The latest trends in orthopedics and spine surgery have tended toward minimally invasive techniques. Making the transition between open spine surgeries to minimally invasive surgery is not easy, says Mark Flood, DO, of Celling Treatment Centers in Austin, Texas. However, Dr. Flood has been able to stay at the cutting-edge of non-fusion spinal surgery by training internationally on laser and stem cell treatment techniques.
"I go to courses all over the world to learn different techniques," says Dr. Flood. "You have to have a passion and dedication in order to learn these different techniques."
Dr. Flood recommends physicians first train in open surgery before learning minimally invasive techniques.
"One of the hardest things for physicians to master in minimally invasive surgery is looking through a little camera. I think the best way for physicians to learn is to do open surgery and then transition to minimally invasive surgery," says Dr. Flood. "It's easier to conceptualize when you go from open surgery to looking through the small aperture of the microscope."
Laser and stem cell technology
The laser techniques can be used for patients with degenerative disc disease as well as other spinal disorders. The laser fiber is passed through an endoscope so the physician can see the surgery site. Alternatively, the fibers can be placed through a small cannula or needle under x-ray guidance directly into the disc. Utilizing the laser in spine surgery can remove bone spurs compressing nerves, remove herniated discs and vaporize scar tissue tethering the nerves.
"When you pass the cannula into the disc, the patient has to be awake so you do not injure the nerve," says Dr. Flood. Once the needle is in place, the patient receives light anesthesia for comfort.
Using laser technology is beneficial for the patient because lasers can remove tissue without damaging adjacent tissue and limit blood loss. The lasers are usually used in combination with other access techniques because overuse can result in bone or disc damage.
"The laser procedure relieves pressure in the disc and then we use stem cells to down-regulate inflammation," says Dr. Flood. "Our goal is not to give the patient a new disc. Our goal is to get rid of the pain in the disc."
Dr. Flood harvests stem cells from an adult patient's hip and processes them in the operating room before they are placed into the patient's spine. The stem cells have the capacity to differentiate into different types of tissue.
One advantage to using these minimally invasive techniques is the ability for quick repairs if an incidental dura leak occurs. Because surgeons use a 16-18 millimeter tube during the surgery, the leak can be repaired quickly using a standard fine suture and either the endoscope or loupes.
"If you don't repair a leak, the patient typically gets horrible spinal headaches," says Dr. Flood. "Repairing any spinal fluid leak is a big deal for the patients."
Reimbursement
While laser and stem cell techniques have advantages for the patient, the technology is still relatively new and expensive for the physician.
"The laser has a number of good uses, but lasers are about $80,000-$100,000 and are not reimbursed," says Dr. Flood. "Because it's not covered by insurance, laser technology for spine surgery is harder to find. There are a few specialized centers across the country offering this kind of surgery."
The use of stem cells can also be costly for the patient and physician.
"There are codes for harvesting stem cells but typically those codes are used for bone marrow transplants," says Dr. Flood. "The codes are not intended for orthopedic applications, so typically these procedures are not reimbursed well."
Compensation for using laser technology during spine surgery usually must come from the patient, says Dr. Flood.
Learn more about Celling Treatment Centers.
Read more coverage on spine surgery techniques:
- Spine Education Labs Critical in Training for Cutting-Edge Procedures
- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs
- Spine Surgery Research Update: Lumbar Spine Treatment
"I go to courses all over the world to learn different techniques," says Dr. Flood. "You have to have a passion and dedication in order to learn these different techniques."
Dr. Flood recommends physicians first train in open surgery before learning minimally invasive techniques.
"One of the hardest things for physicians to master in minimally invasive surgery is looking through a little camera. I think the best way for physicians to learn is to do open surgery and then transition to minimally invasive surgery," says Dr. Flood. "It's easier to conceptualize when you go from open surgery to looking through the small aperture of the microscope."
Laser and stem cell technology
The laser techniques can be used for patients with degenerative disc disease as well as other spinal disorders. The laser fiber is passed through an endoscope so the physician can see the surgery site. Alternatively, the fibers can be placed through a small cannula or needle under x-ray guidance directly into the disc. Utilizing the laser in spine surgery can remove bone spurs compressing nerves, remove herniated discs and vaporize scar tissue tethering the nerves.
"When you pass the cannula into the disc, the patient has to be awake so you do not injure the nerve," says Dr. Flood. Once the needle is in place, the patient receives light anesthesia for comfort.
Using laser technology is beneficial for the patient because lasers can remove tissue without damaging adjacent tissue and limit blood loss. The lasers are usually used in combination with other access techniques because overuse can result in bone or disc damage.
"The laser procedure relieves pressure in the disc and then we use stem cells to down-regulate inflammation," says Dr. Flood. "Our goal is not to give the patient a new disc. Our goal is to get rid of the pain in the disc."
Dr. Flood harvests stem cells from an adult patient's hip and processes them in the operating room before they are placed into the patient's spine. The stem cells have the capacity to differentiate into different types of tissue.
One advantage to using these minimally invasive techniques is the ability for quick repairs if an incidental dura leak occurs. Because surgeons use a 16-18 millimeter tube during the surgery, the leak can be repaired quickly using a standard fine suture and either the endoscope or loupes.
"If you don't repair a leak, the patient typically gets horrible spinal headaches," says Dr. Flood. "Repairing any spinal fluid leak is a big deal for the patients."
Reimbursement
While laser and stem cell techniques have advantages for the patient, the technology is still relatively new and expensive for the physician.
"The laser has a number of good uses, but lasers are about $80,000-$100,000 and are not reimbursed," says Dr. Flood. "Because it's not covered by insurance, laser technology for spine surgery is harder to find. There are a few specialized centers across the country offering this kind of surgery."
The use of stem cells can also be costly for the patient and physician.
"There are codes for harvesting stem cells but typically those codes are used for bone marrow transplants," says Dr. Flood. "The codes are not intended for orthopedic applications, so typically these procedures are not reimbursed well."
Compensation for using laser technology during spine surgery usually must come from the patient, says Dr. Flood.
Learn more about Celling Treatment Centers.
Read more coverage on spine surgery techniques:
- Spine Education Labs Critical in Training for Cutting-Edge Procedures
- Surgeon Analysis: Outpatient Lumbar Discectomy has Excellent Results, is Safe and Low Cost at ASCs
- Spine Surgery Research Update: Lumbar Spine Treatment