New Developments in Neurospinal Surgery
 
There have been many new developments in all types of surgery over the past decade. And now, some of the techniques that have revolutionized other surgical procedures are being introduced into the treatment of spine problems. These include minimally invasive spine surgery and improved implants and grafts for remodeling vertebral structures more effectively.  


“Minimally invasive” spine surgery --

The term “minimally invasive” is used to describe surgery that is performed through tiny incisions, which are used to insert fiber optic viewing instruments and tiny surgical instruments. These so-called “band-aid” surgeries have become the preferred approach for many operations, from gallbladder surgery to heart surgery, and now for some spine procedures. It is less traumatic to body tissues, usually requires less time in the operating room, and results in a much quicker recovery.  Some of these new procedures include image-guided spinal navigation, IDET, and laser surgery.  

     


Image-guided spinal navigation --

Image-guided spinal navigation refers to the use of 3-dimensional imaging of spinal structures to help the surgeon better visualize the operative site. Previous technology only permitted a 2-dimensional image of the problem area, and some of the anatomy was “hidden” from the surgeon’s eye.  The newer technology involves computer-based, multiplane CT scanning, and has evolved from a technique called “stereotaxis” that has permitted brain surgeons to pinpoint a problem area using coordinates from each of 3 dimensions. The result is a clearer picture of complex anatomy that was often obscured from the surgeon with old procedures. This is especially important in cancer surgery, but the technology also has resulted in reduced operating time and improved accuracy for a variety of spine procedures.


IDET --

IDET, or intradiscal electrothermal therapy, is a technique that actually “melts” soft tissues, such as problem disc tissue. Currently, it is being studied for treatment of low back pain when the problem is limited to only one or two discs and when other treatments have failed to provide relief. The procedure is performed with the assistance of fluoroscopic imaging and high-frequency electromagnetic energy. The energy is transmitted into the disc by placement of an electrode attached to a thin, flexible catheter. Heat is generated through the catheter, which shrinks or “melts” the offending portion of disc substance.  IDET is thought to work by shrinking the soft tissue and ablating, or dissolving, local pain receptors.


Lasers --

Laser technology is also being studied for use in treatment of disc problems, using methods similar to the electrothermal technique, for disc decompression and ablation. The laser procedure is performed using an endoscope for visualization of the problem structure, and then applying laser energy through a catheter placed through another small incision.  


Implants, grafts, and plates --

A bone graft is commonly used in spine fusion procedures to aid in the re-molding process required to “fuse” several individual segments of spine into one. Currently, this “donor” piece of bone is taken from the hip, where a small amount of tissue can be taken without affecting the health of the whole bone structure. However, these donor grafts often complicate the surgical process - increasing the length of surgery and recovery, as well as the potential for postoperative infection.

A wide variety of new materials are being studied for use as implants and grafts when vertebral structures are surgically revised or manipulated. The goal is to achieve greater stability of the spine with improved acceptance and binding of the tissues, with less trauma from the harvesting of bone tissue from other areas of a person’s body. The applications include a variety of spine disorders, including traumatic injury, cancers that have spread to the spine, infection, congenital deformities, and degenerative disorders. 

Implants and grafts have made a significant improvement in treatment of the cervical spine, which otherwise requires use of a halo, and in operations lower in the spine where quicker recovery and fusion rates are being seen.  Some of the materials that are being studied include demineralized bone matrix, bone morphogenic proteins, and genetic activating factors from the patient’s own blood.  Space-age metals, such as titanium, and new polymers are also being studied as disc replacements for the cervical spine, which serves primarily to support the head and does not require as much cushioning as the lower vertebrae.