By Eamonn Mahoney, M.D., spine surgeon
Most of us have seen commercials on TV that claim, “If you suffer from chronic back pain, all it takes is as little as 30 minutes and one small incision for you to be up walking within a few hours after surgery, so you can get back to doing the things you love to do.” These advertisements offer hope to those who endure chronic back and neck pain caused by injury or disease.
But can a simple, 30-minute procedure really relieve the ongoing pain? The answer is both yes and no. Yes, because there are small-incision surgical options with short recovery times that may alleviate pain. No, because, unfortunately, not all patients are candidates for minimally invasive surgical procedures. Some patients may require more traditional ‘open’ surgical procedures and some may not be good candidates for surgery at all. In general, surgery is only considered when the exact sources of pain can be identified and after non-surgical options such as physical therapy and medications have failed to provide relief.
Due to advances in technology, spine and neck surgery options have seen dramatic developments, especially in the advancements of minimally invasive techniques. The use of artificial discs, nerve monitoring, computer-aided navigation, real-time X-ray and specially designed instruments have improved significantly in the last 25 years. These improvements mean smaller incisions, decreased postoperative pain and narcotic use, and faster recovery times. Patients can return to normal activity sooner than those who undergo traditional surgery with larger incisions.
Minimally invasive surgery utilizes smaller incisions and is often less traumatic to the body. The surgeon is able to access the spine through a minimal number of small incisions through which a small tube is inserted. Instead of removing or cutting surrounding muscle and tissue, the tube simply pushes them out of the way and provides direct access to a specific area.
Guided by CT-guided computer navigation, the surgeon inserts special instruments through the tube to perform the procedure. In some cases, a microscope is used to enhance or provide a different view. Any tissue, bone or disc fragments can be removed through the tube as well. When the procedure has been completed, the small incisions may require a few stitches and are covered with small bandages. Patients are often able to go home on the same or next day.
Most conditions treated through minimally invasive spine surgery fall into two categories: decompression and fusion surgeries. These conditions may include spinal stenosis; degenerative, bulging or herniated discs; osteoarthritis; pinched nerves; sciatica; scoliosis and facet disease.
Decompression surgery requires the removal of a small portion of the disc or vertebrae to open or enlarge the spaces surrounding the spinal canal where spinal nerves are located. When a disc bulges into the spinal canal, the space for the nerves becomes narrowed, causing severe pain. By removing part of the disc and opening the spaces, the nerves have enough room to perform properly.
Fusion surgery corrects problems of the spine’s small bones (vertebrae) and creates stabilization by fusing or joining two or more vertebrae together. This restricts motion between the bones and allows for decompression of the compressed nerves. Two of the most common fusion techniques are transforaminal lumbar interbody fusion, or TLIF, and oblique lumbar interbody fusion technique, or OLIF. Both involve removal of the damaged disc or vertebrae and fusion of the adjacent bones through an incision in the patient’s back. The primary difference between these two techniques is the angle at which the disc is approached.
Talking with an orthopedic spine physician will help you understand your condition, its causes, your treatment options and any potential risks. When considering a surgeon, be sure he or she has the credentials and experience to perform both minimally invasive and traditional surgery. Taking time to find the right surgeon and facility can be as important as the surgery itself.
Eamonn Mahoney, M.D., is a member of Northern Arizona Orthopaedics’ Spine and Pain Center. He is highly skilled in a wide range of treatment options for people with minimal and advanced neck and spine conditions, and those experiencing chronic pain affecting the back, neck and pelvis. Using state-of-the-art technology, Dr. Mahoney performs the most advanced spinal techniques and specializes in minimally invasive spinal fusion.