April 10th, 2017
Relative to the history of surgical care in the world, the concept of minimally invasive spine surgery has more recently emerged with longer-term data to support its effectiveness in successfully treating a wide range of spinal deformities and conditions – often with significantly reduced risks to the patient compared to "open" spine surgery procedures, which are still performed and were the norm only a few decades ago.
First thing's first: Spine surgery isn't for everyone. It isn't even for most people. In fact, for the millions of Americans who suffer from back pain each year, only a single digit percentage are appropriate candidates for surgery to correct the underlying condition or issue that's causing the pain. A pervasive myth I hear when the public talks of spine surgery is the notion that it's the "easy way out" of back pain. I am here to assure you that for those people who are appropriate candidates for spine surgery, their journey to this decision has been neither easy nor painless. And for the vast majority of people who do undergo surgery, it's because an underlying deformity, traumatic injury or condition is causing the back pain and would not be alleviated with more conservative treatment methods. While medication therapy, lifestyle modifications and exercise can be incredibly beneficial and therapeutic to the occasional back pain sufferer, these conservative treatment options have their limitations when it comes to certain spinal conditions. One cannot reverse scoliosis with ibuprofen, nor can he or she structurally repair a fractured spine with core-strengthening exercises.
When it comes to the treatment of many spinal conditions or disorders, spine surgery of any kind is typically reserved as a type of final resort, when other more conservative treatment options have failed to restore spine health or provide relief from the pain or disability. Though "surgeon" is my job title, it can be slightly misleading for this reason. As physicians, it's our responsibility to keep each patient's best interests in mind, bringing treatments that offer them the least amount of harm and greatest opportunity for benefit. Staying true to that principle serves as a standard guide for every surgeon to proceed with interventions starting with the lowest risk first, and only when those options have been unsuccessful, to move forward with the more intensive options. If you're among the millions of Americans who finds yourself in a cycle of chronic back pain (pain that has lasted three months or longer), with other treatment attempts behind you and spine surgery as the final attempt at a better quality of life, it's important to understand the treatment options available to you and find out whether they can be accomplished using a minimally invasive approach.
After years of practicing traditional "open" spine surgery, many modern technical advances have paved the way to provide the same (if not better) results with much less pain, surgical complications and healing time, allowing patients to undergo the entire process with reduced stress on the body and return to normal life that much faster. So how exactly does minimally invasive spine surgery work?
While no surgical procedure is devoid of risk, minimally invasive spine surgery is what we call "muscle sparing." Due to the innovation of endoscopic technology, the muscles, tendons and delicate connective tissue around the spine no longer need to be stripped away (as they are in traditional, "open" surgical procedures) for direct access to the spine. The preservation of these muscles makes the surgery much less traumatic to the body as it allows for a smaller incision, minimizes blood loss during surgery and greatly reduces the pain and soreness post-surgery, allowing for a quicker recovery with less risk for complications.
The goal of minimally invasive spine surgery is to correct the underlying spinal condition and prevent it from worsening, while simultaneously maintaining as much of the body's natural movement (a term we refer to as range of motion) as possible. This last motion preservation step is of the utmost importance, as correcting a spinal deformity at the expense of previous range of motion doesn't feel to a patient like a correction at all. The goal of the minimally invasive spine surgeon is to achieve these two markers with the least amount of stress to the patient (physically and mentally), and minimally invasive techniques allow us to accurately do this.
The developments in minimally invasive spine surgery, technique and physician training that minimize trauma to patients and their bodies help improve the experience of spine surgery as a whole. Reducing the impact on the surrounding spinal tissues has a positive domino effect on all the other variables involved with surgery: length of hospital stays, risk for complications, incision size and healing time, and all are improved by this modern innovation. The success in achieving the outcomes of traditional spine surgery through minimally invasive approaches make spine surgery a capable, safe and promising treatment option with no shortage of hope to restore and enhanced quality of life for many patients suffering traumatic or painful spinal deformity or injury.