Spine Surgery Offers More Opportunities to Cut Less
Date: November 30, 2009
Operating recently on a man who had broken his back in a car accident, Dan Sciubba made four 1-centimeter incisions and placed a grand total of four screws in the man’s spine. The patient left the hospital the next day. A decade ago, says the spine surgeon, he might have had to use eight screws, and the patient would have stayed in the hospital for at least three days.
Sciubba also recently performed a spinal reconstruction through a 4-centimeter incision, an operation that 10 years ago would have required him to expose a much longer segment of the patient’s spine via a 1-foot incision.
The credit for such improvements, says Sciubba, goes to minimally invasive surgery, an approach that many spine surgeons are finding more versatile than they had expected.
When surgeons used laparascopic tools in 1987 to remove a patient’s gallbladder, the procedure launched an explosion in the use of minimally invasive surgery in a variety of specialties. Spine surgeons, though, have taken longer to explore the approach, says Sciubba, and its application has been mostly limited to one procedure: decompression of a pinched nerve from a herniated lumbar disc.
Because of the spine’s incredibly complex anatomy and its proximity to the spinal cord, spine surgeons have been reluctant to use minimally invasive techniques, which do not afford a direct view of the surgical field, says Sciubba. However, improvements in the technology have made minimally invasive surgery safer, he says. Recent advances in surgical tools and spinal implants now allow surgeons to fuse fractures, decompress the spinal cord and nerves, and alter spinal alignment using minimally invasive approaches. “So if a surgeon is trained in these techniques, then the patient benefits from a less invasive procedure with less soft tissue destruction.”
Now, Sciubba and others with the proper training are performing minimally invasive spinal fusions, spine tumor removals and scoliosis corrections, among other procedures. “In the future,” says Sciubba, “I’d expect that most, if not all, spine conditions will have the option of being treated through minimally invasive approaches.”
He and other spine surgeons say the technique has several advantages. It causes less scarring and pain than conventional surgery, and generally allows surgeons to use fewer screws and other hardware. Patients also appear to recover more quickly and have a lower risk of postsurgical infection. In a recent study involving 1,338 spine surgeries, neurosurgeons at Rush Medical Center, Northwestern University and Vanderbilt University found that patients who underwent a minimally invasive procedure had tenfold fewer postoperative wound infections than patients normally experience following conventional spine surgery.
However, not all spine patients are good candidates for minimally invasive surgery, notes Sciubba. They include patients with certain complex spine deformities; those with primary spine tumors, in which case the surgeon would want to resect the entire tumor in one piece; and patients who have significant scarring from previous operations.
But for those who are candidates, says Sciubba, the technique potentially offers the chance to leave the hospital and resume normal activities sooner, and with less pain and scarring.
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