Nobody relishes the idea of having spine surgery. It sounds inherently intrusive to have the core of your skeletal being surgically disturbed. As spine surgeons, it is not a stretch for us to imagine that patients would rather receive less invasive than more invasive procedures. For better or worse, this realization of likely patient preference has not eluded most other spine surgeons in the United States. Minimally invasive spine surgery (MIS) is trumpeted in advertising literature and on web sites of most spine surgeons in Austin, and probably most spine surgeons in the nation. It seems to be a must of marketing. Even if MIS were a negligible part of their practice, few surgeons would fail to list it on a brochure. We are no exceptions.
So, should a patient with a surgical spine problem seek out a minimally invasive procedure?
First of all, the vast majority of spinal disorders do not require surgery. It is not uncommon for us to go a full week without seeing a patient who needs surgery. In conditions that would benefit from surgery, many require a more traditional, “open” operation. Some operations simply lack a minimally invasive option, such as tumor, many trauma, and many scoliosis operations.
Second, not all minimally invasive procedures are as effective or safe as the traditional open operation. In fact, no minimally invasive spine procedure has yet proven superior to an open procedure in a clinical study with long-term follow up.
Proponents of minimally invasive spine surgery rightly state that many MIS procedures have shown less intra-operative blood loss, shorter hospital stays, and less need for postop pain medication, and may very well show clinical superiority once longer-term comparison trials are completed.
As surgeons who performs a number of minimally invasive operations, we can attest that the blood loss and tissue destruction (a.k.a. collateral damage to the back muscle) tends to be less with MIS procedures. The hope among MIS advocates is that this lessening of muscle disruption will lead to better outcomes and less need for re-operation.
Unfortunately, just as not all MIS procedures are as good as the traditional operations, not all MIS surgeons are created equal. There are plenty of surgeons with the training, skill set, and patience to perform excellent minimally invasive operations. Unfortunately, each of my partners and I have been referred patients suffering from a failed MIS operation, with at least part of the cause being the performance of the original operation lacked the requisite diligence and meticulous attention to detail.
Another potential problem with MIS procedures is their all-too-frequent ephemeral nature. Eager surgeons and investor-conscious spine surgery device manufacturers frequently tout the “next generation” or “game changing” MIS technology. While some of these latest and greatest inventions have merit, the spine world is littered with MIS devices that either failed to work as advertised, suffered from high complication rates, or led to surgical outcomes inferior to traditional open approaches. While our group remains open to new ideas, we believe a healthy dose of skepticism is warranted. We tend to let others do the early experimentation with unproven technologies, with eyes towards adopting those that pan out over time.
But if the pattern across the medical spectrum holds, there will be a gradual adoption of MIS techniques across the spine surgical landscape. Just as nearly all gall bladders are removed laparoscopically and all ACLs are reconstructed with arthroscopic assistance, many spine procedures which until recently had no minimally invasive options will likely be performed exclusively with MIS techniques once training and research catch up with the technology.
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If you would like more information about minimally invasive spine surgery and other spine treatment options at Austin Spine or would like to schedule an appointment with one of our skilled surgeons, please call our office at (512) 347-7463.