Neel Anand, MD, Mch, Orth, orthopedic spine surgeon and director of orthopedic spine surgery of The Spine Center at Cedars-Sinai Medical Center in Los Angeles, discusses six things to know about minimally invasive surgery.
1. Instrumentation, devices and techniques all advancing. Dr. Anand says technology is a major driver of advances in minimally invasive surgery. Technological advances, he says, would include the advances in instrumentation, devices and techniques.
"Instrumentation would be all of the things we need to make the surgery happen, and that includes tubes to lighting sources to instruments that are specifically designed to do minimally invasive work," Dr. Anand says. "Then there's the devices themselves — they are being designed in a way that they can be used effectively in a minimally invasive manner. Finally, the techniques: This is how to do the cases.
"All of these three have grown hand in hand over the last 5-7 years, predominantly due to some very significant collaboration between surgeons and engineers, industry and government and thought processes of how to make surgery better," he says.
2. Ancillary technologies presenting new opportunities. Ancillary technologies have been critical to improving outcomes of minimally invasive surgery. They include areas such as imaging software and the O-arm Surgical Imaging System by Medtronic, which Dr. Anand describes as essentially an intraoperative CT scan. "We have navigation today and it's called virtual navigation," he says. "We are able to virtually map the spine, take O-arm images, put the two together and now we're able to virtually map where the bone is, where the anatomy is and appropriately instrument and operate. Virtual navigation has helped us immensely in planning and doing minimally invasive work."
3. Advances in biologics have helped with bone healing. "That has helped hugely because we used to take bone grafts from the iliac crest and 25-30 percent of patients experience chronic pain from that," Dr. Anand says. "Today we very rarely do that. Today we have BMP (bone morphogenetic protein) and other different types of bone substitutes that they're able to put in to enhance bone formation and fusion. Biologics has taken away that painful part of fusion surgery."
4. Robotics still not viable for spine surgery. Dr. Anand says for spine surgery, robotics has never really taken off like it has for other surgery types, such as laparoscopic surgery, where a robot can hold the laparoscope. For spine procedures, he says, that would never work, at least not with the technology available today. "I think there are a number of reasons why," he says. "Personally I think it's because there's a lot of tactile feel — the surgeons hands and the feeling of where you and what you're doing — which I believe is extremely important in spine surgery."
5. Minimally invasive approach for scoliosis surgery a crowning achievement. Scoliosis surgery is a very significant surgery in spine and because of its extensiveness, Dr. Anand says, it can bring with it a high morbidity due to the stripping and destroying of muscles, tremendous blood loss and a lengthy procedure time. But minimally invasive surgery has changed the landscape for scoliosis procedures. To be able to do spinal deformity and scoliosis surgery minimally invasively today I think is one of the biggest leaps in our technology in the last five years," he says. "We've seen tremendous differences in terms of blood loss and recovery compared to open surgery."
6. Minimally invasive surgery not defined by the incision. Dr. Anand says it is not the incision that makes a surgery minimally invasive. "It has to do with the handling of tissues inside the body and preserving the muscles," he says. "It's like having no collateral damage. You try to do the surgery without collateral damage and that is you try to keep the muscles intact and that is what minimally invasive surgery is all about — to get the job done appropriately."
Learn more about Dr. Neel Anand.
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