Dr. Kim explains how minimally invasive techniques have changed spinal surgery.
When I first started to do spine surgery during my surgical training, I was amazed at how big these surgeries were to take care of most of our patients. To do the surgery safely back then, we had to make a very large incision so that we can see the entire spine with our naked eye so that we can make sure that the nerves are protected.
The problem was that to do that we’d have to put powerful retractors in and the amount of bleeding, and the amount of soft tissue trauma was impressive. And I would say that just about every surgical resident that is starting to learn how to do spine surgery, when they see that incision they are all amazed.
So the same thing happened to me, and the thought came to me that there’s got to be a better way to do this. And little by little, although my training is as a traditional open surgeon, I was able to little by little, make subtle changes that decreased the size of the incision, that decreased the trauma to the muscles and the bones and the ligaments, and even today when I am done with the surgery and I take the retractors out and look down at the incision I am quite surprised at how much work can be done through a small incision, and that is not related as much to skill as it is, the training and the proper equipment.
And I think eventually all surgery in the spine should be done like this because really it’s about learning how to do the surgery in a slightly different way and being more comfortable using a new set of tools and instruments to do the surgery.
Most importantly, these types of surgeries, when we do them minimally invasively are good for the patient. It’s good for the patient in a variety of ways. The first and foremost that I notice is that the post-operative pain is dramatically reduced and the post-operative function – the ability to get up out of bed and walk around and take care of yourself – is dramatically shortened.
Traditionally, when you have an open spine surgery we used to put people in braces; they would be on bed rest for a short period of time, and it would be very painful and very difficult to get up out of bed and take care of yourself. It was a big undertaking. Lots of support, lots of family needed to be around, and lots of people’s lives were affected so that we can take care of the spine patient.
When we do the surgery minimally invasively, they often will get up that night and everyone’s surprised at how functional they are because this is still a new specialty, but the idea is you preserve muscle function; you decrease pain; you decrease the soft tissue trauma, and that allows you to have the ability to get up out of bed by yourself, go to the bathroom, go to the refrigerator and get a drink of water, watch TV, sit up, stand up, go to the bathroom–simple things that we all take for granted.
If you don’t take those into account, it can be a major problem in one’s life, and you combine that with the pain medicines that’s required to control the typical pain that you would have in an open surgery, and that makes a recovery very difficult. And I really notice a big change in that aspect.
In addition to that, probably what patients don’t necessarily notice and think about right off the bat is that the overall infection rate, for example, because no matter what you do, at some percentage of time when you perform an operation you are going to get a wound infection, and our goal is to decrease that risk as much as possible. And when you do it with the minimally invasive surgery techniques the incision is smaller, granted, but when you prevent damage to the soft tissues, those soft tissues are much better at fighting infection.
So the infection rate from the larger spine operations when done minimally invasively just plummeted; it’s almost zero, and it’s not a subtle difference. This is a very large difference. Same thing with the need to go to the ICU, and going to the ICU can be a big undertaking. It’s very difficult to sleep. There’s lots of bells and whistles and beeps that disrupt your rest. It’s not a very peaceful environment to recover in, and because you don’t lose that much blood, the need for a blood transfusion is almost zero as well, even for a larger operation.
And nowadays avoiding a blood transfusion I think is a very important thing because A, there are people that get into major car accidents that need blood. There’s no other way to save their lives, and we need to preserve and save these precious resources for patients that really need it, and two, it’s still a biologic product and every once in a while we can get some funny blood transfusion reaction, and avoiding things like that make a very large difference in patient outcome overall.
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.