Dr. Kim shares if all minimally invasive spine surgeries are the same.
Minimally invasive spine surgery really is not just one procedure. It is a variety of procedures that, depending on the problem that you have, involves a slightly different type of procedure. So, the one that I get asked about most commonly is the laser endoscopic spine surgery. And that is a very powerful minimally invasive surgical technique and one that we use in our practice.
But like anything that we do, like a tool that we have in our toolbox, it is designed for a very specific indication. Besides the endoscopic surgery that treats herniated discs and small areas where the nerve is pinched, there are patients that have problems with scoliosis where they cannot stand up straight. In those patients you can’t use the laser endoscope to straighten their spine up.
That requires a more reconstructive operation where we need to straighten the spine out and keep that spine in that position. And in some cases we need to do that with screws and rods, and that’s where the use of screws and rods are best applied when patients have a spine that is crooked; they can’t stand up straight and the problem that needs to be addressed is to straighten that spine out, cannot do that with a laser endoscope.
Now to do a surgery of that magnitude open requires a very large incision and always involves a lot of blood loss, has a high infection rate relative to many other surgeries, and many patients have to go to the ICU for a short period because of the magnitude of the surgery.
I would say one of the most important emerging fields of minimally invasive surgery today, anyway, is the ability to do those surgeries minimally invasively. So we would still use screws and rods. We would still straighten out the spine, but instead of making a big open incision, we have a large number of very specialized tools that allows us to put all those implants in through poke holes, one at a time.
It’s very tedious, but for the patient not having all their back muscle tissues injured, is a huge benefit and very worthwhile to take the time and to utilize this technology, to do the surgery which can be very tedious and painstaking. It is very worthwhile for the patient because the difference is huge.
So we can take care of problems today, especially at our institution where we have all the equipment that’s necessary for many of these problems. We can take care of a simple herniated disc through a laser endoscope. We can take care of stenosis through small incisions that we can use the tubular retractor that I showed you where we can open just a small area that needs to be treated, one at a time.
And we can take care of degenerative scoliosis, spondylolisthesis, osteoporotic compression fractures–all these things that are usually treated open because of the very nature of their problem can be treated minimally invasively.
So you can imagine each of those different problems is like using an Allen’s head wrench for an Allen head screw, a Phillips head screwdriver for a Phillips head screw and a wrench for a bolt. Each problem has its unique requirements on what tools you use, and the field of minimally invasive surgery is expanding in that way where we are increasing the number of tools that we have in the toolbox so that we can apply these techniques over a wider range of problems.
And today, I treat most of my patients, whether they have a simple herniated disc or severe scoliosis and stenosis where they cannot stand up straight and can’t walk for much more than about 50 feet, through minimally invasive techniques by utilizing a variety of various tools and technologies.
About Dr. Kim, M.D.:
Dr. Choll Kim graduated cum laude from Harvard Medical School and completed his fellowship training in complex spine surgery at the Mayo Clinic. He is board certified by American Board of Orthopaedic Surgeons.
Dr. Kim is a nationally known expert in the modern field of computer-assisted minimally invasive spine surgery. He has trained specialists throughout the country on the safe and effective application of state-of-the-art techniques using image guidance and navigation technologies.