Orthopedics, Spine & Sports Medicine

Surgery

Minimally Invasive XLIF Spine Surgery Can Speed Recovery Time

April 6th, 2012 By Dr. Yoon

Dr. Jim Rothermel, a retired ob/gyn, had been living with back and leg pain for more than three years. He was told that he needed extensive open spinal surgery. However, he came to the Emory Spine Center for another opinion and met with Dr. Tim Yoon, an internationally recognized spine surgeon and expert in minimally invasive techniques. Dr. Yoon diagnosed Jim with stenosis and scoliosis. His condition would typically require complex open spinal surgery, but Dr. Yoon determined that using a less invasive method, the XLIF technique, would reduce the stress on his body and reduce recovery time.

XLIF (eXtreme Lateral Interbody Fusion) is an approach to spinal surgery in which the spine surgeon accesses the intevertebral disc space and fuses the lumbar spine from the side rather than from the front or the back. By going through the side of the body with a small incision rather than through a large abdominal incision, much less soft tissue is traumatized, resulting in a faster recovery. XLIF may be an option for patients who have scoliosis, spondylolisthesis (where the vertebrae have slid in relation to one another), or spinal stenosis. These diagnoses typically causes leg pain and back pain. When XLIF is used to perform a simple one-level fusion surgery, the patient often is able to go home the next day.

The XLIF technique can also be used to access multiple different discs and may be combined with other procedures, such as minimally invasive screws, to handle more complex cases, like Jim’s. This less-invasive approach can make surgery an option for people who, in the past, might not have been chosen surgery because of the prolonged recovery time or because the doctors thought the surgery was too invasive for a frail patient. Therefore, XLIF allows surgeons to treat more spinal conditions and different types of patients.

Emory spine surgeons have extensive experience performing a wide variety of spine surgeries. They know when the minimally invasive approach won’t be effective or should be combined with a bigger surgery. “Not everybody is going to be best treated by an XLIF, but I know who will be, and I choose those people,” Dr. Yoon says. “That way, you maximize the best results and minimize any likelihood of complications.”

Jim and his wife, Midge, couldn’t be happier with Dr. Yoon and their experience at the Emory University Orthopaedics & Spine Hospital. Jim says, “Dr. Yoon spent quality time with me. He thought he could do this XLIF procedure with a three-level fusion. He explained it in detail and then referred me to a website. I looked at the procedure carefully and thought it sounded like the proper way to go about doing it. He scheduled the surgery for two stages. We did the XLIF on a Monday, and he was able to do it in a manner that wasn’t muscle cutting. The recovery time was markedly improved.” Three days later, Dr. Yoon performed the second stage of the surgery, and a few days after that, Jim went home.

“Jim was extremely uncomfortable for over three years, and to see the difference in him now is just an absolute miracle. He’s happy. He’s always been a big teaser and silly, and I’ve got him back again,” Midge says.Have you had XLIF spine surgery, or would you like to learn more about spine surgery at Emory? We welcome your questions and feedback in the comments section below.

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Collapsed Disc Spine Patient Races to Recovery

January 19th, 2012 By Emory Orthopaedics & Spine Center

For years, triathlete Denise Novicki suffered from excruciating spinal pain in her lower back. Founder of Tri2Remember, a triathlon club that raises money to fight Alzheimer’s disease, Denise had always led an active lifestyle, but her back pain made it difficult, if not impossible, to enjoy her favorite pastime.

“I was in such immense pain that I was looking for some very trusted resources to manage my pain,” Denise says. She chose the Emory Spine Center at the Emory University Orthopaedics & Spine Hospital for assessment and a solution.

“What we’ve tried to do here at the Emory Spine Center is take the worry and the guessing out of a spine or back problem,” says Dr. Scott Boden (pictured left), director of the Center. “When people come here, we help them figure out what’s wrong and give them lots of different options.”

Before the spine doctors at the Emory Spine Center suggest surgery, they investigate all possible nonsurgical interventions, but they also know that, in some cases, a simple surgery may make the difference between experiencing debilitating pain and living pain free.

To find out the cause of her back pain, Denise met with spine surgeon Dr. John Heller, who discovered that she had a collapsed disc. It was clear to Dr. Heller that surgery would bring Denise relief and allow her to get her life back. “Denise came to us seeking advice on how to improve back pain that had really gotten in the way of her normal lifestyle,” says Dr. Heller. “She was an avid athlete and was having tremendous difficulty maintaining a training regiment, let alone a normal, everyday life.”

Before her spine surgery, Denise signed up for an upcoming Ironman distance race. She wanted to be sure she had a goal in place that would help her stay focused on recovery. She achieved her goal. “Coming into doing the Ironman, I had a different perspective than probably most athletes do, because I came to the table with thankfulness that I am actually able to compete. I did what I set out to do, and I couldn’t have done it without the team at Emory.” To learn more about Denise’s experience with spine surgery at Emory, check out the short video below:

Dr. Boden says, “The thing I love about taking care of patients with spine problems is that we have a real opportunity to help patients get their lives back, and that’s a very special thing.”

The spine doctors at the Emory Spine Center are dedicated to excellent spine care. “Some places, people are part-time spine and part-time hips and knees, but what’s unique about our group is that everybody primarily focuses on taking care of patients with spine problems, teaching trainees who are learning about the spine, and doing research to try and explore new and better ways to treat spinal problems,” says Dr. Boden (pictured left). “If you end up coming to Emory University Orthopaedics & Spine Hospital, you’ll leave saying that you’ve never been in a hospital that’s anything like it.”

Have you had spinal surgery at the Emory Spine Center? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

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Minimally Invasive Hip Surgery Gets Patients Active Faster – A Patient Story

June 10th, 2011 By Dr. Bradbury

When I first met Mark Putnam, he had chronic pain in his right groin and lower back caused by osteoarthritis of the hip. At 49, Mark felt twice his age. His local orthopedic surgeon was uncomfortable performing surgery because of the extent of the damage to the joint and instead referred Mark to the Emory Orthpaedics & Spine Center.

Mark needed a total hip replacement, and I knew he would be an excellent candidate for anterior total hip arthroplasty, an Emory-pioneered minimally invasive surgery that involved a new approach to the hip joint. Hip arthroplasty traditionally is performed through the posterior, or back, of the hip. This means the surgeon has to remove muscle and ligaments from the bone in order to reach the affected area. Because it takes a while for the tissues to heal after posterior total hip arthroplasty, the range of motion the hip can have for the first couple of months is restricted to prevent dislocation.

Anterior total hip arthroplasty has changed the way we perform hip replacement surgery at Emory. During the procedure, the orthopedic surgeon enters the front of the hip, as opposed to the back, via a single, very short incision to the patient’s leg. Because the surgeon can expose the hip without removing as much muscle and ligament from the bones around the hip joint, the patient retains a better range of motion in the hip and has greater hip stability following surgery.

While anterior total hip arthroplasty takes longer than traditional posterior surgery, the quick recovery time more than makes up for it. After surgery, Mark was pain free for the first time in years.

“It’s been terrific,” he said. “I was out the other day playing catch with my son, and I got down in a catcher’s squat and it didn’t even affect me.”

I encourage you to read up on the details of Mark’s total hip arthroplasty, and watch a video on Mark’s journey. Have you had anterior total hip arthroplasty? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Thomas Bradbury, MD

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.

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3 Cervical Spine Procedures that Reduce Recovery Times

April 22nd, 2011 By John G. Heller, MD

When people think about neck conditions requiring surgery, they usually think about cervical spine injuries. We’ve all seen those tense moments during football or other sports when a player is injured and lies motionless on the field. A dramatic example comes from a Boston Celtics basketball game back in February, when Marquis Daniels bumped into another player and then fell motionless to the floor.

Fortunately, these events are rare. Most cervical spine surgery is needed because of wear and tear that affects your discs over time. In younger adults, this tends to be a herniated disc, which compresses the nerve roots or spinal cord. And, as we age, we all develop bone spurs to varying degrees (the “gray hair of the neck”). These spurs can be a source of nerve root or spinal cord compression, as well.

Cervical spine procedures are typically performed through the front of the neck, or anteriorly. In the United States, the primary surgical technique for the past 50 years has been the anterior cervical discectomy and fusion (ACDF). Since bone spurs form at the margins of the discs as they degenerate, these operations involve a discectomy, or the removal of the entire cervical disc, plus any bone spurs that border the discs.

Over the last two decades, spine surgeons at Emory have been leading the way in performing several innovative cervical spine procedures: laminoforaminotomy, artificial cervical disc, and laminoplasty. These procedures are performed from the back, or posteriorly, and don’t require a spinal fusion, thereby allowing patients to retain range of motion in the neck and also get back to their normal activities more quickly.

How do surgeons at Emory determine if one of these procedures might be right for you?

The first, laminoforaminotomy, is reserved for disc herniations that sit far enough to the side of the spinal canal that they do not compress the spinal cord. This procedure has been performed for many years, but new technology is allowing it to now be done using a minimally invasive microsurgical technique.

The second, for patients who meet the right selection criteria, is an artificial cervical disc, which may be inserted in place of the traditional bone graft with a plate and screws. This artificial disc is a moving part that’s ready for use when the patient wakes from anesthesia. Essentially, this procedure is a “get up and go” operation that avoids most of the limitations we traditionally impose on fusion patients while they heal. The artificial cervical disc is a ground-breaking option that has been very successful in clinical trials, many of which took place at Emory. Like any novel technology, longer term follow-up is needed to fully assess the risks and benefits of artificial cervical discs. But the data thus far are quite promising.

The third procedure, laminoplasty, is most often used in patients who are older and have three or more levels of spinal cord compression that would usually take three or four fusions. During this procedure, which is performed from the back of the neck, the roof of the spinal canal is re-shaped to provide more room for the spinal cord without the need for fusion. A mini-plate device, developed by surgeons at Emory Spine Center, is used during this procedure – allowing patients to move their necks right away after surgery, speeding up rehabilitation.

If you have been told you need cervical spine surgery, I would encourage you to contact the Emory Spine Center for an appointment to learn more about these innovative procedures.

Have you had or are you going to have cervical spine surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About John G. Heller, MD:
John G. Heller, MD, Baur Professor of Orthopedic Surgery and spine fellowship director, specializes in the research and development of instrumentation in cervical spine surgery, including disc arthroplasty and laminoplasty plates. He is the past-president of the Cervical Spine Research Society. Dr. Heller started practicing at Emory in 1989.

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