Jefferson Specialists Expand Minimally Invasive Spine Surgery (MISS) to Correct Major Deformities
Spine
specialists at Thomas Jefferson University Hospital are expanding the
field of minimally invasive spine surgery (MISS) by refining new
techniques to correct even complex spinal deformities such as scoliosis
and kyphosis. Correction for these conditions using standard surgery
historically required a recovery period of at least three to six
months, and even up to a year. But with MISS, selected cases can be
managed with recovery times as short as three to six weeks. Led by D.
Greg Anderson, M.D., the Jefferson team is the only in the Philadelphia
region, and one of only a handful in the U.S., employing an MISS
approach to treat patients with major multi-level deformities involving
the lumbar and thoracolumbar spine.
The
benefits of MISS for patients with complex spinal deformities such as
scoliosis (a side-to-side curvature of the spine) and kyphosis (forward
rounding of the spine) as well as other complicated problems such as
spinal fractures, tumors, and infections include: significantly smaller
scars; decreased blood loss; reduced post-operative pain; and shorter
hospital stays (average two to three days, compared to a week or
more). Also, since time in the hospital is decreased and patients are
able to resume normal activities sooner, like getting back to work,
MISS is considerably more cost effective.
“Minimally
invasive spine surgery offers the benefits of traditional spine
surgery, but with limited trauma to the body and an easier, faster
recovery period,” says Dr. Anderson, spine specialist at the Rothman
Institute at Jefferson, and associate professor of Orthopaedic Surgery
at Jefferson Medical College. “Today, we are successfully using these
less invasive techniques to treat patients with complicated,
multi-level spinal disorders—a feat that was not possible even five
years ago.”
With
traditional surgery for significant deformities, the spine is generally
approached through sizeable incisions made on the front and back sides
of the patient’s body. First, major organs must be mobilized and large
blood vessels retracted to gain anterior (front) access to the spine.
From this position, the rigidity of the deformity is loosened, the
angle of the curve is corrected (by filling the slanted space between
vertebrae with structural bone grafts until it becomes parallel), and
an anterior fusion is performed. The surgeon then reaches the spine
posteriorly (from the back), stripping the back muscles away to make
room to position screws and rods, and fuse the vertebrae again from
behind. The anterior and posterior components of the procedure are
often carried out on separate days, up to one week apart (allowing the
patient time to recover from the stress of the first surgery).
In
contrast, MISS is performed through very small incisions using special
scopes, instrumentation, and state-of-the-art, real-time imaging
equipment to accomplish the complex components of these surgeries
during only one procedure, in the least invasive manner. Working
through narrow tubes placed under x-ray guidance, orthopaedic surgeons
are able to correct and fuse the spine, from both the front and back,
while avoiding unnecessary manipulation and injury to the surrounding
soft tissue and organs.
Depending
on the type of deformity and the number of vertebrae affected, a
certain number of tiny incisions are made along the patient’s side,
near the ribcage, to gain anterior access to the spine. From there,
muscles and tissue are spread, rather than cut, to expand an operative
channel. Football-shaped implants are then slid between the vertebrae
to lift the deformed disc, making the vertebrae parallel. After
obtaining most of the correction, the vertebrae are fused from the
front. Next, small, puncture-like incisions are created on the
patient’s back, at which time the spine is fused again from behind, and
specially designed screws and rods are guided in place to correct and
maintain the spine’s new position.
According
to the American Academy of Orthopaedic Surgeons (AAOS), scoliosis
affects approximately two percent of the population (mostly females),
but if someone in a family has the condition the likelihood of
incidence goes up to 20 percent. It is termed thoracic when located in
the thoracic spine (mid and upper back), and lumbar when it is located
in the lumbar spine (lower back). Thoracolumbar scoliosis refers to
curves located at the junction of the thoracic and lumbar spines. The
condition can be first noted at any point in life, and in addition to
genetics, is frequently related to degenerative arthritis, leading to
disabling pain in the back and legs.
Other
spinal deformities such as kyphosis are associated with osteoporosis,
prior spinal trauma, surgery, or infections. As more people in the
U.S. reach the age of 65 years or older, the incidence of scoliosis and
kyphosis is expected to increase.
MISS
is now being used to treat a wide variety of spinal conditions
including trauma, tumors, infections and degenerative diseases. It is
important to consult a spine specialist for an accurate diagnosis and
to discuss treatment options.
For an appointment with a Jefferson spine specialist, please call 1-800-JEFF-NOW or visit www.JeffersonHospital.org.
Media Only Contact:
Ed Federico
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 2/13/2008