Awareness of advanced, minimally invasive spine surgery has been brought to the mainstream through TV commercials and internet ads touting robots and lasers.
Many patients fear addressing spine-related issues with surgery as these interventions are thought to involve a lot of pain related to the surgery, prolonged recovery/hospitalizations and uncertain long-term improvement.
The images of patients being able to now get up and walk on the day of surgery and feeling a significant improvement in their symptoms immediately after surgery are now a reality in Northwest Indiana.
A few national and international spine surgeons have dedicated their careers to advancing the field of minimally invasive spine surgery. The goal of these procedures is to preserve the functioning patient’s soft tissue, muscle and bone while decompressing pinched nerves and providing stability to the spine in certain cases.
“God built patients better than any surgeon can fix them” is a term I often use with my patients while discussing these procedures. In 2017, I co-authored a position statement published in SPINE, Breaking through the glass ceiling of minimally invasive surgery.
The article detailed how far the field has progressed. Decompressions, fusions, disc replacements and even fractures now can all be treated with minimally invasive approaches with minimal downtime. Most patients are able to go home a few hours after the procedure.
There is no better example of the progress of minimally invasive spine surgery than MAS Midline fusion. I had the opportunity to serve as a design surgeon for this procedure.
The procedure begins with a small midline incision usually less than 1.5 inches. The muscles are spread, and a specially designed retractor is inserted to hold the muscles in position. Midline Cortical fixation in the bone is obtained using an inside-out trajectory, minimizing any disruption of the soft tissue.
This exposure allows for the direct decompression of the nerves with an intraoperative microscope. A small spacer is placed between the two bones to provide stability, restore height and alignment.
A large emphasis has been placed on addressing spinal alignment with any spinal procedure to avoid breakdown above or below the stabilized segment. This is one of the few minimally invasive approaches that can consistently restore alignment.
I published on the ability to restore alignment using this technique at Society for Minimally Invasive Surgery and International Society for the Advancement of Spine Surgery (ISASS) in 2017.
These procedures routinely can be performed on an outpatient basis with no overnight stay. I presented this data on my patients at ISASS in 2017 with patients being discharged, on average, 2.5 hours after the procedure.
There is no better validation for a procedure than seeing the technology in action for patients. A patient recently shared this story:
Hi Dr. Khanna, I know you have a lot of patients, so I'm not sure if you remember me. I was referred to you for my workman's comp case. You did a spinal fusion on my L5/S1. Everything went great, and I am still doing amazing. I'm a runner, and you suggested I only do light/shorter runs. And I told you completing a half marathon and a full marathon was on my bucket list. Well, I have officially checked both off my bucket list! I ran the Hero Half Marathon September 2017, and I ran the Chicago Marathon this past Sunday. ... Thank you for doing my surgery and giving me my life back. I feel better than ever, and I do not think I would have ever been able to accomplish my goals had I not gotten the surgery to relieve my back pain.
The future is now for patients suffering from painful conditions related to the spine.