the same as that used in the microsurgical approach. 

With the microsurgical approach described above, virtually the same size surgical incision is made and the same surgical technique is used for discectomy.  The primary difference, therefore, is the muscle dissection versus a muscle splitting dissection which, is minor. Dr. Maroon, and others, have demonstrated the incision size, hospital stay, and results, and all are equivalent to that reported with the MED system.  The return to work interval is also comparable.  Recently, Dr. Maroon (Team Neurosurgeon for the Pittsburgh Steelers) returned an NFL defensive end to football in one month after minimally invasive microsurgical approach for a herniated fragment. 

Dr. Maroon and his Associates have spent the last 25 years investigating and reporting on minimally invasive approaches to the lumbar disc.  Their belief is that minimally invasive ways to treat lumbar and cervical disc disease is still the most safe and best technical available and continues to be the standard against which all other procedures must be measured. 

Disclaimer

Tri-State Neurosurgical Associates-UPMC
Office Addresses:
Administrative Oakland Office
Presbyterian University Hospital
Department of Neurosurgery
Suite 5C
200 Lothrop Street
Pittsburgh, PA 15213
 

Phone: 1-888-234-4357