Only Surgeons in Region using MISS to Treat Patients with Lumbar and Thoracolumbar Scoliosis and Kyphosis

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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.