doctor looking at a model of a spine

Spinal Surgery: When Less Invasive Options Have Proven Unsuccessful

Evidence-based medicine is the driver for patient care at Inova. When spine surgery is required the surgeon will review procedure options that may be available.

A decision to have spine surgery requires careful evaluation of several factors. (These include the severity of the disorder, the presence or absence of pressure on the spinal cord or nerves, how long the pain has been present, the intensity of the pain and past medical history.)

Minimally invasive surgical procedures can be good options for treatment of herniated discs or compression fractures. Inova has the latest in minimally invasive spine surgical technologies including robot-assisted equipment and augmented reality instrumentation for spine surgeries.

Commonly Performed Spinal Surgery Techniques

Lumbar Disc Replacement and Cervical Disc Replacement

Lumbar and cervical disc replacements are similar in concept to hip or knee replacements. Surgeons remove the damaged, painful disc in the cervical or lumbar spine and replace it with a metal and plastic implant. The implant is designed to move like a normal disc and recreate spinal motion and function.

Laminaplasty

Laminaplasty is a procedure in which the lamina (the bony arches on the vertebrae) are cut free along one side and hinged open like a door to enlarge the spinal canal and relieve pressure on the spine.

Laminectomy

A laminectomy removes the bony arches on one or more vertebrae to relieve pressure on the spinal cord or a nerve branching from the spinal cord.

Spinal Fusion

Spinal fusion connects two or more vertebrae together and keeps them from moving until they have a chance to grow together, or fuse. Surgeons place metal screws into the vertebrae and attach them to metal plates or rods that are bolted together in the back of the spine. Bone is grafted into the spaces between the vertebrae.

Interspinous/interlaminar Implant

This device is a shock absorber that fits between two vertebrae to provide cushioning and stability, and relieve pressure on the spine.

Microendoscopic Discectomy for Herniated Discs

Surgeons insert a tiny metal tube to access the herniated disc and remove the portion pressing on the nerve. Muscle is displaced rather than cut, so when the tube is removed, the muscle falls back into its natural location.

Kyphoplasty for Compression Fractures

Surgeons insert a balloon tamp at the site of the compression fracture and inflate it, pushing the bone back to its normal height and shape. The cavity is filled with bone cement. When it hardens, the tubes are removed.

What is Minimally Invasive Spine Surgery?

Minimally invasive spine surgery is an effective option for many patients. These methods usually are performed through smaller incisions and reduce the risk of damage to nearby parts of the spine. Patients benefit from less scarring, reduction in soft tissue damage, less injury to muscles, reduced blood loss and post-operative pain, a shorter recovery time and a quicker recovery. Evidence-based medicine is the driver for patient care at Inova. When spine surgery is required the surgeon will review procedure options that may be available. One of them might be minimally invasive spine surgery.

Not all spine surgeries can be done with minimally invasive spine surgery techniques; however, new techniques for minimally invasive spine surgery continue to evolve.

Compared to open spine surgery, minimally invasive spine surgery, sometimes referred to as MIS or MISS, accesses the spine through smaller incisions. These can be from 2-4 inches long compared to longer incisions in open approach spine surgery. Through the smaller incisions the surgeon is still able to move muscle tissue and expose the affected spine region.

These conditions can often be treated using minimally invasive surgical techniques:

  • Degenerative disc disease
  • Herniated disc
  • Lumbar spinal stenosis
  • Spinal deformities such as scoliosis
  • Spinal infections
  • Spinal instability including spondylolisthesis
  • Vertebral compression fractures
  • Spinal tumors

Minimally Invasive Spine Surgery with Augmented Reality

Augmented Reality (AR) guidance for spine surgery provides spine surgeons the ability to visualize the three-dimensional spine anatomy of a patient during surgery. This can be compared to working with "X-ray vision" glasses.

The benefit of this is to accurately navigate surgical instruments and implants while keeping focus directly on the patient, rather than a remote screen which had been the more common practice.

Augmented Reality spine surgery, like spine robots provides a safer, more efficient surgery. Having the aid of augmented reality guidance systems takes the best surgical navigation systems and improves upon them to meet the needs of spine surgeons and provide technical confidence in the operating room.

Minimally Invasive Spine Surgery with Robotic Instrumentation

Robotic-assisted spine surgery is an advancement in spine surgery. It enables surgeons to plan their surgery even before their first patient cut. Once spine surgery begins, the robot provides screw placement with better accuracy due to the guidance system in the robot. Since the surgery was pre-programmed with prior imaging both the patient and operating room staff are subjected to less perioperative X-ray radiation. This minimally invasive surgery technique can be more beneficial for patients, usually resulting in a smaller incision and less pain.

As it continues to grow, robotic surgery will likely become a prevalent technology for select spine surgeries.

Robotic-assisted spine surgery allows surgeons to perform many types of spine surgery more accurately, efficiently and safely. There are some surgeries where robot-assisted spine surgery is not the best option. This is best determined with a surgeon's consultation.