Monday, August 6, 2012

Minimally Invasive Back Surgery

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

There are three levels of surgery, for those few patients who need it.   

Open surgery is the old fashioned kind where the surgeon opens up a surgical field big enough to use carpentry tools and play golf: hammer, saw, wedge and putter.  This was the way all surgeries were done until the arthroscope and laparoscope were invented.  I have  two 4 inch scars on my right knee from a knee exploration done in 1969.  The surgeon could have driven a BMW through the holes he made, and he still missed the fact that I had torn loose my ACL.  Didn't matter at the time, though, because they didn't repair ACLs back then.  The recovery time for open surgery is the longest because many supporting structures are cut (damaged by the surgeon) and they have to heal.

Microsurgery followed the advent of the arthroscope and operating microscope.  The tools are smaller, so the incisions are smaller: 1-2 inches instead of 4-6 inches.  Because the incision is smaller, fewer supporting structures (ligaments, muscle, and bone) are damaged and healing takes less time.  The trade-offs include the loss of visual field for the surgeon, so finding and getting to the part needing repair takes longer.  Also the tools are microscopic, so it may take a long time to remove damaged structures one small bite at a time.  This means more time under anesthesia, something some patients can not tolerate.

Minimally invasive surgery leaves the smallest scars and recovery time is the shortest because fewer tissues are damaged.  The surgeon makes a one inch incision and then pushes a solid instrument into the hole.  Over this instrument he passes larger and larger dilators until he has a tunnel through which his instruments fit.  Instead of cutting structures, he is pushing them to one side.  Healing time for stretched muscles is a lot shorter than for cut muscles.  Time under anesthesia goes up, again, because of the smaller visual field and smaller instruments.

Some surgeons will tell you they can only do one level of minimally invasive surgery at a time and that may be true, depending upon what they are fixing.  Sometimes they just want to do more than one procedure.  They get paid for each one.  I had spinal stenosis on both sides at three levels in my lumbar spine.  One physician I know would have required me to have 3-6 separate procedures.  The man who actually did the surgery did all six locations in one operation.  I was really uncomfortable for about a week, but I only had to undergo anesthesia and recovery one time.

Think about your choices and get the surgeon to explain them thoroughly if you need surgery.

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