Minimally Invasive Spine Surgery

For many years, traditional spinal surgery has usually involved making a large incision up and down the middle of the back, and spreading apart (or retracting) the back muscles to access the spine. This is commonly referred to as an "open" technique. One of the advantages of open techniques is that the large incision provides the surgeon with easy access to the spinal anatomy. The downside of "open" spine surgery is that the muscle retraction damages the spinal muscles and can cause significant post-operative pain . In addition, such surgery results in significant blood loss, a large scar and relatively long recovery times.

While in many instances "open" techniques are still preferred, more and more conditions are now being surgically treated using new techniques called minimally invasive (or minimal access) spine surgery. Dr. Akbarnia and his staff at the San Diego Center for Spinal Disorders (SDCSD) are well trained in these new spine surgery techniques, and offer minimally invasive spine surgery as an alternative to open surgical techniques.

What is minimally invasive spine surgery?

As the name suggests, minimally invasive spine surgery allows the surgeon to make smaller incisions in the skin and avoid large muscle retraction. In certain situations, the surgeon uses a thin telescope-like instrument, called an endoscope, which is inserted through a small incision. A tiny video camera and light are connected to the endoscope and send images from inside the body to a screen in the operating room. Small tubes are then inserted through other small incisions. Special surgical instruments are inserted through these tubes and used to perform the surgical procedure.

Advantages of minimally invasive techniques

Minimally invasive spine surgery generally results in the same surgical outcome as with more traditional techniques. However, there are a number of advantages to minimally invasive techniques, including:

•  Reduced operative times.
•  Less soft tissue damage, due to reduced muscle retraction.
•  Surgical incisions are less painful.
•  Reduced blood loss.
•  Recovery is faster with less post-operative pain.
•  The hospital stay is shortened.
•  Since incisions are much smaller, scarring is less noticeable and cosmetically more pleasing.

Our Use of Minimally Invasive Techniques

At SDCSD our priority is providing the best care for our patients. For this reason, we offer a variety of minimally invasive techniques that we feel are scientifically proven, but we avoid others that remain unproven or are not right for a particular problem. The minimally invasive techniques we offer include:

•  Discectomy -
  Discectomies involve the removal of intervertebral discs. At our practice we do many discectomies minimally invasively, using small incisions to access the spine and to perform the discectomy, with or without the use of a microscope.
• Anterior Lumbar Interbody Fusion (ALIF)
  A traditional approach for an ALIF procedure involves significant soft tissue incisions and blood loss. We utilize a mini-open approach for ALIF. This is a far less invasive procedure than the traditional approach, but is also safer than the laparoscopic technique. We have tried the laparascopic lumbar fusion for several years and we have stopped this technique for the past 3 years.
• Posterior Lumbar Interbody Fusion (PLIF)
  We utilize a mini-open PLIF and TLIF techniques for such conditions as spondylolisthesis and degenerative disc disease.
• Pedicle screws
  Until recently, the insertion of pedicle screws has required the surgeon to expose the pedicles. Today, we use different techniques that allow us to implant pedicle screws through the skin without disturbing muscles and tendons.
• Minimally Invasive Lateral Approach to Vertebral Body and Discs
  This procedure allows access to the side and from there to the anterior aspect of the vertebral body and discs. Anterior bone graft, insertion of cages and even placing implants are now possible through this approach.
• Vertebroplasty and Kyphoplasty
  These relatively new procedures are used to treat vertebral compression fractures by injecting orthopedic cement into the affected vertebrae. We have considerable experience with these techniques, and excellent outcomes.

Conclusion

We are at the forefront of adopting new technologies and techniques for the benefit of our patients.