Minimally Invasive or Open Spine Surgery: Rush’s Dr. Kern Singh on His Study to Compare ProceduresWritten by Molly Gamble | November 02, 2010
Rush University Medical Center in Chicago is conducting a study to compare minimally invasive spinal surgery to open spinal surgery, examining factors such as complication rate, recovery time, outcome and cost. Leading this groundbreaking research is Kern Singh, MD, an orthopedic spinal surgeon who is known for his work in MIS and performs nearly 200 MIS procedures a year. Dr. Singh’s findings have been published in major medical journals, and he is the principal investigator in several FDA trials involving motion preserving spinal technology.
Compared to traditional open spine surgery, MIS utilizes detailed knowledge of anatomy and advanced technology to treat spinal conditions without undue injury to the surrounding soft tissues. While patient demand and popularity within the orthopedic industry are currently driving MIS, Dr. Singh wanted to conduct a scientific study to determine if one method is more cost-effective and better for patients.
Patients demand it, but surgeons are hesitant towards MIS
Dr. Singh said traditional open spinal surgery typically takes about three hours and involves a four-to-six-inch incision and 400-500 milliliters of blood loss. MIS procedures, however, take about 75 minutes. The incision is a little smaller than an inch, and typical blood loss is about 40 to 50 milliliters. Additionally, the procedure doesn’t require the cutting of any muscle, which may reduce post-operative pain. The average recovery time after MIS is one to two days, whereas open spinal surgery can land a patient in the hospital for two to three days of recovery.
While it may seem like one method is clearly more lucrative and patient-friendly, there has yet to be a scientific study comparing the two, much less determining which is more effective than the other. “That’s not been proven, but that’s why we’re looking at the study,” said Dr. Singh. “We want to prove it.”
For instance, although MIS may require less hospitalization than open surgery, the costs of MIS training and equipment may exceed that difference. Additionally, although it’s more time consuming, open surgery is already known to work and doesn’t involve such a steep learning curve, says Dr. Singh. “Most physicians are hesitant since there’s a tried and true method that works well already,” says Dr. Singh.
Details of the study
The study involves at least 50 patients afflicted with spinal stenosis — an age-related condition where areas of the spine narrow, placing pressure on spinal nerves. As it worsens, spinal stenosis leads to increasing back and leg pain and greatly interferes with daily activity by limiting how long people can walk, sit and stand. An additional inclusion criteria is that participants in the study have been diagnosed with spondylolisthesis, a condition in which a vertebra in the lower part of the spine slips forward and onto the vertebra beneath it.
Spinal fusion surgery will be performed on all of the patients, where two are welded together to prevent abnormal movement causing pressure and pain. Half of the patients will undergo a minimally invasive procedure and half open surgery.
The study has two arms: cost analysis and gait analysis, examining not only the clinical effects of each procedure but which is more cost-effective as well. Cost analysis will examine the cost of equipment, implants, surgeons, operating time, hospitalization and reoperation for each method. The gait analysis involves a camera that tracks how people walk, examining the strength of the back and its movement, before and after surgery. Patients will be tracked up to two years after the procedure.
Read more about Dr. Singh’s study comparing minimally invasive to open spinal surgery.
Read about more about spinal procedures:
-Study: Growing Rods for Childhood Scoliosis Treatment Likely to Cause Autofusion
-Stryker's David Veino: In Support of Vertebroplasty
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