Advances in Spinal Surgery
Significant advancements have been made in the field of spinal
surgery. Today, patients of all ages are benefiting from new technology that
allows surgeons to perform complex operations on the spine with greater safety
and faster recovery.
What are minimally invasive surgery and microsurgery?
Minimally invasive surgery is a type of surgery that is performed through
several small incisions (less than 1 inch in diameter), or puncture sites. An
endoscope (a thin, lighted tube with an attached camera) and surgical
instruments are passed through these tiny incisions. The endoscope enables the
surgeon to view the problem area without having to make a large incision.
By completing the operation through small incisions, the surgeon
can safely work on the spine without disturbing normal tissue. As a result,
patients are less likely to develop complications, recover sooner, and can
quickly return to normal activities. Many of these procedures can be performed
as outpatient surgery. Controlled studies have proven that these procedures are
safe, very successful, and cost-effective.
Microsurgery is performed through very small incisions, using an
operating microscope, and specially designed instruments. The microscope allows
surgeons to perform delicate operations through an incision of 1 to 1½ inches in
length. Traditional surgical methods for delicate operations require incisions
from six to 10 inches in length.
Which types of spinal problems are amenable to minimally invasive surgery or microsurgery?
Herniated disc
Patients who have a herniated disc typically complain of severe pain that
runs down the leg or arm. This pain is caused by a pinched nerve. Nerve damage
may cause pain, numbness, weakness, or partial paralysis. Candidates for surgery
usually have pain that has failed to improve after at least 6 weeks of
nonsurgical care. Often, they are unable to work or care for their families
because of severe pain that requires the use of strong pain medicine.
Ruptured disc material (nucleus pulposus) in the spine is most
commonly responsible for this pinched nerve. Microsurgery allows the surgeon to
remove the ruptured disc material from the spinal canal using a microscope along
with special small instruments. The surgery is often performed under spinal
anesthesia only, and most patients leave the hospital within eight to 12 hours.
Ninety-five percent of the patients report excellent pain relief after
microsurgery.
Spinal stenosis
Spinal stenosis is a condition that results from degeneration and arthritis
of the spine. Thickening of the bone and ligaments of the vertebrae narrow the
spinal canal, which contains nerves. Nerve damage can produce severe pain,
numbness, weakness, bowel and bladder problems, and in severe cases, partial
paralysis. Patients typically feel better if they sit or lean forward. They have
difficulty walking any distances without their legs going "dead," and many
patients cannot shop for groceries without "hanging onto the cart."
As with herniated disc surgery, microsurgery allows the surgeon
to remove the offending bone or tissue microscopically, thereby relieving the
pressure on the spinal nerves and improving the patient's condition. Most
patients leave the hospital within 23 hours and start physical therapy shortly
after.
Spinal fusion
Spinal fusion is a process in which a number of vertebrae are made to grow,
or "fuse," together. The surgery is performed for spinal instability, certain
types of deformities (such as scoliosis), and for painful spine degeneration. An
anterior fusion consists of placing bone between two or more vertebrae to
promote the growth of bone between the vertebrae. Over time, the vertebrae fuse
together and can no longer move.
The surgery eliminates painful, abnormal motion, reducing nerve
irritation and increasing function in most patients. A laparoscope (a type of
endoscope), special surgical instruments, and spinal cages (hollow, metal
cylinders) are placed between the vertebrae through puncture incisions in the
abdomen to fuse the spine. Most patients having this surgery can leave the
hospital in two or three days.
Spinal deformity
Spinal deformities such as scoliosis (curvature of the spine), kyphosis
(hump back), fractures, and tumors require major surgical procedures from two
approaches: the front and the back. Today, surgeons can use minimally invasive
surgery techniques to work on the front and back simultaneously, in many cases
eliminating the need for two separate surgeries. This approach has proven to be
safer, to have fewer complications, to allow quicker recovery, and to be more
cost-effective than traditional surgical approaches.
Which patients are candidates for minimally invasive spine surgery?
First, the patient must be evaluated by a spine surgery specialist. This
evaluation includes a detailed history and physical exam. At the initial visit,
patients are asked to bring with them all previous information, test results,
letters from physicians and surgeons, and any previous X-rays or imaging
studies. Patients may also be asked to complete a spine information form.
Additional testing may include:
- X-rays
- MRI scans
- CT scans
- Bone scan
- Discography
Consulting with the patient, a spine surgery specialist will
review this information and discuss options for surgical treatments, including
minimally invasive spine surgery.
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Copyright 1995-2010 The Cleveland Clinic Foundation. All rights reserved
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