In surgery, inches are important. Every inch of an incision could mean more complications, longer hospital stays, and longer rehabilitation. But what if those five inches could be reduced to the size of small paper clip? For that question, Dr. Armond Levy has an answer.
It’s called minimally invasive surgery, commonly known as MIS. “The goal is to do essentially the same surgery, achieve the same surgical goals through not just smaller incisions, but much less destructive techniques,” says Levy, neurosurgeon with SSM St. Clare. Levy has applied MIS to complex fusion back surgery, combining two, three, or even five disks at a time.
Instead of ripping apart muscles, nerves and bone to reach the disk space, Levy makes diagonal incisions to the right and left of the spine, which causes minimal to no nerve retraction. Having performed and witnessed the effects of open surgery, Levy cites the advantages for MIS: “Small incisions, not removing anywhere near as much bone, probably one-tenth the blood loss, and hospital stays that are dramatically shorter, pain medicine requirements that are much less, and people getting back to function.” A small percentage of Levy’s patients have even left the hospital the same day after having minimally invasive back surgery.
During fusion back surgery, two or more arthritic or painful disks are fused together, typically using rods and screws to hold the bones in place. Because disks are fusing together, much like healing a broken bone, the patient loses some flexibility, but the pros far outweigh the cons. “People can sometimes move better after the surgery than they could before because the pain is gone,” Levy says. “My goal is while fixing a problem to cause as few new problems as possible. You don’t want to make the cure worse than the disease.”
Levy has spent the last decade developing minimally invasive techniques, first performing simple surgery, such as a diskecotomy, before moving onto complex, fusion back surgery. Of the approximately 200 spine surgeries that Levy performs annually, 85-90 percent are completed using MIS. Although the view is restricted due to the small incisions, inter-operative CAT scans help guide Levy through surgery. Perhaps the only negative aspect to MIS is time. Minimally invasive procedures take more time to perform because you are working with less space and employing more complicated techniques.
Although the benefits for MIS are abundant, there is still resistance to abandoning open techniques. “Doctors tend to have a lot of inertia,” Levy says. “There are people who are doing cases that are clearly MIS candidates, that are getting open surgeries.” Levy recommends that any patient looking for back surgery options to be sure to find a practice that offers both MIS and open surgeries, because every inch counts.
