Recent advances in medicine have cleared the way for minimally invasive treatments for many spinal conditions, easing pain and expediting recovery for patients. In this blog, we’ll address some of the technologies involved in these treatments, along with many of the options.
Imaging
A thorough and accurate patient history, physical exam, and imaging studies have important roles in the diagnosis and treatment of spinal conditions. The advent and improvement of advanced imaging such as CT and MRI in the last two decades have set the stage for minimally invasive treatment of spinal conditions in this millennium.
High-resolution CT and high-field MRI allow us to confirm the correct clinical diagnosis early in the non-operative treatment of spinal conditions. Caution should be used when interpreting the images, as a high rate of abnormal findings have been shown in healthy volunteers. One study reported abnormal MRI findings in 30% of healthy, pain-free individuals. Another study showed degenerative findings in 75% of healthy individuals older than 70 years.
Computed Tomography
Computed Tomography (CT) uses radiation to evaluate bony elements of the spine and create 3D reconstructions for preoperative and intraoperative use. Recently, intraoperative CT with an O-arm has enabled minimally invasive spinal surgery by increasing precision and reducing complications in certain cases.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) produces better images of soft tissue without any radiation. MRI imaging can detect increased water content in the presence of inflammation, acute fractures, or disc herniations.
Back Pain Relief
Most patients recover within 3-4 weeks from a back condition with the help of activity modification, physical therapy, and anti-inflammatory and muscle-relaxing prescriptions.
About 10% continue to have symptoms and need an intervention to shorten the period of disability. Depending on the condition, injections can help to reduce pain, quicken recovery, and shorten the duration of disability.
Here are some options that can be used to help relieve pain:
- Epidural steroid injections have been used since 1952. With the help of local anesthesia and x-ray guidance, steroids are injected into the spinal canal.
- Selective nerve root blocks are used to treat single nerves for pain relief in arms and legs (radiculopathy/sciatica).
- Diskography is used for the evaluation of the discs of the spine.
- Facet injections help to treat painful conditions of the small joints in the back of the spine. These joints are prone to degenerative changes and are a common source for back pain.
Minimally Invasive Surgery
Minimally invasive surgery of the spine is an evolving field and borrows technologies from many fields, such as state-of-the-art advanced imaging, fiberoptic endoscopes, microscopes, cannulated screws, tubular retractors, and image-guidance technology. Minimally invasive surgical approaches embody the goal of achieving the same benefit as open surgery while offering many benefits.
Possible benefits to minimally invasive surgery include:
- Decreased injury to soft tissues
- Less injury to the nerve and blood supply to the back musculature
- Shorter hospital stays
- Less blood loss
- Earlier recovery from surgical procedures
- Less scarring with smaller incisions
Minimally Invasive Decompression
Decompression of the spinal canal at the neck or lower-back level can be achieved with the help of small incisions through small tubes which are guided down to the spine. This is an outpatient procedure and allows early return to work. The muscles are dilated instead of being cut, leading to less post-op pain. Then, with the help of a microscope, the disc herniation can be treated and the spinal canal can be decompressed.
Minimally Invasive Fusion and Decompression
For certain conditions, fusion surgery is recommended. A fusion in the lower spine can be achieved with the help of tubular retractors. The hardware, such as cannulated screws and rods, can be guided down with wires. This technique leads to less disruption of the musculature and earlier discharge from the hospital.
Fusion of the Lumbar Spine from the Side
Extreme Lateral Interbody Fusion (LIF) and Direct Lateral Interbody Fusion (DLIF) are minimally invasive surgical procedures in which a small incision is made on the side of the patient. In cases where the patient has had previous back surgeries and breakdown of the adjacent segment, this approach may be preferred to prevent further scar formation and muscle disruption, leading to minimal blood loss and early recovery. Recently, this approach has been used to treat adult scoliosis successfully.
This procedure is highly dependent on good collaboration of the surgeon with the x-ray technician. Life monitoring of the nerves ensures optimal placement of the smaller retractors and implants.
Interspinous Process Decompression System (X-Stop)
The X-stop is one of the first spacers allowing spinal stabilization and decompression at the same time without exposing the spinal canal. A subset of conditions can be treated with this outpatient procedure with a good outcome. During the procedure, a spacer is placed between the bony elements in the back of the spine, providing room for the nerves in the spinal canal.
Kyphoplasty and Vertebroplasty
Kyphoplasty and vertebroplasty are minimally invasive procedures to treat compression fractures of the spine. The goal of this outpatient procedure is to provide early pain relief. Under light sedation, bone cement can be injected to treat painful fractures. For this purpose, guide wire and a small cannula are used to place the bone cement at the fracture site.
Disc Replacement in the Neck
Disc replacement in the neck preserves motion without the need for a fusion. Since there is no need for the fusion to occur, patients usually recover a few weeks earlier. Currently, this procedure is only approved for a single level.
Biologic Enhancement
In addition to the advances in imaging and implant design, the use of biologic enhancement achieves improved outcomes and quicker healing.
Biologic enhancers which are commonly used are:
- Ceramics
- Demineralized bone matrix
- Bone protein
- Collagen sponges
Appropriate use of these products can lead to faster healing without the need for harvesting bone graft from the patient. Under certain conditions, bone graft harvest is still the gold standard. For this purpose, we developed less disruptive approaches.
Conditions Treatable with Minimally Invasive Surgery
There are many conditions that may qualify for minimally invasive surgery. These include:
- Disc herniations
- Spinal stenosis
- Slipped disc
- Spondylolisthesis
- Spondylolysis
- Adjacent segment breakdown
- Spinal curvature
- Compression fractures
Conclusion
Minimally invasive treatments of spinal conditions use state-of-the art diagnostic equipment and implants to achieve the same outcomes as open surgery with less soft-tissue disruption and earlier recovery. At Suburban Orthopaedics, we closely follow new developments and use them judiciously to best help our patients.
Want to see if you are a candidate for minimally invasive treatments? Contact us to make an appointment and learn more.