The MIS landscape: What excites spine specialists the most?


Here, four specialists weigh in on the new and exciting developments in minimally invasive spine treatments.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

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Question: What are the most exciting new developments in minimally invasive treatments for spinal disorders?


Jeffrey C. Wang, MD, Chief, Orthopedic Spine Service, Co-Director USC Spine Center, Keck Medical Center of USC, Los Angeles: I think that MIS surgery is becoming more popular and easier to do with the newer technologies. Image guidance has changed my own application of MIS, in that I can see more of the anatomy with greater accuracy through small incisions.


I also feel more confident about the placement of hardware and the extent of my MIS decompressions. I think it has changed the way I approach spinal pathologies in considering how to best deal with each individual patient. Each year technology advances and I find that there are better retractors, better neuromonitoring, better lighting and just better instruments that allow us to do more via an MIS approach. Outside the United States, on an international level, I see an increase in the interest for endoscopic surgery, which is different than what I see in the U.S. It will be interesting to see if this trend affects the U.S.


Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: The most interesting thing I have seen is new and emerging motion-preservation treatments. Most fascinating are the newest generation of artificial cervical discs. As surgeons, we are seeing options that are much better than simply fusing patients. The biomechanics of the spine have not changed, but our options to restore them to normal have gotten better. I think motion preservation, rather than long segment fusions will be the treatment of choice for most patients.


Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: We have been working increasingly with adult stem cells. I think the technology has a long way to go, but the initial results have been encouraging. I think this has the potential to become more minimally invasive than anything we could have imagined when I was in training.


Medhat Mikhael, MD, Pain Management Specialist, Medical Director, Center for Spine Health at Orange Coast Memorial Medical Center, Fountain Valley, Calif.: There are many exciting developments in minimally invasive treatments for spinal disorders.  Excellent relief from the pain associated with central, lateral recess or foraminal spinal stenosis can be obtained through the minimally invasive procedure of percutaneous decompression and spacer placement. Another common spinal disorder, bulging disc, can successfully be treated in many patients through the minimally invasive percutaneous discectomy procedure.


In addition, there is currently a clinical trial underway for FDA approval of intradiscal stem cell therapy, a minimally invasive procedure for treatment of degenerative disc disease and disc herniations.  


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