ITHACA, N.Y. — Back pain can range from a dull, constant ache to a sudden, sharp pain that makes movement difficult, and the condition is among the most common reasons patients see their physicians. For most patients, conservative treatments involving rest, medications, physical therapy or massage will resolve back pains. However, a small percentage of patients will need spinal surgery to correct conditions that are responsible for their back pain. Increasingly, minimally invasive surgery is used in these spinal procedures.
Minimally invasive spinal surgery has rapidly advanced in the last two decades as the technology and techniques for performing microsurgery improved. The procedure is used to treat a variety of degenerative spinal diseases such as stenosis and herniated discs as well as fractures, tumors, infections, instability and deformities.
When is spinal surgery recommended?
While most back pain is treated without surgery, there are situations when spine surgery is the best
option for the patient. Some symptoms that indicate spinal surgery should be performed include:
Severe pain for a lengthy period of time, particularly if the pain includes numbness and tingling in the arms or legs.
- Loss of sensation in the arms or legs.
- Decreased motor strength in the arms or legs.
- Loss of bowel or bladder control.
- Paralysis or difficulty walking.
How is minimally invasive spinal surgery performed?
An operating microscope and specially designed instruments are used to perform the microsurgery. The microscope allows surgeons to perform delicate operations through an incision of 1 to 1½ inches in length compared to 6 to 10 inches for traditional spinal surgery.
Often, minimally invasive spinal surgery utilizes instruments such as a tubular retractor that is inserted through the incision in the skin. The microscope provides surgeons with an inside view, enabling surgical access to the affected area of the spine. A fluoroscope is an imaging device used by the surgeon to view internal body structure on a screen, during the microsurgery. The surgeon uses specially designed equipment to move tissue and muscles away from the spine, enabling the surgeon to access the affected area. Microsurgery allows the surgeon to remove tissue to relieve the pressure on the spinal nerves or make repairs to improve the patient’s condition. Often, state of the art equipment, such as intraoperative computer guided navigation, is used in microsurgery. These are available at the Cayuga Medical Center, and they increase the accuracy of the surgical intervention.
What are the benefits of microsurgery?
Minimally invasive spinal surgery was developed to treat spinal disorders with less trauma to surrounding tissue and muscles. The result for the patient is quicker recovery, decreased blood loss and faster pain relief, which leads to an overall better quality of life.
Because muscles are only moved, not cut, trauma and pain to the area surrounding the damaged segment of the spine is reduced. Generally, 80 to 90 percent of patients report pain relief after surgery, and most patients leave the hospital within 23 hours and soon start physical therapy to aid their recuperation.
Who is affected by degenerative spine disease?
Stenosis and herniated discs are two common degenerative spinal diseases that are successfully treated with minimally invasive spinal surgery. The conditions are most often the result of aging-related wear and tear on the spine. Spinal discs lose some of their water content as a person ages. That makes the discs less flexible and more prone to tearing or rupturing with even a minor strain or twist. Patients with spinal stenosis are more often between the ages of 50 to 70. Herniated discs, which most often occur in the lower back, are most prevalent in male patients ages 30 to 50. Injuries are a less common cause for herniated discs. This web link to UR Medicine in Rochester, which has a collaborative relationship in neuroscience with the Cayuga Health System, provides more details on spine disease and minimally invasive spinal surgery.
What is spinal stenosis?
The condition most often develops in the cervical (neck) or lumbar (lower back) areas of the spine and is most commonly caused by arthritis that can narrow the diameter of the spinal canal and reduce the spaces between the vertebrae. Those changes can put pressure on the spinal cord or the spinal nerves.
Cervical stenosis symptoms may include pain, tingling and numbness that radiates from the neck through the shoulders and arms. The condition is linked with spinal cord compression, which, in extreme cases, can cause debilitating issues such as weakness, paralysis and incontinence.
Symptoms of lumbar stenosis may include tingling, weakness, numbness and discomfort in the lower back that radiates through the legs. Pain and other symptoms often worsen with walking and other lower body-centered activities.
Minimally invasive spinal surgery to treat spinal stenosis typically involves decompressing pinched nerves in the spine by removing tissue that has intruded around the spinal cord or nerve roots. Another microsurgery technique uses a bone graft and cages, screws, rods, to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.
What is a herniated disc?
Spinal discs are located between vertebrae and are made up of a soft, gel-like inner nucleus and a hard, outer casing. When a disc is damaged by disease or injury, the nucleus can seep through a weak point and cause a hernia, or slipped disc. That puts pressure on the nerves, ligaments and tissues in the surrounding area. Dull or sharp pains, muscle spasms, sciatica or leg weakness can result from a herniated disc. In rare, but very serious instances requiring immediate medical care, a slipped disc may cause incontinence or loss of motor function and feeling in the lower body.
Minimally invasive spinal surgery to treat herniated discs uses techniques to decompress spinal nerves and stabilize vertebrae that are similar to those used in treating spinal stenosis.
Dr. Vassilios Dimopoulos is a spine fellowship trained neurosurgeon with Cayuga Medical Associates and practices full time at the Cayuga Health System hospitals in Ithaca and Montour Falls. He is an assistant professor in the Department of Neurosurgery at University of Rochester where he completed his neurosurgery residency. He completed a complex spine and minimally invasive spine fellowship in the University of Miami. He can be reached at (607) 269-0033.