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Review of Newer Methods of Lumbar Spinal Fusion
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Posted on: 06/21/2007
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In this review article, orthopedic spine surgeons discuss minimally invasive (MI) methods of lumbar spinal fusion. MI refers to surgery performed with an endoscope passed through a very small incision to the lumbar spine.
An endoscope has a tiny TV camera on the front end to allow the surgeon to see inside the spine. It also provides a channel down which the surgeon can pass surgical instruments needed to perform the operation. Pros and cons of open surgery versus the closed or MI approach to fusion are presented.
With MI operations, there is less cutting into the soft tissues. Less trauma to the muscles may mean faster recovery. There is also less blood loss. And patients like the smaller scar that's left behind.
The downside of this method is the steep learning curve for surgeons. They can't expect to conquer this new technique with just a few patients. And until the surgeon has done enough of these operations, the surgery time is longer.
Two new methods of MI fusion are presented. These include the lateral transpsoas and anterior presacral methods. Illustrations of the surgical technique for both approaches are provided. The surgeon uses a new electromyography-based monitoring system to avoid damaging nerves.
The authors point out that MI lumbar spine surgery is still in its infancy. Studies of results comparing open methods versus MI are in their early stages. Long-term results aren't ready yet. So far it looks like the final outcome (rate of spinal fusion) is the same with either operation.
The authors suggest that if the fusion rates aren't better with the MI methods, then the risk of MI and the time and effort needed by the surgeon to learn this method may not be worth it. It looks like newer and better ways of using MI may be needed to get past this bump in the road of improving lumbar spine fusion.
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References:
Jason C. Eck, DO, MS, et al. Minimally Invasive Lumbar Spinal Fusion. In Journal of the American Academy of Orthopaedic Surgeons. June 2007. Vol. 15. No. 6. Pp.321-329.
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