Journal of Spine published an opinion piece on minimally invasive lumbar spine surgery by Anthony Yeung, MD, of Phoenix-based Desert Institute for Spine Care.
Here are seven takeaways:
1. Dr. Yeung notes all spine surgeons support MIS spine, but the approach takes many forms depending on the surgeon's view. Some view MIS as making smaller incisions while still performing traditional approaches whereas others may leverage tubular retractors or microscopes and endoscopes.
2. Studies demonstrate MIS' efficacy and cost-effectiveness as well as the fact that it is associated with less blood loss; less operating room time; reduced patient pain; and faster ambulation.
3. Dr. Yeung provides four goals surgeons must achieve to successfully perform MIS:
• Understand the patho-physiology of pain
• Identify and visualize the patho-anatomy of pain
• Surgically treat the pain generator in a staged manner
• Reserve expensive salvage procedures, such as fusion, as the last procedure except for gross instability and deformity
4. In order to understand pain, Dr. Yeung recommends in vivo visualization of pain generators with endoscopic transforaminal visualization. He notes the "ability to provide relief will need to be tied in with the surgeon's ability to isolate and visualize 'pain' generators in the foramen as well as the pain relief requirement of the patient with an endoscope." The basis of transforaminal endoscopic surgery involves surgeons treating chronic pain by visualizing inflammation and decompression of nerves.
5. Dr. Yeung developed the selective endoscopic discectomy of the Yeung Endoscopic Spine Scope System technique, which offers access to the disc and foramen covering a large area of painful pathologies.
6. He argues the U.S. does not provide an environment for the adoption of transforaminal surgery because of a dearth of academic training programs and unfavorable reimbursement. And surgical approaches using tubular retractors and endoscopes require additional training.
7. Dr. Yeung concludes, "In the U.S.A., if visualized endoscopic spine surgery is not adopted by newly trained specialists to perform transforaminal endoscopic properly, safely and effectively, our patients will lose out, and our healthcare system will continue to spiral out of control."