Data collection on minimally invasive spine surgery techniques is more common today than in the past, and long term data on several procedures will be available over the next decade to show efficacy.
"I think minimally invasive procedures are the direction spine surgery is going to head because of the data coming out," says Jian Shen, MD, a spine surgeon at St. Mary's Healthcare in Amsterdam, N.Y. "I am interested in collecting patient data compared to historic open surgery. Then we can really show we are doing the same procedure but with less collateral damage, quicker recovery and fewer complications."
Data collection
Dr. Shen has performed around 1,600 minimally invasive spine procedures with no postoperative infections or major complications. He collects patient data with the standard questionnaire comparing their pain and functionality before and after surgery, with promising results.
"I do a full spectrum of minimally invasive spine surgeries, and some of the procedures are very unique," he says. "I'm among the only surgeons in North America to perform a minimally invasive bilateral cervical laminectomy through a unilateral approach — an endoscopic laminectomy — without fusion."
The procedure is designed to avoid tissue damage and fusion while achieving the same decompression as open surgical procedures. The technique began a few years ago in Japan and a few surgeons around the world are performing it. Dr. Shen has done around 10 cases with the MIS bilateral cervical laminectomy through the unilateral approach and continues collecting data.
He is also involved in the Society of Minimally Invasive Spine Surgery patient registry for endoscopic discectomy. He has performed around 400 surgeries included in the registry data.
"Patient follow-up shows they have better results than open surgery and the complication rate — such as dural tears or nerve damage — is much lower," Dr. Shen says. "We haven't had any infections and readmission rate is below traditional data. Patients undergoing minimally invasive procedures can go back to work much more quickly as well."
Robotic guidance is another tool spine surgeons now have at their disposal to increase precision. Dr. Shen has used the Mazor robotic system in his surgeries, beginning in July 2013. He uses it to place pedicle screws percutaneously.
"It's very accurate and I'm happy with it," he says. "Because of its accuracy, I have better patient safety and reduced radiation for everyone in the OR. Before the robot, I did MIS fusion surgeries like TLIF and had a fluoroscopy time of around two to three minutes for single-level cases. With the robot, it's about 30 seconds."
The robotic technology also allows for preplanning surgical procedures based on the patient's CT scan so surgeons are prepared to execute the surgical plan. "Since July, I have used the robot in 70 cases and I'm very happy with it. It is a good investment and has helped attract patients from this community as well as different places around the United States."
Data use
The initial data shows promising results for minimally invasive surgical techniques, but long-term outcomes are necessary before surgeons can complete valuable comparative studies. Dr. Shen is currently writing three papers based on data collected and has presented at a few conferences.
"Once the data is published showing minimally invasive spine surgeries have real advantages to patient outcomes, the spine surgery community as a whole will experience pressure from patients to make the change, adapt and constantly innovate to make it better," says Dr. Shen. "I think over the next five to 10 years, Medicare and other insurers will request more data from us to justify surgical procedures."
Dr. Shen believes data will also support the advantages of endoscopic discectomy surgery, which only a few spine surgeons in the United States perform, but more data could lead to growth in the future.
"I am very excited and happy to be in this evolving field," he says. "MIS technique has a steep learning curve because you have to know exactly where the structures are even if you see only a small area in the endoscope. But the benefits of MIS will encourage more and more spine surgeons to adopt these techniques. Ultimately patients will receive greater outcomes. That is always my number one goal."
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