Spine surgery's biggest misconception debunked by Dr. Issada Thongtrangan


Spine surgery is very delicate while also intense. Issada Thongtrangan, MD, knows this as a spine surgeon at Minimally Invasive Spine in Phoenix.

Dr. Thongtrangan discussed the rise of endoscopic surgery, biologics and what he wants everyone to know about spine surgeons with Becker's Spine Review.

Question: What trends do you see in endoscopic spine surgery, minimally invasive spine surgery and robotic spine surgery?

Dr. Issada Thongtrangan: Endoscopic spine surgery has been more advanced and popularized in the U.S. in the past five to six years as more evidence has shown excellent outcomes as compared to open surgery. Advanced technologies in endoscopic spine surgery can address disc and bony pathology. Many centers in Asia are far more advanced with endoscopic spinal fusion technology. There is also great advancement in spine navigation, especially robotic spine surgery. There are at least three robotic systems on the market, which ultimately helps with precise hardware placements and more importantly reduction of intraoperative radiation to the patient and operating room staffs especially in minimally invasive spine cases.

Q: How have biologics and regenerative medicine changed spine surgery?

IT: Surface technology, 3D technology and biologics are hot topic in the past two to three years; however, the mid- and long-term data are still lacking. Regenerative medicine is still early in the spine arena as there is lack of level 1 evidence which in my opinion will be very difficult to gather.

Q: What is the biggest misconception spine specialists have? What is the biggest misconception people have about spine specialists?

IT: The biggest misconception in regards to endoscopic approach in spine community is that endoscopic spine surgery is a percutaneous surgery without direct visualization. In fact, the endoscopic spine surgery is the least invasive surgery that can treat disc and bone pathologies, such as stenosis using direct visualization under high magnification. Some of the patients still have misconception about spine surgery in modern days. Some of them still think that they will lose lots of blood, they will be down for 12 months and will be in the hospital for a week, among others . In modern days, most spine surgeries can be performed safely in outpatient facilities in appropriate patients especially with endoscopic technology. It is my job to educate my patients at their consultations as the technology has come a long way.

Q: How has endoscopic spine surgery advanced in the past five years? What do surgeons/practices need to know about it?

IT: With advanced technologies, not only the disc pathology but surgeon can also treat stenosis and facet pain using the endoscopic approach. There are some centers performing fusion surgery using endoscopes with very promising outcomes. In my opinion, this technology will continue to evolve and might be a 'new' standard in the future similar to arthroscopic knee/shoulder surgery.

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