Advances in Surgical Treatment of Lumbar Degenerative Disk Disease:
It’s Not Your Father’s Back Surgery
By Paul T. Geibel, M.D.
With 80 percent of adult Americans sustaining at least one episode of
severe disabling lumbar
back pain in their lives, lumbar surgical
treatment alternatives are always in the news. Approximately 85 percent
of these patients will improve with non-surgical interventions in the
form of physical therapy, medications, pain management, or a
significant lifestyle change. The remaining patients may be left with
surgical decisions to alleviate their lumbar symptoms.
Have the surgical options changed? Indeed they have. A myriad of new
surgical techniques and a pipeline of new technologies are being
developed. Not all can be addressed in this short article, so we will
concentrate on some of the newer and more efficacious surgical advances.
For patients who present with symptoms of lower extremity radicular
pain or sciatica due to lumbar herniated nucleosus pulposus (HNP) or
stenosis, a minimally invasive posterior approach is frequently
recommended. The procedure, termed MITR (minimal invasive tubular
retraction), uses a 16 mm to 18 mm skin incision with a series of
cannulated tubes docked onto the appropriate intervertebral space.
The
exact position and location is verified by fluoroscopic guidance. The
decompression procedure is then usually accomplished with the aid of an
operating microscope and specialized instrumentation through this
cannulated apparatus. Lumbar disc fragments, synovial cysts, or
osteophytic stenotic lesions can be treated in this manner in one or
two level procedures. Most patients obtain a 90 percent to 95 percent
improvement in their symptoms.
Significant advantages of this procedure include minimal tissue
destruction, the fact that it can be performed in an outpatient
surgical center, and patients often are able to return to light work
activities within three to seven days. A majority of patients have a
successful outcome from this minimally invasive procedure that avoids
the increased morbidity and pain of an open procedure.
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