Minimally invasive spinal surgery procedures

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, PA-C

Why do people opt for minimally invasive spine surgery? Doctors at the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, came to these conclusions in the journal Clinical Spine Surgery (April 2018).

“Minimally invasive spine surgery has increased in popularity due to proposed advantages in the perioperative and immediate postoperative periods.”

Comment: There is an understanding among patients that in the period just before the surgery and in the recovery after the procedure there are advantages to having the Minimally invasive spine surgery.

The Rush researchers discovered that the 3 most important criteria for patients when choosing between open (traditional spinal surgery) and Minimally invasive spine surgery were:

  • long-term outcomes,
  • surgeon’s recommendation,
  • and complication risk.

When compared with Minimally invasive spine surgery, the majority of patients thought that:

  • Traditional open surgery would be more painful (83.8%) than Minimally invasive spine surgery
  • Traditional open surgery would have increased complication risk (78.5%), than Minimally invasive spine surgery.
  • Traditional open surgery would have increased recovery time (89.3%),  than Minimally invasive spine surgery.
  • Traditional open surgery would have increased costs (68.1%), over Minimally invasive spine surgery.
  • Traditional open surgery would require heavier sedation (62.6%) than Minimally invasive spine surgery.
  • If required to have spine surgery in the future, the majority of both patient groups would prefer a minimally invasive approach (80.0%).

But is the understanding that Minimally invasive spine surgery is less complicated, less risky, less painful, accurate? NYU Study

Researchers at New York University Langone Medical Center warn about the growth and popularity of minimally invasive surgery (MIS) procedures. They say that the procedures are easily marketable to patients as less invasive with smaller incisions, minimally invasive surgery is often perceived as superior to traditional open spine surgery. The NYU researchers put this to the test.

A systematic review of randomized controlled trials involving minimally invasive surgery versus open spine surgery was performed.

  • For cervical disc herniation, minimally invasive surgery provided no difference in overall function, arm pain relief, or long-term neck pain.
  • In lumbar disc herniation, minimally invasive surgery was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation (as the procedure requires imaging) in return for a shorter hospital stay and less surgical site infection.
  • In posterior lumbar fusion, minimally invasive surgery transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy.
  • The highest levels of evidence do not support minimally invasive surgery over open surgery for cervical or lumbar disc herniation. However, minimally invasive surgery transforaminal lumbar interbody fusion demonstrates advantages along with higher revision/readmission rates.
  • Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding minimally invasive surgery versus open spine surgery, particularly in the current advertising climate greatly favoring minimally invasive surgery.(2)

But is the understanding that Minimally invasive spine surgery is less complicated, less risky, less painful, accurate? British journal of neurosurgery Study

In research from August 2017 appearing in the British Journal of Neurosurgery, surgeons said this:

“Though different techniques have been successfully employed in the treatment of recurrent lumbar disc herniation, the one which should be considered most ideal has remained a controversy, (minimally invasive surgical techniques).”

“In view of the currently available data and evidence, minimally invasive techniques for revision of recurrent disc herniation do not really appear to be superior to the conventional open surgical approaches and vice-versa. Spinal fusion should not be undertaken in all recurrences but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.”(3)

Prolotherapy an option to any spinal surgery

In his article Prolotherapy non-surgical treatment of a herniated or bulging disc, Ross Hauser, M.D writes: “In our many years of treating patients with cervical neck and back pain, we came across patients who had continued back pain after spinal surgery. The reason? A coincidental finding on MRI of a herniated disc. Coincidental means, “oh, by the way, you have a herniated disc, we are not sure that is the problem, but to make sure, let’s go to disc surgery.” The outcomes of this medical strategy did not go as well as hoped for in many patients we have seen.”

In that article and in the video below, we present our argument for Prolotherapy as being an option to any spinal surgery.

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Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | Ross Hauser, MD | David Woznica, MD

1 Narain AS, Hijji FY, Duhancioglu G, Haws BE, Khechen B, Manning BT, Colman MW, Singh K. Patient Perceptions of Minimally Invasive Versus Open Spine Surgery. Clinical spine surgery. 2018 Apr 1;31(3):E184-92. [Google Scholar]

2 McClelland S, Goldstein JA. Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us? Journal of Neurosciences in Rural Practice. 2017;8(2):194-198.[Google Scholar]

3 Onyia CU, Menon SK. The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review. British Journal of Neurosurgery. 2017 Aug 22:1-8. [Google Scholar]

 

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