Orthopedic spine surgeon Bennett Grimm, MD, shares insight into the latest trends and advances in minimally invasive spine surgery.
Minimally invasive surgery is a driving force in the field of spine surgery. Orthopedic spine surgeon Bennett Grim, MD, of Resurgens Orthopaedics in Georgia, delves into the latest in minimally invasive technology and looks to the future of MIS techniques in spine surgery.
Q: What are a few of the most exciting trends in minimally invasive spine surgery?
Dr. Bennett Grim: While many surgeons have been performing minimally invasive discectomies through tubular retractors for several years, the next wave will be the widespread adoption of arthroscopic techniques that have, thus far, been more prevalent outside of the United States. These techniques will continue to evolve to the point where surgeons will be able to perform lumbar spine fusions arthroscopically with the aid of expandable interbody implants.
Q: How are these trends changing spine surgeons' approach to patient care?
BG: The ultimate goal for spine surgeons should be to perform the majority of elective cases as outpatient procedures in ambulatory surgery centers like our sports medicine colleagues. As surgeons continue to embrace minimally invasive techniques that decrease tissue damage and blood loss, especially in the lumbar spine, this is becoming a reality.
Q: Are there currently any procedures that minimally invasive techniques will be able to dramatically change within the next decade?
BG: Surgeons are experimenting with ways to perform posterior cervical decompressions through tubular retractors in an attempt to decrease the severe pain and blood loss associated with traditional posterior cervical spine surgery. These techniques are in their infancy and will become more widespread in the coming years as they are refined.
Q: What have you found to be the most useful advancement in spine technology since you have begun to practice?
BG: Transpsoas interbody fusion with percutaneous screw fixation has been revolutionary in the treatment of degenerative spondylolisthesis. This technique produces a 50 percent increase in foraminal height and a 30 percent increase in central canal area allowing for an indirect decompression, thereby avoiding the blood loss and muscle stripping associated with a traditional posterior open decompression and fusion.
Q: What do you think will be the next big leap in spine care technology?
BG: Expandable interbody cages that can be inserted through a minimally invasive approach, yet offer the ability to increase the size of the implant's footprint once inserted, represent the next revolution of spine implant technology. These dynamic cages give the surgeon the capability to restore disc space height, while decreasing the risk of vertebral body fracture that may occur with overzealous implant trialing. This technology will evolve so that the surgeon will be able to expand the implant in the axial, sagittal and coronal planes to better recreate the natural dimensions of the native disc and allow for greater fusion surface area.
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