Types of Spine Surgery and How to Know When You Might Need Surgery

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Dr. Neil Malhotra Spine

There are many questions to consider before pursuing spine surgery. Is surgery necessary to treat the issue or would a non-surgical method be more appropriate? If surgery is required, is it better to have traditional spine surgery or minimally invasive spine surgery? What is minimally invasive spine surgery and how does it differ from traditional spine surgery? Michael R. Murray, MD says many people don’t understand the major differences between traditional and minimally invasive spine surgery or aren’t sure which surgery is best for their unique situation. Dr. Murray, orthopaedic surgeon at Penn Medicine, and Neil R. Malhotra, MD, a neurosurgeon at Penn Medicine, discuss factors to consider before pursuing spine surgery and how Penn Medicine is positioned to deliver a wide array of spine care needs.

How do you know when you need spine surgery?

When someone comes to us with extremity symptoms, we almost always suggest they first get an evaluation with their primary care physician. If a person is experiencing low back pain or neck pain, we will usually watch them over time and encourage them to maintain good, stable physical activity to see if the issue resolves. If the issue is not resolving with physical activity, over the counter treatments, or pain management and anti-inflammatory medication, the next step would be to see a doctor for an evaluation.

The only two things that are really proven to help a patient who is experiencing problems with their spine are time and surgery. Everything else is used to manage symptoms while your body fixes it naturally. If your body doesn’t fix it, then surgery becomes a good option.

The vast majority of patients with spine problems can be treated in a conservative and non-surgical fashion. With very few exceptions, we recommend that all patients try physical therapy, home exercises, medication and often times spinal injections prior to considering surgery.

If the person has problems with their spinal cord, has significant weakness in an arm or leg or limb, or if they have tried all of the conservative treatments and have been unsuccessful, we might recommend they go directly to surgery.

What are the major differences between traditional spine surgery and minimally invasive spine surgery?

Traditional open spine surgery involves the complete exposure of the anatomy. In minimally invasive spine surgery we see much less of the anatomy which means, in many cases, an easier recovery for the patient. In minimally invasive spine surgery, we often use additional data, such as CAT scans, final navigations, and 3D images to accomplish the same end result as traditional/open surgery.

Whether minimally invasive or traditional, the goals are the same for the long-term; we want to see the same overall improvement in symptoms or a halt in degeneration. Ultimately, we want our procedures to result in less blood loss, shorter hospital stays, lower infection rates and faster recovery.

Surgery is a controlled trauma. So, we’re always trying to maximize the benefit for the patient while minimizing the trauma of surgery as much as we can. So if there is a tool or technique that allows us to do that we’re always going to implement it, and there is no tool or technique that is proven that we don’t do here at Penn.

What types of ailments do you treat at the Penn Medicine Spine Center?

At the Penn Medicine Spine Center, we often see patients who have brain cancers and spine cancers, but we also treat patients who have symptoms in their arms or legs deriving from a nerve problem. Patients also come to us for issues related to scoliosis (curvature of the spine), degenerative disc disease (arthritis of the spine), and patients who have spinal stability problems which are associated with back or neck pain with or without arm or leg pain.

In addition, we treat people who have neck and back injuries, spinal deformities, congenital spine disorders, herniated discs, spinal stenosis and sciatica.

What should you look for in a good spine surgeon?

A good spine surgeon is dedicated to patient care and excellent outcomes, and is willing to learn new approaches and techniques while gaining expertise in standard approaches and techniques. A spine surgeon should also be a good communicator who is willing to spend time explaining their reason for surgery as well as the treatment options they offer.

What makes Penn such a special place is that, because it’s so collaborative, if someone comes in to see one of our surgeons and that surgeon is not the perfect fit for that person, we can reach across our vast network to find the surgeon that is right for them. We have such a broad range of expertise here we can always find surgeon that is the right fit for each individual.

What types of spine surgery are offered at Penn Medicine?

spine surgery, MISSPenn's Spine Service offers an array of traditional and minimally invasive surgical treatment options for the spine.

Some of the traditional spine surgery procedures we provide include laminectomy, microdiscectomy and traditional lumbar fusion. Laminectomy is a procedure that is used to treat spinal stenosis or pressure on the nerves of the low back. The surgery involves an incision on the back of the spine that allows the surgeon to remove bone spurs and thickened ligaments that are pressing on the nerves of the low back.

Microdiscectomy is used to treat nerve pain (sciatica) that is due to a herniated disc pressing on a nerve in the spine. This surgery involves making a small incision in the low back. The surgeon can then identify and remove the herniated disc that is pressing on the nerve.

Traditional spinal fusions are used to treat instability of the spine, scoliosis, severe degeneration of the discs, or a combination of these issues.  A fusion involves using bone from the patient’s body to fuse one vertebrae to another.  Often, metal screws (pedicle screws) are placed into the vertebrae to assist with the fusion process.

Some of the most common minimally invasive spine procedures we perform are the Lateral Lumbar Interbody Fusion (LLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) and percutaneous instrumentation.

LLIF is a fusion during which the surgeon makes a small incision on the person’s side, under their ribs to approach the spine from a lateral direction.   This allows the surgeon to perform a spinal fusion without disrupting the muscles of the spine.

The LLIF procedure may be accompanied by another procedure that is fairly common, what we call percutaneous instrumentation of the spine. In this procedure, the surgeon places rods and screws between the muscle fibers, often using computer navigation or intraoperative X-ray as opposed to removing the muscles from the spine as is done with traditional spinal fusion surgery. When possible, we will always try to see if a minimally invasive approach is an appropriate option.

Why should you choose the Penn Medicine Spine Center?

We strive to help patients by giving expert surgical opinions, and when surgery is not needed, we help them navigate the other appropriate options by connecting them with the appropriate spine care provider for their unique problem.

Our doctors are publishing the papers and teaching the courses that other doctors around the country are learning from; we are often the first to perform groundbreaking spine procedures and teach other doctors how to perform them. Patients who come to Penn benefit from a multidisciplinary team approach and gain access to the full breadth of care from our doctors and surgeons who are world leaders in quality improvement and risk mitigation (reducing risks for patients).

Our spine team has the ability to handle every spine issue from the very simple to the extremely complex, seamlessly, all within the same health system.

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