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Minimally Invasive Spine Surgery

By Dr Fong Shee Yan

Surgery on the spine that once required large incisions, hours in the operating room and extensive blood loss, can, in some cases, be done through an incision less than an inch long.

After the common cold, back and neck pain are the second most frequent reason that Americans visit the doctor, according to the North American Spine Society. Treatment of low-back pain alone costs Americans at least $50 billion each year and is the most common cause of job-related disability and a leading contributor to missed work.

Minimally invasive spine surgery, for the right patient, can make the sometimes difficult decision of whether to undergo surgery a little easier. In traditional spine surgery, a surgeon has to make a large incision and dissect several layers of muscle to access the area of the spinal column he or she is trying to correct. The injury caused by cutting through this muscle and tissue significantly adds to a patient’s recovery time after surgery. In some cases, it can leave long-lasting weakness in the back muscles. Minimally invasive techniques limit injury to surrounding muscle and tissue without compromising results.

A vivid example is a procedure called endoscopic lumbar microdiscectomy, which is used to treat a ruptured or herniated disc in the lower back. The bulging disc compresses nerves in the spine, causing disabling leg pain. Traditional discectomy requires lengthy incisions and the stripping of several levels of muscle to give the surgeon a good view of the area where the disc material compressing the nerve needs to be removed. Now, microdiscectomy can be done through a two-cm incision. A tube is inserted through the incision, creating a tunnel for the surgeon to reach the affected disc with a microscope and surgical instruments with minimal blood loss (Huang 2004, J Orthop Res 23: 406-11). Patients typically can go home the same day or next. This is achieved as post-operative pain is significantly reduced and these often young working adult patients can return to work early. In fact, the average number of disability days was reduced from 49 to 27 days (Hermantin 1999, JBJS 81: 958-65).

Other spine procedures that now may benefit from minimally invasive approaches include: lumbar fusion to correct back and radiating leg pain caused by spondylolysis, a defect or fracture of the wing-shaped parts of a vertebrae in the lumbar region or lower back. The fusion procedure, which traditionally required an incision that exposed the vertebrae, can now be done through incision an inch long. Similarly, the rods and screws that hold the spine in place while the fusion heals can be inserted via multiple small incisions even less than an inch. Thoracoscopic instruments — tools that aid in visualization and operation through portal holes in the chest — allow a surgeon to address part and, in some cases, the whole correction of a patient with scoliosis. During kyphoplasty to treat painful vertebrae fractures caused by osteoporosis, the surgeon makes two small incisions and inserts a tube in the centre of the vertebrae. Cement is injected into the weakened vertebrae, creating almost immediate pain relief.

Knee Ligament Anatomy Animation

This is an excellent animation showing the four key ligaments in the knee and their functions in holding the knee joint together. Read more

I keep getting stress fractures. Why?

This question was posed to Dr. Lewis G. Maharam. Often getting to the bottom of a problem is about asking the right questions. His answer covered the basic questions that one should ask for recurring stress fractures.

I am experiencing my fifth stress fracture in two years. First my right tibia, then my left hip, my right tibia, and now my fourth metatarsal. I heal fine; my doctor has me rest for eight weeks, and then I go back to run and another problem occurs. I work up slowly to 40 miles per week and then bam!… another stress fracture! Why does this keep happening to me? – Jennifer V., Little Neck, NY

Read about Dr. Maharam’s basic questions here.

Read more

Mind and Body (III) – Imagination and Self Talk for Sports Injury Rehabilitation

In the past article in this series, Mind and Body (II) – Mental Goals for Sports Injury Rehabilitation, we looked at goal-setting. Goal-setting is the crucial first step and is the psychological foundation for faster injury recovery. To aid you in achieving your goals, we will look at two other supporting psychological factors – Mental Imagery and Positive Self-Talk. We will cover these two factors along with concrete take-away suggestions and examples that a recovering athlete can use. Read more

Understanding Muscles and How They Contract

The animation below explains the structural components of skeletal muscles and the mechanism by which they contract.

 

This animation resource is linked from www.brookscole.com

Mind and Body (II) – Mental Goals for Sports Injury Rehabilitation

In the previous article in this series, Mind and Body (I) – Psychological Factors for Sports Injury Rehabilitation,we took a broad overview of the various key psychological factors crucial in enhancing an athlete’s recovery from injury. One of the key factors, goal-setting, was distinct from the other four factors was that it formed the bed-rock on which the rest work off. Without goals, the other factors cannot help drive the athlete in the desired direction and rate of recovery. Read more

Mind and Body (I) – Psychological Factors for Sports Injury Rehabilitation

In the past much of our efforts to rehabilitate an injured athlete focused on the physical causes and their treatment options. It leaves out much of the psychological dimensions of the injury and its rehabilitation. Today, psychological factors increasingly plays an important role in rehabilitation, particularly for sports where there are greater time pressures to return the athlete to optimal peak peformance as quickly as posisble. There are five key psychological factors – goal-setting, imagery, positive self-talk, relaxation and social support – that play an integral role in the recovery process. Read more

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Ask the Specialists

Ultrasound Therapy, Imaging and Shockwaves

"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing... Read more »



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