More than 80% of adults will experience back or neck pain at some point during their lifetime for which they will seek medical attention. Back problems affect hundreds of thousands of people annually. There are many contributing factors that can cause back or neck pain; physical injuries from accidents, physically demanding jobs, poor body mechanics, and disease as well as the wear and tear of aging.
Patients, who are troubled with back and neck problems that cannot be corrected by non-surgical means, especially when nerves are effected may indeed require surgery. Conventionally, spine surgery has required invasive procedures resulting in large incisions accompanied by a long hospital stay. Now, thanks to recent advances in surgical biotechnology, minimally invasive spine surgery is possible.
“The spine provides key functions for the human body,” says New York Neurosurgeon Ezriel E. Kornel MD. “The spine protects the spinal cord, which connects nerves to the brain. It supports our head, allows for us to walk upright and enables our body to maintain flexibility. But, when there is a deformity, injury or disease of the spine, common activities such as turning, bending, or stretching often become painful. Of even more importance the spinal cord or nerves may become damaged or injured resulting in weakness and loss of feeling. Many spinal disorders can now be corrected with minimally invasive spinal surgery.” Dr. Kornel was one of the first neurosurgeons in the New York metropolitan area to replace damaged cervical discs with the newly introduced artificial discs.
“Minimally Invasive Surgery is composed of a wide array of techniques that have been developed to minimize trauma to tissues allowing for speedier recoveries, fewer complications and fewer long-term concerns,” Dr. Kornel emphasizes. “When it comes to the spine, the area where minimally invasive surgery has the greatest impact is in the lumbar spine or lower back. The components of the spine that are impacted are the muscles, the tendons, the ligaments, the joints and the nerves. In standard surgical approaches to the spine, the paraspinal muscles sustain damage, the tendons holding the muscles to the bones are divided, ligaments holding the spinal segments are cut and the joints are removed. The consequence of these is that muscles can remain irritable and tight long after surgery and sometimes permanently. Flexibility may become limited and movement restrained. When joints are removed, greater instability results, requiring more hardware to fuse and stabilize the spine.”
According to Dr. Kornel, “To reduce complications and improve outcomes minimally invasive spine surgery techniques have been developed and continue to evolve. Much smaller incisions are utilized that separate muscle fibers rather than cutting them and tendons are spared as well.”
Dr. Kornel explains Minimally Invasive Spine Surgery (MISS):
This approach is often done through a tubular system that creates a circular exposure of the area of interest ranging in size from about a half an inch in diameter to one and a half inches, the resultant operative field being visualized through a microscope or through a fiber-optic camera system. Less bone may be removed, a joint may be spared, and the nerves may require minimal exposure. Often the implantation of hardware is necessary to stabilize a spine. With MISS systems, hardware such as screws and rods can be inserted through very small “stab” incisions directed by fluoroscopic x-rays, computer guidance and CT guidance as well. This allows for very precise placement of hardware, again, with minimal disruption of the surrounding tissues and minimal risk of nerve damage.
When spinal discs need to be removed and fused, this can also be achieved percutaneously as well, through a narrow tube and a very small incision. This even allows fusion surgery to be performed on an outpatient basis. It is now possible to remove damaged discs and fuse them or replace them with artificial discs without going through the spinal canal at all. This can also be accomplished through the abdomen in what is referred to as a retroperitoneal approach where the abdominal contents are swept aside and the spine is exposed from in front.
Discs can also be removed through a lateral approach, going through the flank, the hardware then being placed through a small percutaneous approach as described above.
New methods are continuously being developed to further refine MISS techniques. The most exciting advances will be when discs can be regenerated via injection of biologically active materials such as stem cells. This is already under investigation with some human subjects. The time will come when, after using current MISS techniques to remove extruded disc material and bone spurs, substances will be injected to create brand new discs.