10 Questions You Should to Know about minimally invasive spine surgery instruments

The amount of flexibility or mobility in each segment of the spine depends on the shape, size, and spacing of the vertebrae. It also depends on their attachment to surrounding structures.

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For example, the thoracic segment is the least flexible portion of the spine because each thoracic vertebra is tethered to a pair of ribs. Nevertheless, the thoracic vertebrae do bear weight and allow rotational movement. Your cervical spine is the most flexible segment, followed by the lumbar spine.

In the wide range of treatment options for back and neck pain, you may hear the term &#;conservative therapy&#;, &#;conservative treatment&#; or &#;conservative care&#;. This applies to a number of non-surgical (non-invasive or less-invasive) therapies which should be tried before you even consider spine surgery.

Physical therapy, chiropractic care, and over-the-counter pain medications are among the most common first line treatments which can help manage or improve your back condition. Other complementary and alternative medical (CAM) treatments that may be recommended are acupuncture, massage and even yoga.

If pain and physical limitations persist after three to six months of conservative care, your doctor may recommend a course of epidural spinal injections (steroid shots) or other pain management treatment.

The bad news is it may take up to a year to find an effective way to stop your back pain. The good news, however, is that up to 90% of spinal problems can be resolved without surgery. For more information on Inspired Spine&#;s conservative therapy protocols, please refer to our non-surgical back pain treatments.

Complementary and Alternative Medicine, also known as CAM, is commonly used to describe treatment approaches that are outside the realm of traditional Western medicine.

Examples would include Acupuncture, Chiropractic Care, and even Yoga. Recently, the National Institutes of Health has divided this concept into 2 separate categories:

• If a non-mainstream practice is used together with conventional medicine, it&#;s considered &#;complementary.&#;
• If a non-mainstream practice is used in place of conventional medicine, it&#;s considered &#;alternative.&#;

Most people in the US who use non-mainstream approaches use them along with conventional treatments and the two approaches are becoming more integrated into our healthcare system.

TENS therapy is a pain management treatment that uses a small battery-powered unit to deliver a low-voltage electrical current to painful muscles in the back.

This sensation may trick the brain into focusing on the harmless electrical stimulation generated by the TENS unit, rather than on pain signals arising from the same area.

For example, the thoracic segment is the least flexible portion of the spine because each thoracic vertebra is tethered to a pair of ribs. Nevertheless, the thoracic vertebrae do bear weight and allow rotational movement. Your cervical spine is the most flexible segment, followed by the lumbar spine.

If the idea of having an ultrasound conjures up those cute prenatal pictures that excited parents-to-be post on Facebook, you&#;re thinking of diagnostic ultrasound imaging, which just one use for this soundwave-based technology. However, ultrasound treatment for back pain is actually a very popular physical therapy technique that has nothing to do with imaging.

Ultrasound therapy uses very high frequency sound waves to focus energy on soft tissue deep within your body. The resulting heat increases blood flow, reduces inflammation, and promotes healing. What&#;s more, therapeutic ultrasound is quite painless and doesn&#;t require any needles or incisions. All that&#;s needed is to apply a jelly-like substance to the skin area to prevent friction as the ultrasound device gently massages the affected area of your back.

For example, the thoracic segment is the least flexible portion of the spine because each thoracic vertebra is tethered to a pair of ribs. Nevertheless, the thoracic vertebrae do bear weight and allow rotational movement. Your cervical spine is the most flexible segment, followed by the lumbar spine.

A discogram is a diagnostic test that is used to help identify exactly which disc (or discs) of your spine cause your back pain. It works by using a fluoroscope (a video X-ray machine) as a guide, the doctor injects the suspect discs with a dye, one at a time. The dye increases the pressure on the disc and surrounding nerves, making a bad situation worse. In short, getting the diseased disc to cry out in pain.

A discogram is not very pleasant. The purpose of the test is to make the painful disc act up.

The simple answer is to avoid unnecessary surgery. An MRI or CT scan doesn&#;t always get the whole picture. Or course, they can accurately spot degenerated or herniated discs, bone spurs, osteoarthritis, and many other visible signs of spinal disease. However, these are merely anatomical signs of wear and tear that commonly show up as we age. In fact, degenerated disc disease is so common that it&#;s found in 90% of people over 65. Most cases don&#;t cause any back pain at all, and fewer than 10% need surgery.

The Oswestry Disability Index (ODI) is an index derived from the Oswestry Low Back Pain Questionnaire used by medical professionals to measure the quality of life impairment of a person with low back pain. Zero is the least amount of disability and 100 is the maximum disability possible.

The questionnaire covers ten topics of everyday life ranging from intensity of pain to social life and sleep quality. Patients are given different scenarios on each topic that indicate varying degrees of disability and asked to check the one that most closely resembles what they are experiencing or feeling. Each question is then scored to obtain a disability index.

Different patients experience pain differently and the 1-to-10 pain scale commonly used in the medical community is an attempt to quantify each patient&#;s subjective rating of her pain. What one person may rate a 7 (Very Severe Pain), another may rate a 4 (Moderate Pain). Therefore, the best measure of whether your condition is getting better or worse, is to compare your own pain assessment from one visit to the next or before or after treatment.

For more information on the pain scale, see this article on our blog.

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The amount of flexibility or mobility in each segment of the spine depends on the shape, size, and spacing of the vertebrae. It also depends on their attachment to surrounding structures.

For example, the thoracic segment is the least flexible portion of the spine because each thoracic vertebra is tethered to a pair of ribs. Nevertheless, the thoracic vertebrae do bear weight and allow rotational movement. Your cervical spine is the most flexible segment, followed by the lumbar spine.
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In the wide range of treatment options for back and neck pain, you may hear the term &#;conservative therapy&#;, &#;conservative treatment&#; or &#;conservative care&#;. This applies to a number of non-surgical (noninvasive or less-invasive) therapies which should be tried before you even consider spine surgery.

Physical therapy, chiropractic care, and over-the-counter pain medications are among the most common first line treatments which can help manage or improve your back condition. Other complementary and alternative medical (CAM) treatments that may be recommended are acupuncture, massage and even yoga.

If pain and physical limitations persist after three to six months of conservative care, your doctor may recommend a course of epidural spinal injections (steroid shots) or other pain management treatment.

The bad news is it may take up to a year to find an effective way to stop your back pain. The good news, however, is that up to 90% of spinal problems can be resolved without surgery. For more information on Inspired Spine&#;s conservative therapy protocols, please refer to our non-surgical back pain treatments.

Fluoroscopy is used in our advanced minimally invasive spine surgery to provide what is called &#;indirect visualization.&#; Indirect visualization allows the surgeon to work through a small incision, rather than cutting down to the spine and pulling back all the muscles and surrounding tissue with retractors to expose it to direct view (known as &#;direct visualization).

Fluoroscopy is something like an x-ray movie. Radiographic C-shaped arms, called C-arms, provide a 360-degree view of the spine and the entire procedure in real time. With these highly magnified images projected on monitors, the surgeon has full view of his instruments as he works around the nerves and structures of the spine at all times&#;better than the view in direct visualization. In this way, the procedure can be guided more accurately, without damaging back muscles or surrounding tissue.

Intraoperative neuro-monitoring&#;short for intraoperative neurophysiologic monitoring (IONM)&#;is a standard safeguard employed in spinal surgery to reduce the possibility of nerve damage.

Many different methods of testing electrical activity in the nerves can be used to detect any changes in nerve function during the operation and ensure that the flow of stimuli from the spinal cord through the nerves is not compromised in any way during the procedure.

Traditional &#;open&#; spine surgery may require several days in the hospital as it may involve a three-inch long incision, in which muscles and tissues are separated for optimal access to the injury site. The surgery usually results in trauma to surrounding tissues and some blood loss. Because of this the affected tissues and muscles need adequate healing time.

Spine surgery then home the same day

Experienced spine surgeons use the latest minimally invasive techniques and instrumentation to help patients recover in a shorter period of time and allow for a quicker return home.

Innovative developments in minimally invasive techniques have pioneered better ways for the surgeon to access the spine, moreover making the recovery process more seamless. In minimally invasive spine surgery, a smaller incision is made, sometimes only a half-inch in length. The surgeon inserts special surgical instruments through these tiny incisions to access the damaged disc in the spine.

Entry and repair to the damaged disc or vertebrae is achieved without harming nearby muscles and tissues when using minimally invasive techniques. Minimally invasive spine surgery requires extensive training and experience to master use of the tools, but there is tremendous benefit for the patient.

About Minimally Invasive Equipment and Techniques

All of the surgical equipment used in minimally invasive spine surgery must be able to pass through a keyhole-sized portal. These portals are left in during the entire surgery to allow specially designed surgical tools to move freely into the patient&#;s spinal column and not to damage the soft tissue from exiting and inserting equipment.

When the portal is removed at the end of the surgery, the surrounding soft tissues slowly fall back into their normal place and only require a small amount of stitches to close the area.

Benefits of minimally invasive spine surgery include:

• Smaller incision and smaller scar
• Less damage to tissues and muscles
• Less blood loss
• Less post-operative pain
• Less painful recovery
• Quicker return to activity

Minimally Invasive Surgery FAQs

What is involved with a minimally invasive procedure?

Minimally invasive spine surgery in the lumbar area uses a small 1-inch incision to allow insertion of a special tubular retractor instrument with a camera to provide a constant video feed. Other instruments are inserted through this retractor to perform surgery on the disc level.

What is a Minimally Invasive Tubular Retractor?

A minimally invasive tubular retractor (MITR) is used to gain access to the spinal column. The device goes through a small keyhole in the muscles of the back, reducing damage to the spine where as normal open back surgery pulls the muscles away from the spine causing soft tissue damage. This device also helps control blood loss since it is not as harsh on the body than the alternative procedure.

What is a fluoroscopy?

A fluoroscopic C-arm is used to show continuous x-ray images on a monitor which enables the surgeon to navigate to precise areas in the back or neck.

Can all spine problems be treated using a minimally invasive approach?

Minimally invasive spine surgery cannot be used for all surgeries. Some procedures, like scoliosis surgery or reconstructive scoliosis surgery, can require a longer incision.  Even so, scoliosis surgery is changing. Dr. Matthew Geck at Ascension Texas Spine and Scoliosis in Austin, Texas is one of few scoliosis surgeons in the nation proficient in &#;mini scoliosis surgery&#;. With mini scoliosis surgery, Dr. Geck is able to correct a spinal curve through three smaller incisions rather than one long 10-inch incision. This provides for a faster and less painful recovery for the scoliosis patient.

How do I know if minimally invasive surgery is right for me?

Not every spinal procedure or patient is a candidate for minimally invasive spine surgery. Your spine surgeon can advise you if there are new techniques and instrumentation available for your particular problem. Also getting a second opinion for spine surgery can help ensure that you are receiving the least invasive surgical option.

Are there risks involved with minimally invasive surgery?

Typically minimally invasive spine approaches lessen blood loss and reduce risks. Some of the risks associated with ANY type of spine surgery includes: adverse reactions to the anesthetic, blood loss, infection, blood clots, pneumonia, instrumentation tools causing damage to spine and surrounding tissues, and even paralysis (extremely rare).

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