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Return to Minimally Invasive Back Surgery Improves Outcomes Overview

More on Minimally Invasive Back Surgery Improves Outcomes

Minimally Invasive Back Surgery Improves Outcomes

New York (Feb 18, 2010)

Woman with back pain

While minimally invasive techniques are the standard of care for a variety of surgical procedures, these techniques are just beginning to be applied to back surgeries. Researchers from NewYork-Presbyterian Hospital are pioneering research in this field and bringing the benefits of minimally invasive surgery to patients with problems ranging from degenerative spinal disorders, such as disc herniations, to more complicated conditions such as spinal tumors and scoliosis.

"The goal of minimally invasive spine surgery is to perform the same operation with less side effects, pain, and potential complications and with the same or better outcomes," explained Roger Härtl, MD, Chief of Spinal Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and an Associate Professor of Neurological Surgery at Weill Cornell Medical College.

Roger Hartl, MD
Roger Härtl, MD

Minimally invasive means that smaller incisions are used to reach the area in need of repair and that specialized instruments are used to preserve as much of the muscle and tissue as possible. "Common back conditions that can be treated with these techniques include disc herniation, lumbar spinal stenosis, spondylolisthesis (the slipping of one vertebral body in relationship to another), and spondylolysis (stress fracture of vertebral body)," said Alfred Ogden, MD, Director of the Minimally Invasive Spine Surgery Program at NewYork-Presbyterian Hospital/Columbia University Medical Center and an Assistant Professor of Neurological Surgery at Columbia University College of Physicians and Surgeons.

The benefits of the minimally invasive approach include less blood loss, less postoperative pain, lower risk for postoperative infection, less damage to surrounding musculature and tissue, and earlier return to normal function and work. "Typically, this approach cuts the post-operative pain level, length of hospital stay, and recovery time in half," said Dr. Ogden, adding that the degree of these benefits depends on the type of surgery. Research by Dr. Ogden and Dr. Härtl suggests that these techniques are safe and effective regardless of the patient's weight. With traditional open surgery, an obese patient would require a longer than normal incision to access the spine.

Alfred T. Ogden, MD
Alfred T. Ogden, MD

"In the hands of a skilled surgeon, the risks of minimally invasive spine surgery are the same as a traditional open surgery," noted Dr. Ogden. "The techniques are 'technically' more demanding and require more training and experience, but I think those surgeons who are experts and have mastered these challenges will be able to do these procedures with the same or better outcomes than conventional surgery and with less complications," said Dr. Härtl. "Thus, it important to seek out surgeons with adequate training and experience in this field as there is a considerable learning curve."

Specific Innovations

Tubular Retractors

In traditional spine surgery, a midline incision is made along the length of the spine and the muscles, ligaments, and tissue in the area of the repair must be retracted (or pulled back). But, the introduction of tubular retractors has allowed for major advances in spine surgery by allowing the surgeon to use a small incision and insert a small tube through the muscle belly to spread apart the muscle rather than cutting it to gain access to the problem area.

Bioabsorbable Implants

Bioabsorbable implants eliminate the need to use permanent metal implants for spinal fusions. Fusions are used to treat such conditions as disc herniation, spondylolisthesis, and spondylolysis. The metal implants are used to provide stability until the bone grows to form its own fusion, typically over a year after surgery. Because of the risks of surgery, the metal implants are never removed after bone fusion occurs even though the implants are no longer necessary. "These metal plates cause rigidity to the surrounding area and may be linked to degenerative conditions in the vertebrae above and below the fusion," Dr. Härtl said. The bioabsorbable plates are "digested" by the body over about 18 months to two years and eliminate this risk. Research by Dr. Härtl and colleagues suggests that the bioabsorbable implants have similar outcomes to metal implants.

Computer-Assisted Neuronavigation

Computer-assisted neuronavigation allows surgeons to use precise, small incisions and eliminates the need to expose large areas of the spine in order to locate the area for repair. Neuronavigation is regularly used for brain surgery, but development in the field of spine surgery has been slower as the technique required is more complicated. Dr. Härtl is actively involved in a number of research trials with international spinal organizations to look at the benefits of neuronavigation and thinks that it will become a standard of care over the next 5 to 10 years.

Bioengineered Interverterbral Discs

Dr. Härtl is involved in developing tissue-engineered intervertebral disc implants grown from human cells that have the potential to reduce the need for more invasive fusion surgery in patients with degenerative disc disease. Mechanical disc prostheses have been developed and are currently available, but these are made of metal alloys and polymers that are subject to wear and fatigue and do not fully integrate with patient anatomy. This research is currently being tested in animal models.

Expanding the Field

Dr. Ogden is currently involved in research that expands use of minimally invasive techniques for scoliosis and tumors in and around the spinal cord as well as tumors in vertebral bodies from metastatic disease. Dr. Härtl is involved in research on minimally invasive techniques for spinal tumors and spinal trauma. In addition, Dr. Härtl is involved in working to build a minimally invasive spine surgery center at NewYork-Presbyterian/Weill Cornell that should be finalized in the next six months.

Contributing faculty for this article:

Roger Härtl, MD, is the Chief of Spinal Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and an Associate Professor of Neurological Surgery at Weill Cornell Medical College.

Alfred T. Ogden, MD, is the Director of the Minimally Invasive Spine Surgery Program at NewYork-Presbyterian Hospital/Columbia University Medical Center and an Assistant Professor of Neurological Surgery at Columbia University College of Physicians and Surgeons.

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