Many patients ask me if they are a candidate for minimally invasive surgery or laser surgery or video-assisted surgery. The answer is that it really depends. It depends on the diagnosis, the number of levels of discs involved, the specific anatomy of the individual patient…the list of issues to consider is very long. However, whenever possible, I use minimally invasive techniques to reduce the pain and overall recovery time after the surgery.
A wonderful illustrative case involves Billy Rider, a 77-year-old gentleman who had been very physically active his whole life. Mr. Rider’s pleasures in life included taking walks and gardening. Unfortunately, he developed spinal problems and had so much pain in his back and legs that he just couldn’t do the things that gave him joy. He could stand or walk only for very short intervals. Conservative treatments had failed, and things were getting worse. His x-rays showed a significant curvature (scoliosis), and his MRI showed multiple areas of spinal narrowing (lumbar stenosis), causing nerve pinch.
At his age and considering the extent of Mr. Rider’s problems, some surgeons may have said no to surgical treatment or compromised and performed only part of the necessary surgery. However, I thought that by combining minimally invasive surgery methods with traditional surgery, it would be possible to reduce the overall “hit” to Mr. Rider’s body. Mr. Rider, his family, and I carefully went over the options and risks and potential benefits and decided to go ahead with the surgery.
The surgery was divided into two separate days to decrease the overall stress on Mr. Rider. On the first day, we performed “anterior spinal fusion” from L1 to L5. This was done in a minimally invasive manner to place “cages” between the vertebra to regain the height that he had lost and straighten out his scoliosis significantly. Mr. Rider recovered well from this and was able to get out of bed right away. His spirits were high.
About three days later, we did the bigger surgery on Mr. Rider’s back. This involved doing the traditional laminectomies to decompress his nerves that were “pinched” by the lumbar stenosis. We then placed in screws, rods and cages to stabilize the whole curve– from T10 down to the sacrum (part of the pelvis). We were able to reduce the amount of soft-tissue injury because we had already completed much of the fusion work on the first day. It was tougher for him to recover from the second surgery, but he did much better because of the less invasive techniques we used. As a result of the surgery, he has excellent curve correction and overall alignment. He recovered nicely and was discharged to go home.
Now, when I see him in the office, Mr. Rider is one of my happiest patients because he can walk without pain, and can work in his garden again.
Have you had or are you considering having minimally invasive spine surgery? We welcome your questions and feedback in the comments section below.
About S. Tim Yoon, MD, PhD:
Dr. Yoon specializes in minimally invasive surgery and is assistant professor of orthopedic surgery and chief of Orthopedics at the Veterans Administration Medical Center at Atlanta. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.