Accidents and Injuries

Minimally invasive surgical procedures can be used to treat spinal compression fractures. These procedures are utilized to reduce severe pain, stabilize the fracture itself, and restore lost height or shape of the broken vertebral body. These procedures are known as:

• Balloon kyphoplasty
• Vertebroplasty
• Vertebral body augmentation

A vertebral compression fracture is a type of spinal fracture that can be caused by osteoporosis. This is a metabolic disease that weakens bone density and increases the risk of fracture/s in the spine, wrist, and hip. Osteopenia and osteoporosis affect millions, according to the National Osteoporosis Foundation. If left untreated, it can progress without an individual knowing and painlessly until the bone/s fracture. A vertebral compression fracture is more frequent than hip fractures and can lead to extended disability.

Vertebroplasty

Vertebroplasty is a minimally invasive treatment done through the skin for painful vertebral compression fractures. It also helps with strengthening the surrounding vertebral bodies also at risk of fracturing. Orthopedic bone cement is injected into the fractured vertebral body.

How is it performed?

Under general anesthesia, a specialized needle for bone is slowly inserted through the soft tissues of the back towards the vertebral compression fracture. The surgeon sees the position of the needle at all times through a real-time x-ray. Once reached a small amount of orthopedic bone cement, called polymethylmethacrylate, is injected into the vertebral body. Polymethylmethacrylate is a medical-grade bone cement that'ss been used for years for various orthopedic procedures.

The cement can sometimes be combined with an antibiotic to reduce the risk of infection along with a powder that has barium or tantalum. This allows it to be seen on the x-ray. The cement is a thick paste that hardens quickly. The fractured body is injected on the right and left sides, the midline of the back. After a few hours, the patient is up and moving. Most go home on the same day.

Balloon kyphoplasty

Balloon Kyphoplasty is another newer minimally invasive surgery for vertebral compression fractures that can be associated with osteoporosis. Kyphoplasty utilizes a balloon that expands the compressed bone to help restore lost vertebral height while creating a space where bone cement is injected. Kyphoplasty stabilizes fractures, restores lost vertebral height, and reduces deformities.

How it is performed?

Balloon kyphoplasty is performed under local or general anesthesia. Using real-time x-ray two small incisions are made, and a probe is inserted into the vertebral body space. The bone is drilled and balloon/s, called a bone tamp is a pump that is inserted on each side.

These balloons are inflated with contrast medium so the surgeon can see on the real-time x-ray until each balloon expands to the correct height, and then are taken out. The balloon is used to create a space for the bone cement and helps expand the compressed vertebral body bone. The cement binds and stabilizes the fracture. The cement provides:

• Strength
• Stability
• Hardens rapidly
• Restores height
• Relieves pain

Vertebral augmentation implant

A vertebral augmentation implant is different from vertebroplasty and kyphoplasty. This minimally invasive procedure for middle and lower back spinal compression fractures utilizes a flexible loop spring style spinal implant. It is performed under local or general anesthesia. A real-time x-ray is used to visualize the spinal anatomy and guide the placement of the device. The implant is delivered through a small incision. Once the implant is in place, the bone cement is injected, and the implant is removed.

Potential benefits include:

• Reduction of new fractures above or below the existing fracture
• Improves the spine's angle
• Reduced spinal deformity
• Reduces bone cement leakage
• Reduces the amount of bone cement

Benefits of all

Vertebral compression fractures and the limited abilities of traditional surgical options led to the refinement of these surgical systems. Each procedure provides options, as to how the treatment helps relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the progressive worsening of untreated osteoporosis.

Added benefits:

• Surgical time is minimal
• Local or general anesthesia is all that is needed
• Hospital stay is a day or only a few hours
• Patients can quickly return to normal activities
• No bracing required

A spine surgeon will explain the purpose and aims of the recommended procedure, including the benefits and risks to help make an informed decision.

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Minimally invasive spine surgery known as M.I.S.S is an option to traditional open surgical procedures, as well as an alternative when non-surgical approaches are working but the pain or condition is becoming worse, regardless. These are performed to treat a variety of spinal disorders like:

• Bone spurs
• Degenerative disc disease
• Herniated disc
• Scoliosis
• Spinal instability
• Spinal stenosis
• Spinal tumors

Minimally invasive surgery can offer potential benefits. These include

• A small/tiny incision/s
• Minimal cutting through soft tissues like ligaments, and muscles
• Outpatient option/s
• Reduced post-operative pain
• Quicker recovery

The Focus of Spine Surgery

There are two main goals when it comes to spine surgery or rather the goal/focus of the surgery. These are decompressing and stabilizing the spine.

Decompression of the spine

Spinal decompression involves removing any tissue/s that are compressing/pinching the nerve structures like a spinal nerve root or the spinal cord itself. Bone spurs and fragments from a herniated disc are the types of tissue/s that can cause neural compression.

Stabilization of the spine

An abnormal movement of one or more levels/segments of the spinal cord can cause back pain, neck pain, or both. Surgeries that are meant to stabilize and stop these abnormal movements utilize spine instrumentation combined with fusion.

Spine Surgery Techniques

Minimally invasive spine surgery techniques include:

• Percutaneous or through the skin
• Mini-open or small incision procedure/s

Rather than cutting through soft tissues, a tubular retraction instrument generates a tunnel that expands and passes between the muscle/s to access the spine's column. Then an endoscope or a tiny video camera goes in and around the area, projecting a visualization of what's happening on a monitor during the procedure.

This is the surgeon's/team's eyes as they work to repair the damage. The surgery is run through the tubular retraction system along with any specially designed instruments that are needed. Types of surgical procedures performed with minimally invasive surgery include:

• Discectomy
• Microdiscectomy
• Foraminotomy
• Microforaminotomy
• Microlaminectomy
• Microlaminotomy

The micro means that the surgery is done using a special microscopic camera to view the disc/s and nerve/s. Imaging scans, systems, and image-guidance technologies, like fluoroscopy, which is a real-time x-ray are utilized during the surgery pinpointing the key aspects of the patient’s spinal anatomy. The surgical imaging shows 2D and 3D views, which guides the placement of any instrumentation, like pedicle screws.

Disorders Treated with Minimally Invasive Surgery

Degenerative disc disease

Degenerative disc disease is known as DDD often develops progressively in older adults and affects the intervertebral discs. The normal wear and tear of cellular age-related changes in the body can cause the spine's discs to:

• Stiffen
• Lose Flexibility
• Loss of Strength
• Loss of Height
• Lose shape, along with the ability to absorb/distribute the forces associated with moving

These structural changes increase the risk of disc herniation and subluxations.

Herniated discs

A herniated disc also called a slipped, bulging, and ruptured disc. This happens when the soft gel cushion of a disc breaks through the protective outer layer. Other than the damaged disc, the loose interior gel can also irritate and inflame the nerves causing back pain.

Scoliosis

Scoliosis is an abnormal sideways curve of the spine that can cause progressive spinal deformity. A scoliotic curve can look like an “S” or “C.” Most cases have no known cause, and while the condition is more commonly associated with children, adults can develop scoliosis, as well.

Spinal stenosis

Spinal stenosis happens when the spinal nerve roots and the spinal cord become compressed/pinched. These nerves branch off the spinal cord and exit the spinal canal through passageways called neuroforamen. Nerve and spinal cord compression can cause symptoms like:

• Pain
• Weakness
• Tingling sensations
• Numbness
• Sometimes, pain can travel into the arms or legs

Spine Surgery Risks

With any spine surgery there are potential risks and complications that can occur. Here are some possible complications that can happen during and after surgery, with both open and minimally invasive procedures.

• Bleeding
• Blood clots
• Failed fusion pseudarthrosis/non-union
• Nerve damage
• Symptoms come back
• Infection/s 

Candidate for Surgery

Minimally invasive spine surgery does offer many benefits:

• Tiny incision
• Less pain
• Reduced risk
• Faster recovery

Let's not forget that M.I.S.S is still surgery. Less than 5% of people with back or neck pain need spine surgery and, surgery is the last resort for treating pain and symptoms caused by a spinal condition/disorder.

It is only when non-surgical treatments like chiropractic, acupuncture, physical therapy, medication, or spinal injections do not reduce symptoms in 3 to 6 months. This is when you qualify to be a candidate for spine surgery. There are certain types of spinal disorders that require urgent or immediate surgical intervention.

Talk with your doctor, chiropractor, or spine specialist about the pain, the symptoms, and compare the results of the different therapies/treatments and go from there. With any type of surgery there are many considerations to discuss before making a decision to treat back or neck pain and if minimally invasive surgery could be an option.

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