Every Day

May - July 2006 Issue

Minimally Invasive Back Surgery Helps
Speed Recovery Time

Christopher E. Wolfla, MD

Medical College of Wisconsin Neurosurgeon; spine specialist;
Named one of the Best Doctors in America 2005® by Best Doctors Inc.

Back surgery can be one of medicine’s most beneficial operations, as it can dramatically improve a patient’s quality of life. Minimally invasive back surgery at Froedtert & the Medical College of Wisconsin puts that quality-of-life improvement in reach with less trauma and shorter recovery time than patients experienced in the past.

Q: What is minimally invasive back surgery?

It’s a way of doing a surgery that doesn’t do so as much damage to the surrounding tissue as occurred the way we used to do things. We used to make a bigger incision and go down through the muscles, taking the muscles off the bone to get where we were going. A lot of that was unnecessary. With this surgery we make a very small incision, about three-quarters of an inch long, and basically spread the muscles instead of cutting them to get to where we’re going.

The beauty of it is that you can do the same operation with less damage to the surrounding tissue, less blood loss, less scarring and shorter hospital stays. The patients get up faster, they get around faster, they heal faster, and their pain goes away faster. It probably cuts off a third to a half of the recovery time, making it two to three weeks instead of four to six.

Q: What conditions do you use it for?

The most common thing we treat with this is herniated discs, which is one of the most frequent operations that we do. We can treat certain kinds of spinal stenosis, or narrowing of the spinal canal, with this technique. We can do some spinal fusions of the vertebrae, for disc degeneration and other conditions. We can also remove certain kinds of tumors, and we can do biopsies. It’s a very adaptable technique.

Q: And the tools you use for the procedure?

We use a microscope that focuses down into the nerves and gives you stereoptic vision with excellent light, or an endoscope that goes down into the patient. We use small instruments that are specially made for the job. They often have handles that are bent so they don’t get in your way and you can see down this long narrow tube to do your operation.

Q: What is the history of the technique?

Twenty years ago, people used to take out gallbladders using a great big incision. In the 1980s people started removing gallbladders laparoscopically — meaning doing it through some sort of a camera device. And a lot of the technology used in that was adapted to do minimally invasive spine surgery.

We use a microscope because it gives us a much better view than a camera. When you use a camera you see it on a TV screen, so it’s only two-dimensional. But a microscope gives us three-dimensional vision, and we have depth perception, which is very important in spine surgery.

The technique is becoming widespread. I would predict that in another two years 90 percent of back surgeries will be minimally invasive.

Q: What are the drawbacks of this surgery?

There are limits to what you can do right now with minimally invasive techniques. If you’re doing multi-level fusion — fusing more than two vertebrae — it becomes quite difficult to do minimally invasive. And there are cases where you would want more exposure and be able to see more. For example, certain tumors, birth defects and fractures are not well-treated this way. The technology is changing rapidly, though.

Q: And what do you see on the immediate horizon for this technology?

One of the things on the horizon is minimally invasive surgery for the cervical spine — the seven vertebrae beginning at the base of the skull. Also for trauma and for more complicated fusion and stenosis cases. It’s going to be awhile before that last one is going to be reasonable but it won’t be forever.

Q: Who should consider the procedure?

I think that anyone who’s considering back surgery needs to seriously consider having it done in a minimally invasive way. If it is appropriate for your condition, there’s no real reason not to.

Source: Every Day

Date: May - July 2006