Minimally Invasive Spine and Neck Surgery

Why undergo a major operation, when a smaller one could provide similar results?

Back pain is a leading cause of lost productivity at work and diminished quality of life at home. Yet, most of us will have at least one serious episode of back pain within our lifetimes. If that’s all you have to contend with, consider yourself lucky. Many others will face constant pain, rendering some completely disabled.

Conventional treatments, such as avoiding strenuous activity, taking non-steroidal anti-inflammatory medications and physical therapy, will prove sufficient to control the symptoms for many back and neck pain patients. A small percentage, however, will become candidates for spine surgery. While it might seem like a quick cure-all, undergoing an operation should be the last resort—after all other means have been tried and have failed.

There are many different types of spinal procedures, all targeted to the specific problem believed to cause the symptoms. If a nerve is being “pinched,” resulting in numbness and weakness in an arm or leg, it is often due to a displaced or “slipped” disc.

Discs are the “shock absorbers” between vertebrae. They are made of tissue similar to cartilage, which can bulge out of place and put pressure on a nearby nerve. A “discectomy” typically involves removal of the displaced part of the disc and some adjacent bone, which takes pressure off the nerve.

Back and neck operations are frequently more complex than that. Spinal procedures commonly involve a “fusion” of two or more vertebra in the neck or lower back. This requires the removal of most of the disc and insertion of materials that facilitate bone growth across the space. This usually results in a solid link between the two adjacent vertebrae— a fusion. Similar to the time it requires to recover from a fracture, this may take a few months. Thus, a “splint” is applied to prevent motion between the vertebrae as the bone grows. In the case of the spine, an effective splint cannot be placed outside the body, so metal screws and rods are used inside to fasten adjacent vertebrae to one another.

These operations typically require large incisions in the skin and profound stretching of nearby muscles to expose an area large enough to perform the surgery. Recently, however, a small number of surgeons have succeeded in achieving the same results with far less skin and muscle disruption, greatly increasing the safety and comfort of having an operation on the spine.

Reduced exposure of the spine decreases the risk of infection, as well as the need for blood transfusion. The amount of time spent under anesthesia is shortened, as well. More importantly, post-operative pain is reduced. Therefore, patients require less time in the hospital and get back to their normal routines more quickly.

A person considering spine surgery should know a few things:

First, there is the distinction between neurosurgeons and orthopedic spine surgeons. Neurosurgeons spend at least half their medical school years and residencies, along with roughly half their time in practice, operating on the spine. Neurosurgeons study the nervous system —this means the nerves and spinal cord in and around the spine, as well as the brain— throughout their careers. Moreover, in the US, only neurosurgeons are “certified” in spinal surgery.

By contrast, most orthopedic surgeons gain limited spinal surgery experience during their primary training, and do not study the nervous system located within the spine. Orthopedic surgeons interested in becoming spine specialists do spend an extra year of intensive training in spine surgery, but there is currently no certification process for this. However, none of this is to say that all neurosurgeons are great, and no orthopedic surgeons are.

Clearly, choosing a superior spine surgeon requires careful consideration. It’s recommended that you find out as much about a surgeon as you can. Internet information will likely not reveal enough about the caliber of the surgeon, and you may not have the same experience with a surgeon as a friend or family member. Still, these are good places to begin. Your primary doctor can also refer you to surgeons with whom their other patients have had good experiences. Much of your decision should be based on your comfort level with the surgeon during your consultations. Just know that all surgeons have had patients with unsatisfactory results.

Be wary of hasty or emphatic recommendations to have an operation on your spine. Remember, everything else must have failed and you must have a clear indication that your case would be best served by an operation. Even then, a significant percentage of spine operations will not be completely successful. Fortunately, most people do experience some relief.

A good surgeon will take the time to explain all of this to you, along with the possible complications of a recommended procedure. All operations come with risks. The estimated potential benefits, however, should greatly outweigh any risks associated with the surgery. Run from any surgeon who does not take the time to explain everything clearly to you.

Last, but not least, get at least two opinions. If the first two differ greatly, that might be reason to seek a third. Also, look for a spine surgeon skilled in minimally invasive techniques. No need to have a big operation when a smaller one could work just as well.