Posts Tagged ‘minimally invasive surgery’

3 Cervical Spine Procedures that Reduce Recovery Times

John G. Heller, MDWhen 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.

New Technology for Reducing Risk & Recovery Times for Young Athletes

John Xerogeanes MDWhether your child plays football, basketball, soccer or gymnastics, a common worry for many parents is the looming possibility of a sports injury. In many of these sports, anatomic anterior cruciate ligament (ACL) tears are one of the most common injuries young athletes experience. For most children who injure their ACL, treatment consists of rehabilitation, wearing a brace, and reducing athletic activity levels until they stop growing (usually around their mid-teens), at which point ACL reconstruction surgery can safely be performed.

Why do we wait until kids stop growing to perform the surgery? ACL operations are typically conducted with extensive use of X-rays in the operating room, which often leads to a large margin of “chance” when working around growth plates. Essentially, performing ACL surgery on a young child significantly increases the risk of causing a growth plate disturbance.

To help ease this fear and risk, we’ve developed a new 3-D MRI technology at Emory Sports Medicine Center. The 3-D MRI technology makes it possible for surgeons to reconstruct ACL tears in young athletes without disturbing the growth plate. This technology allows us to better pre-operatively plan and perform ACL surgery with more precision and less risk.

As one of the four major ligaments in the knee, the ACL is somewhat like a rubber band, attached at two points to keep the knee stable. In order to replace the ligament, a tunnel is created in the upper and lower knee bones (femur and tibia) and a new ligament (typically taken from a hamstring or allograft tissue) is slid between those tunnels and attached at each end.

With the new 3-D technology being used at Emory, we can actually see from one end to the other on either side of the knee, and can correctly position the tunnels so we are able to place the new ligament with more precision. With this technology, ACL surgery can be done in less time than the traditional surgery, and we have great confidence that the growth plates in our young patients will not be damaged.

Kids who undergo this type of operation will still have at least one year of recovery time. The good news, is that it does allow them to eventually pursue normal activity much sooner than they would with the traditional surgery. This new method of ACL reconstruction is able to be performed on children and adults alike. My hope is that this new technology will aid us in preventing future re-injury for athletes who have suffered from ACL tears.

About John Xerogeanes, MD:

Dr. Xerogeanes, or Dr. “X”, is chief of Sports Medicine at the Emory Orthopaedic & Spine Center. He is also head orthopaedist and team physician for Georgia Tech, Emory University, and Agnes Scott College. As a member of a number of professional societies and organizations, including the American Orthopaedic Society for Sports Medicine, and the American Academy of Orthopaedic Surgeons, Dr. Xerogeanes has contributed to many textbooks and has received numerous research awards. Dr. Xerogeanes’ work has been featured on CNN, ESPN and network television news

Minimally Invasive Spine Surgery

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.