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Winter 2005 Minimally Invasive Spinal Surgery Offers Quick ReliefPeople are looking for procedures that will minimize pain, relieve symptoms, and allow for a full and quick recovery. Spinal surgeries for conditions such as herniated discs used to involve days in the hospital and many weeks of recovery. But more and more frequently doctors at Anne Arundel Medical Center are performing spinal procedures using non-invasive techniques and sending patients home as early as the same day. AAMC is the only hospital in the area that offers full service minimally invasive spine surgery (MISS), including lumbar and cervical discectomies, decompressive laminectomies, kyphoplasties, and spinal fusions. “Our goal is to minimize operative trauma
to surrounding normal anatomic structures
while effectively relieving symptoms.”
—Dr. Timothy Burke, AAMC neurosurgeon What patients want, says AAMC neurosurgeon Dr. Timothy Burke, are less painful and invasive methods to treat their spinal conditions. “People are looking for procedures that will minimize pain, relieve symptoms, and allow for a full and quick recovery,” he said. “Our goal is to minimize operative trauma to surrounding normal anatomic structures while effectively relieving symptoms.” Specialists such as neuroradiologists, orthopedic surgeons and neurosurgeons also perform MISS procedures and provide complementary treatments. For Dr. Burke’s 60-year-old patient Mary VonVille, a minimally invasive fusion meant she could resume her active lifestyle sooner. As owner and operator of a country store in Harmony, Maryland, VonVille is usually at work before dawn, making muffins and breads for local farmers who stop in for supplies. 
In kyphoplasty, an inflatable surgical balloon is inserted next to the spine and gently inflated to carefully move a collapsed portion of the vertebra and restore the fractured bone to its original shape. Then the balloon is removed, leaving a cavity, which is then filled with a special cement (see above) to stabilize the bone and prevent further collapse. “I’m just a physical person, always doing something around the store. My customers are like my family—they depend on me,” she said. So when compression of her spinal nerves caused VonVille to experience debilitating leg and back pain, it literally put a cramp in her lifestyle. “One day I tried to get out of bed and fell. My leg was so weak it wouldn’t support me. It felt like it was asleep and wouldn’t wake up,” VonVille said. A few days later VonVille was diagnosed with spinal stenosis. Stenosis (the term means “narrowing”) refers to a condition in which the pathway for the spinal cord becomes too small and pinches the nerves in the cord. Fortunately the spinal fusion alleviated VonVille’s pain and got her back to normal activity quickly. People who suffer from spinal nerve disorders may experience neck, back and leg pain and weakness. Simply trying to walk or stand can be exhausting. Traditional open-back surgeries can result in significant postoperative pain and disability. And patients whose activity level is limited after surgery may experience complications like infections and stress-induced depression. But MISS procedures allow physicians to operate using smaller incisions, and patients tend to experience less blood loss, fewer infections, reduced hospital stays, and faster recoveries. “We are developing new methods to treat pain and compression that were impossible just a few years ago,” Dr. Burke pointed out. “Many patients can go home within 3-5 hours of surgery. Minimally invasive procedures take already good operations and make for even better experiences and outcomes.” Making spinal surgery less invasive and traumatic can be particularly important for elderly patients, who may have a harder time tolerating an operation and its aftermath. Because of degenerative disc changes, older people are particularly prone to conditions that destabilize their spines. “Many patients can go home within
3-5 hours of surgery. Minimally invasive procedures take already good operations
and make for even better experiences and outcomes.”
—Dr. Timothy Burke “There are clear advantages to using these procedures,” said Dr. Roy Bands, an AAMC orthopedic surgeon. “For the right patient with the right problem, they can be very effective.” Orthopedic surgeon Alex Speciale, M.D., has performed hundreds of kyphoplasties, a procedure used to correct spinal fractures associated with osteoporosis. Fractures in the spine are not only painful, but can result in deformities as the backbone shortens and falls forward. By using an inflatable bone tamp—a surgical balloon—inserted through two tiny incisions, surgeons can move the collapsed portion of the vertebra and restore the fractured bone to its original shape. Dr. Speciale said that having MISS procedures available means that some patients are more likely to seek treatment sooner. This reduces the chance that they will have further problems. “By preventing permanent deformities from developing, we can decrease the risk of refracture,” he said. Dr. Timothy Eckel, a neuroradiologist who performs both kyphoplasties and vertebroplasties (a similar procedure to kyphoplasty that does not employ a bone tamp), agreed. “These patients are in a lot of pain, and don’t think they have a lot of options,” Dr. Eckel said. Dr. Burke wants to inform more people about the less invasive options to alleviate their misconceptions about spinal surgery. “Back and neck operations are uniformly disruptive and people can feel intimidated and fearful about undergoing them,” he said. “By telling people about minimally invasive procedures, we can give them a very different impression of what their experience and outcome will be." |
