Minimally Invasive Spinal Surgery

With minimally invasive spine surgery, surgeons make small incisions, usually with the aid of microscopes or endoscopic visualization (very small devices or cameras designed for viewing internal portions of the body). This inside view of the patient's body is projected onto television screens in the operating room.

Minimally invasive techniques offer several advantages, including tiny scars instead of one large scar, minimal muscle-related injury, a shorter hospital stay (two to three days versus five to six), reduced postoperative pain, a shorter recovery period and the ability to return to work and daily activities much sooner.

Neurosurgeons (surgeons who specialize in the treatment of diseases and disorders of the brain, spinal cord, peripheral nervous system and sympathetic nervous system) and orthopaedic surgeons (surgeons specializing in the surgical treatment of bone and joint disorders) at The George Washington University Hospital Spine Center perform the following minimally invasive spine procedures:

Disc Surgery

Radiculopathy may occur in the neck (cervical) or low back (lumbar). Most patients respond to nonsurgical treatment. However, when symptoms are severe enough to interfere with the enjoyment of daily activities, surgery is needed. Symptoms can include weakness in the arm or leg, and burning pain in the arm or leg (sciatica).

Cervical (Neck)

Surgeons at the GW Spine Center offer minimally invasive treatment for both cervical and lumbar radiculopathy. For patients with cervical radiculopathy without arthritis of the joints in the neck, a small incision can be made in the neck. A microscope decompresses the spinal nerves to relieve pain. Many patients go home the same or next day following the procedure.  

For patients with pre-existing arthritis of the neck, the best option can be anterior discectomy and either fusion or disc replacement. Anterior discectomy for decompression of the nerve roots is a minimally invasive procedure with very high success rates. The procedure involves a small incision on the neck. Once the decompression is performed, either a fusion or disc replacement may be performed. That decision is made preoperatively based on the extent of arthritis and number of levels in the neck that are diseased. With either procedure, most patients are able to go home from the hospital the same or next day.

Lumbar (Low Back)

Lumbar radiculopathy, or sciatica, causes a stabbing pain that shoots from the back or buttocks into the leg. It can also cause numbness or weakness in the leg and foot. The most frequent cause of this condition is a herniated/ruptured disc in the back, also known as lumbar disc disease. When a disc is herniated, it can create pressure against one or more of the spinal nerves, leading to severe pain, numbness or weakness in the lower back, legs and/or feet.

With minimally invasive disc surgery, a ½-inch incision is made in the back so the procedure can be performed through a small hollow tube. A tiny camera is placed into the tube, allowing a clear view of the nerve and its relationship to the herniated disc. This enables the surgeon to remove the herniated disc.

Not all herniated disc patients are eligible for minimally invasive spine surgery. The ideal candidate has a well-maintained disc height, preferably with 30 percent or less disc collapse, and no evidence of severe spinal stenosis (build-up of bone in the spinal cavity). Benefits of this approach include reduced time in the hospital and a faster recovery.

Spinal Stenosis Surgery

Lumbar spinal stenosis (LSS) occurs as a result of aging and everyday wear and tear on the spine. Symptoms can include persistent, progressive lower back pain (with or without radiation), numbness or weakness in the buttocks and legs and symptoms that improve with resting, lying down or bending forward. Stenosis of the spine can also occur in the cervical (upper spine and neck) or thoracic (middle spine) region of the body.

Micro-endoscopic laminotomy (MEL) is an exciting new treatment option for patients who are candidates for spinal stenosis surgery. MEL accomplishes the same goal of an open laminectomy, but is minimally invasive.

With fluoroscopic (X-ray) guidance, a thin needle is placed under the skin on one side of the midline spine. A small (up to one-inch) incision is made around this needle. A set of tapered metal dilators are passed over the guiding needle, and  the tissue and muscles are then gently spread off of the underlying bone.

Next, a hollow metal cylinder is passed down to the area of the stenosis and secured. A rigid surgical micro-endoscopic camera placed through this working channel provides the surgeon with a close-up, magnified view. With this close-up operative view, the surgeon can micro-surgically remove the bone compressing the nerve roots. Benefits of this approach include reduced time in the hospital and a faster recovery.

Spinal Fusion for the Lumbar Spine

Patients with degenerative spinal disease may require spinal fusion surgery to stabilize the vertebrae and alleviate severe, chronic back pain. Spinal fusion involves correcting an unstable part of the spine by joining two or more vertebrae. Traditional open-surgery spinal fusion has been associated with a low complication rate and pain relief for 90% of patients; however, many patients report back pain and fatigue as a result of muscle loss that can occur following surgery.

Laparoscopic spinal fusion is a minimally invasive alternative. The lower spinal vertebrae are repaired through an incision directly over the spine (posterior lumbar approach). The upper spinal vertebrae are repaired through an incision in the back or side of the neck (cervical spine). The middle spinal vertebrae are repaired through an incision made in the chest and abdomen (anterior thoracic spine). The abnormal or injured vertebrae are repaired and stabilized with bone grafts, metal rods or both. Benefits of this approach include reduced time in the hospital and a faster recovery.