Minimally Invasive Surgery
The physicians stand at the forefront of minimally invasive surgical treatment. They can diagnose and treat many types of bone and joint problems using these highly advanced techniques. Use of minimally invasive surgical techniques decrease the recovery time of many patients because the surgical incisions are considerably smaller than conventional surgery and therefore less damaging to the other vital soft tissue structures.
This form of surgery is proving to be particularly successful in joint replacement for arthritis as well as reconstruction of fractures and bones and realignment of extremities. In addition, these new techniques allow indirect fracture reduction and fixation, with less likelihood of injury to blood flow to vital structures and less harm to blood vessels and nerves. It is important to note that the technology used to perform minimally invasive orthopedic procedures has undergone significant advances in recent years and the surgeons are continuing to improve and refine ways to make surgeries even less invasive.
Several weeks of recovery may be required for traditional “open” spine surgery as it may involve a three-inch long incision, in which muscles and tissues are separated for optimal access to the injury site. The surgery usually results in trauma to surrounding tissues and some blood loss. Because of this the affected tissues and muscles need adequate healing time.
Spine surgery then home, same day
We use state of the art minimally invasive techniques and instrumentation to help patients recover in a shorter period of time and allow for a quicker return home. Innovative developments in minimally invasive techniques have pioneered better ways for the surgeon to access the spine, moreover making the recovery process more seamless.
In minimally invasive spine surgery, a smaller incision is made, sometimes only a half-inch in length. The surgeon inserts special surgical instruments through these tiny incisions to access the damaged disc in the spine. Entry and repair to the damaged disc or vertebrae is achieved without harming nearby muscles and tissues when using minimally invasive techniques.
Minimally invasive spine surgery requires extensive training and experience to master use of the tools, but there is tremendous benefit for the patient.
Benefits of minimally invasive spine surgery include:
- Smaller incision and smaller scar
- Less damage to tissues and muscles
- Less blood loss
- Less post-operative pain
- Less painful recovery
- Quicker return to activity
Unlike many other spine care providers, the spine patients who undergo minimally invasive surgery with Dr. Jatana can often have their surgery on an outpatient basis and be home later the same day. Recovery in one’s own home can be more comfortable than staying in a hospital bed.
Cervical Lamino-Foraminotomy:
A motion-preserving non-fusion neck surgery
Unlike many neck surgeries that involve fusion, where two vertebrae are locked together, the Cervical Lamino-Foraminotomy procedure avoids fusing the neck vertebrae. This retains the natural movement in the neck.
While “motion preservation” is the goal of most surgeries, most spine surgeons are not able to do a Cervical Lamino-Foraminotomy because of the experience needed. Because most spine surgeons divide their time between neck surgery and low back surgery, they don’t gain the proficiency in this particular neck surgery. Also, this neck surgery requires use of a microscope and the use of small 1mm and 2mm instruments to repair the damaged disc rather than removing all of the disc and replacing it with a fusion and metal instrumentation.
The second reason a spine surgeon may not recommend this motion preserving surgery, is that the insurance reimbursement for a fusion surgery is higher, so there can be some financial benefit for doing a fusion rather than a non-fusion surgery.
Consequently, the patient with a herniated disc in the neck will likely be recommended a cervical fusion because most surgeons are not able to perform a Cervical Lamino-Foraminotomy. During a cervical fusion, metal instrumentation may be used along with a bone graft to lock two vertebrae in place. The downside to a traditional fusion is that it can cause “adjacent segment disease” where more strain is place on the other healthy discs above and below a fusion site, increasing the risk of further disc herniations, and the need for another fusion in the future.
Consequently, where possible, a person with a herniated disc in the neck should explore surgical options that preserve the motion in the neck, where possible.
The advantages of a Cervical Lamino-Foraminotomy include:
- Less invasive surgery
- Non-fusion, retaining the natural movement of the neck vertebrae after surgery
- Faster return to work
There are relatively few spine surgeons in the State of Colorado trained to perform this surgery. Dr. Sanjay Jatana is one of a handful of surgeons in Colorado that offers this less invasive, non-fusion surgical option.
Cervical Laminoplasty:
A motion-preserving non-fusion neck surgery
Like the Cervical Lamino-Foraminotomy, this surgery is also performed through the back of the neck and is intended to retain the natural movement of the neck after surgery. The surgery involves great proficiency and the use of a microscope.
However, most spine surgeons are not able to do a Cervical Laminoplasty because of the experience needed. Because most spine surgeons divide their time between neck surgery and low back surgery, they don’t gain the proficiency in this particular neck surgery.
Within a laminoplasty surgery, a small portion of the bony part of the spinal canal (lamina) is removed to enlarge the spinal canal, thereby relieving symptoms of nerve root compression. By enlarging the spinal canal, it can relieve symptoms of radiculopathy, where there is weakness or numbness in the arm or hand. Severe spinal cord compression can cause myelopathy, where there is severe weakness or numbness in an extremity. Compression of the spinal cord in the low back can cause a numb and weak leg, or even loss of control of the bowel or bladder. In the neck, compression can cause severe weakness in the hand. Spinal cord compression needs to be addressed quickly (within a week) to prevent permanent damage to the spinal cord where the symptoms could become permanent and lifelong.
For spine surgery; spinal cord compression and disc herniation at multiple levels, the options are limited to traditional an ACDF surgery (anterior cervical decompression and fusion) or Cervical Laminoplasty.
The difference between a laminectomy and a laminoplasty is that more of the lamina is left in place in a laminoplasty procedure. Also in a laminoplasty, the trained neck surgeon leaves more of the normal bone and ligaments intact, and provides a protective layer that lessens scar tissue formation on the dural sac after surgery.
However, when fusion the levels of the neck in the range of C3 to C7, this unfortunately limits motion significantly. Adjacent segment disease is also more likely, increasing the risk of other disc hernations below the fused levels.
The advantages of a Cervical Laminoplasty include:
- Less invasive surgery
- Non-fusion, retaining the natural movement of the neck vertebrae after surgery
- Faster return to work
Again, there are relatively few spine surgeons in the State of Colorado trained to perform this surgery. Dr. Sanjay Jatana is one of a handful of surgeons in Colorado that offers this less invasive, non-fusion surgical option.
Minimal Access Spinal Technologies (MAST)
With the introduction of minimal access spinal technologies (MAST), spine surgeons can make a smaller incision, while at the same time accomplish identical results as open spine surgery. Due to the acute accuracy provided by these tools, surgeons can access the vertebrae through the narrow probes with surgical cameras and tools.
Bone Graft Substitutes: When a fusion is necessary
When damaged disc tissue is removed during spine surgery, the surgeon may need to perform a bone fusion to stabilize the vertebra as well as maintain the disc space between the vertebral bones, which in turn provides room for the nerve roots.
To perform a fusion, the surgeon may harvest a piece of bone from the patient’s pelvis. Unfortunately, this process may cause additional pain and discomfort that may actually be worse than the spine surgery itself.
Other options include using bone from a bone bank, which was harvested from a cadaver and carefully sanitized, or using new man-made bone graft substitutes. Bone graft substitutes have the necessary proteins for healthy bone to heal and regenerate. Consequently, these new man-made bone graft substitutes can be used instead of having to harvest bone from a patient’s hip or from a cadaver. This bone graft is made from pure bone protein (minerals and collagen) and an absorbable collagen sponge that promotes new bone formation where it is needed.