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Minimally Invasive Procedures for Spinal Surgery Offer New Options

by Lynn Shapiro, Writer | October 15, 2008
Cedars-Sinai Medical Center
Surgeons at Cedars-Sinai Medical Center's Institute for Spinal Disorders have combined three innovative minimally invasive spine surgery procedures to treat spinal curvature in adults, a common consequence of aging.

An article in the October issue of the Journal of Spinal Disorders and Techniques is believed to be the first to document the use of these procedures in combination to correct this condition, known as adult lumbar degenerative scoliosis.

"Many patients suffering from degenerative scoliosis are elderly and have coexisting medical problems that make them poor candidates for traditional surgery and a long recovery process. But as a result of three new technologies and minimally invasive approaches, we are able to offer patients who otherwise might not be candidates for surgery, a solution that is safe and provides very good results," said orthopaedic surgeon Neel Anand, M.D., Mch. Orth, director of Orthopaedic Spine Surgery at Cedars-Sinai.

Anand said lumbar degeneration and curvature can be caused simply by the wear and tear of aging. Discs - the cushions and spacers between vertebrae - wear down and collapse, allowing the spine to shift out of alignment. In other cases, minor scoliosis that may have existed since childhood becomes more pronounced with age. In either situation, pain is the primary complaint.

The article reviews 12 cases of Anand's. These cases were examined as part of a retrospective chart review for patients who underwent these techniques as part of standard care. Patients were 50 to 85 years old, with an average age of about 73. Each had undergone extensive conservative treatment, such as medical management and physical therapy, without long-term success. Curvature resulted from the degeneration of multiple discs, ranging from two to eight segments of the spine.

The first stage of the two- to three-step correction procedure was performed through small incisions in the patient's side, working through a tube to access the front of the spine. Using either of two systems - the XLIF® (Extreme Lateral Interbody Fusion) or the DLIF® (Direct Lateral Interbody Fusion) - Anand cleared out damaged disc material and replaced it with spacers filled with bone and a protein that promotes fusion.

"We used to access the front of the spine through the abdomen. The biggest advantage of going in from the side is that we no longer have to work around the organs and large blood vessels of the abdomen. We work through a very safe corridor to get to the discs in question. We go in and correct each disc that has collapsed, like building a skyscraper. As we put in spacers from the bottom up, we get considerable correction, just from doing the lateral approach, the first stage," Anand said.