Neurosurgeons and orthopaedic surgeons at The George Washington University Hospital Spine Center perform the following minimally invasive spine procedures:
When a spinal nerve root is compressed, injured or inflamed, it causes a condition called radiculopathy. Radiculopathy may occur in the neck (cervical) or low back (lumbar). Symptoms can include weakness in the arm or leg, and burning pain in the arm or leg (sciatica). Most patients respond to nonsurgical treatment, however sometimes surgery is needed.
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.
For patients who have pre-existing arthritis of the neck, the best option for treatment may 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.
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, an 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 that allows 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. Using the aid of a surgical micro-endoscopic camera, surgeons can 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 who have 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 percent 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 abnormal or injured vertebrae are repaired through small incisions and stabilized with bone grafts, metal rods or both. Benefits of this approach include reduced time in the hospital and a faster recovery.
For those who qualify, non fusion procedures, such as dynesys and cervical disc replacement, offer alternatives to traditional spinal fusion surgery.