Find A Physician

Return to For Those With Back Pain, Spinal Fusion Isn't What It Used To Be Overview

More on For Those With Back Pain, Spinal Fusion Isn't What It Used To Be

Research and Clinical Trials

Return to For Those With Back Pain, Spinal Fusion Isn't What It Used To Be Overview

More on For Those With Back Pain, Spinal Fusion Isn't What It Used To Be

For Those With Back Pain, Spinal Fusion Isn't What It Used To Be

New York (Feb 14, 2011)

Man holds his aching back

According to the American Association of Neurological Surgeons, 75-85 percent of Americans can expect to suffer from back pain in their lifetimes. Degenerative disc disease is extremely common and is simply a result of aging – most people show some signs of degeneration by the time they reach 50. Other conditions that affect the lower back include thickening or loosening joints and ligaments, scoliosis (curvature of the spine), spinal stenosis (a narrowing of the canal that houses the spinal cord and nerve roots), and spondylolisthesis (a disc slipping forward). Degenerative disc disease does not always interfere with a person's normal activities. But when it does intrude, it can significantly disrupt even simple daily tasks.

Often, the only symptom of disc degeneration is back pain. When severe disc degeneration exists in conjunction with spinal stenosis, patients may also experience hip pain or pain, weakness, or numbness in the legs. Initial treatment usually includes rest, anti-inflammatory medication, and physical therapy. But when those yield no results after six months or so, it may be time to consider spinal fusion surgery. The good news is that newer, minimally invasive surgical techniques have radically changed treatment, resulting in faster recovery time, reduced complications, higher patient satisfaction, and improved long-term outcome.

text from article

Traditional spinal fusion is performed through either a posterior or anterior (back or front) approach, both of which involve a six inch incision, scar tissue, significant blood loss, and the risk of infection from tissue and muscle dissection. But over the past few years, alternative techniques have taken hold. In what is generically known as minimally invasive transpsoas interbody fusion (marketed under several different brand names), the surgical incision is made through one or more small incisions in the patient's side.

Alfred T. Ogden, M.D.
Alfred T. Ogden, M.D.

The surgeon inserts a retractor – used to spread the tissue and allow a full view of the spine – and performs a discectomy: a procedure to remove the damaged part of the disc. He or she then inserts a polyethylene spacer or cage into the space where the disc was – metaphorically, like slipping a coin into a slot. The cage is filled with a supportive, but somewhat spongy material, meant to mimic the removed disc, and bone graft (small pieces of bone) are placed around it to promote fusion between the spacer and surrounding bones in the spine. Additional support is sometimes added through percutaneous pedicle screws that help stabilize the bone. Throughout the process, a combination of x-rays, fluoroscopy and neuro-monitoring systems are employed to ensure the spacer is positioned correctly and nerve function is not compromised.

text from article

"The smaller lateral incision spares manipulation of the back musculature, which is a distinct advantage because you avoid potential injury to muscles and nerves in the area," says Alfred T. Ogden, M.D, the Director of Minimally Invasive Spine Surgery at NewYork Presbyterian/Columbia University Medical Center, who uses a technique known as DLIF® (Direct Lateral Interbody Fusion).

"I perform about 80 lumbar spinal fusions in a year and last year I did only one open traditional fusion," says Eric Elowitz, M.D., an Assistant Attending Physician in Neurological Surgery at NewYork-Presbyterian/Weill Cornell Medical Center, who favors the XLIF® (Extreme Lateral Interbody Fusion) approach.

Eric H. Elowitz, M.D.
Eric H. Elowitz, M.D.

Consider the following case from Dr. Elowitz's files. Over a six month period, a 60-year-old very active woman who worked full-time developed increasing pain in her left leg that left her barely able to walk one or two blocks. An MRI scan revealed L4-L5 spinal stenosis. After physical therapy and anti-inflammatory medication failed to relieve her symptoms, Dr. Elowitz performed an XLIF® fusion followed by placement of percutaneous titanium pedicle screws. The patient was discharged from the hospital the next day and started walking over an hour a day just a few days later. She returned to work full-time one week after her fusion.

graphic for Back in Action web cast view webcast Back in Action, a recently aired webcast about
treatments for neck and back pain features
doctors from NewYork-Presbyterian's Spine
Centers, including Drs. Ogden and Elowitz.

Disc degeneration or spinal stenosis does not make these procedures an automatic choice – a doctor must make that decision in consultation with the patient. The operation can only be performed for the vertebrae L 4-5 and above. The surgery may also not be appropriate for patients with significant stenosis, spondylolisthesis, osteoporosis, or those with nerve root compression. But the vast majority of patients who can benefit from spinal fusion surgery are candidates for some type of minimally invasive approach.

The number of people affected by back pain will only grow as the population ages and the known risk factors of obesity and a sedentary lifestyle exacerbate naturally occurring degeneration. That can only lead to increased demand for minimally invasive spinal procedures.

Contributing faculty for this article:

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

Eric H. Elowitz, M.D. is an Assistant Attending Physician in Neurological Surgery at NewYork-Presbyterian/Weill Cornell Medical Center and an Assistant Professor of Neurological Surgery at Weill Cornell Medical College.

  • Bookmark
  • Print

    Find a Doctor

Click the button above or call
1 877 NYP WELL


eNewsletters

Newsroom



Top of page