SpineUniverse continued its conversation with Douglas Won, MD, an orthopaedic spine surgeon who performs spinal surgery utilizing minimally invasive surgical techniques. Dr. Won commented earlier, “Even the patients we evaluate in our spine center, over 95% are treated without surgery. Most patients get better with a short course of over-the-counter anti-inflammatory agents, ice, and a brief period of rest followed by stretching and moderate exercise.” Here, Dr. Won answers questions about the benefits of minimally invasive spine surgery (MIS), as well as those related to what happens after surgery and during post-operative recovery.
The minimally invasive approach is ideal for procedures that treat nerve compression (eg, herniated disc). However, MIS techniques can also be utilized in more complex procedures that require spinal stabilization using interbody devices (eg, cage, screws, and rods).
Over the past 7 or 8 years while performing minimally invasive procedures—whether it’s a minimally invasive decompression or decompression and stabilization—it has not been necessary to give anyone a blood transfusion. This is significant. I remember 10 years ago, when performing large open back surgeries, a significant number of patients required blood transfusion because of blood loss during surgery, which can cause other complications.
Spine surgery performed using MIS techniques can help reduce the incidence of adjacent segment disease.
Additionally, because the soft tissues and supporting structures are kept intact during minimally invasive procedures, the incidence for recurrent disc herniation may be avoided.
With all those advantages in mind, I think for the majority of cases—whether the procedure required is a small decompression or a decompression and fusion, there's really no reason why a patient should have open back surgery.
Patients who undergo a microdiscectomy are usually able to return to routine activities in about 6 weeks. During the first 6 weeks after surgery, activities are restricted. We call it a period of spine precaution when patients avoid certain activities that stress the spine.
Depending on the type of surgery, within that 6-week period, most patients begin an organized physical therapy program to build flexibility, strength, and endurance. Each patient progresses to unrestricted activities at their own pace.
Many of our patients experience resolution of radicular symptoms (eg, leg pain) immediately after surgery. Therefore, they ask, “Why do I need physical therapy?”
We encourage our post-operative patients to complete an organized physical therapy or rehab program. Studies show patients who work with a physical or rehabilitation specialist have much better outcomes than patients who perform home exercise.
We usually recommend 6 weeks of therapy that includes an exercise program. Physical therapy helps build core strength necessary for spinal stabilization, and can help prevent future injury. Patients with back pain minimize their movement, which decreases flexibility (eg, tight hamstring muscles), strength, and endurance.
Not always. It really depends on the patient and the type of surgery. After decompression, bracing is not necessary for most patients. However, if the patient underwent a spinal fusion procedure, typically we brace the patient. The purpose of bracing is to provide additional stability to the surgical area and help minimize pain. Not every patient needs a brace after surgery.