One of the fastest-growing fields in spine is minimally invasive surgery. Historically, spine operations involved big incisions for open procedures with more blood loss, pain and higher risk of infection than the less invasive procedures today.
"Although open operations worked well, the initial recovery period would be difficult because of the trauma to the muscles and swelling that would occur," says Eric A. Williams, MD, MBA, director of the orthopedic residency and spinal cord injury program at Einstein Healthcare Network. "We also found that because of the long incisions, irreparable damage was done to the muscles; they would scar and lead to additional back pain. Now with the smaller incisions, and certain operations we can do through a tube, there is less muscle damage to access the level of the spine we want to operate on."
With less postoperative pain, and better pain control, patients can ambulate and return home sooner; they require less postoperative narcotics and can begin their physical therapy sooner — sometimes even within 24 hours.
"Just yesterday I did a minimally invasive fusion that required taking the pressure off the nerve, placing screws in the back and replacing the disc," says Dr. Williams. "Normally the patient would stay at the hospital for three or four days, but this was just a 23-hour admit case."
In addition to his clinical work, Dr. Williams advances the field through his role as a consultant for DePuy. He trains residents on minimally invasive procedures and speaks with device representatives in the industry about the benefits of less invasive procedures.
"Minimally invasive surgery is really important right now because hospitals and insurance companies are emphasizing outpatient procedures," he says. "If we can do procedures where patients don't have to stay in the hospital, they will cost less and the percentage of GDP dedicated to healthcare will decrease. The biggest benefit is if we continue to develop this technology and do a better job of postoperative pain management, the patient will recover more quickly and have a better outcome."
In some markets, insurance companies are already stressing outpatient procedures for certain cases.
"Five years down the line, if we perform certain cases in the hospital instead of the outpatient center, they will be denied," says Dr. Williams. "But if we can do it in 23 hours, that's more advantageous."
As technology advances, surgeons and engineers are working together on less traumatic techniques and instrumentation for spine cases. They're also learning more about damage control orthopedics, which means controlling patient pain after a traumatic injury until inflammatory markers calm down and surgeons are able to perform a surgical intervention.
"If we can limit the local reaction, we can help the patient," says Dr. Williams. "We're examining inflammatory markers like interleukins, as well as other things that cause inflammation and pain."
Spinal trauma is an exciting field today because emerging technologies allow surgeons to percutaneously place screws to stabilize certain fractures that will heal. In the past, patients would be placed in a brace that would limit their activity. However, some patients are unable to have the brace because it restricts breathing; for instance, if the patient has a breathing problem or broken ribs, the brace would not be appropriate.
"We found that we can make small incisions that are less than an inch and put the screws in and pass the rod under the muscles," says Dr.Williams. "This allows patients to get up and walk with less pain. After the fracture heals we can remove them in an outpatient procedure."
Dr. Williams recently performed this procedure for a patient who was injured in a car accident. The patient was a college student and after the procedure was able to return to finish her semester. After the semester ended, the patient returned to remove the screws.
"This is something people have been doing for about 10 years and allows us to expand our treatment for trauma situations," says Dr. Williams.
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