Spring 2005 Issue

Minimally Invasive Spinal Fusion Got Sandra Back On Her Feet The Day After Surgery
Sandra Doster’s long ordeal with back pain began in 1998. By 2004, she knew she could no longer live with the constant pain and sought the help of her primary care physician. He referred her to the Concord office of Carolina Neurosurgery & Spine Associates. An MRI showed the disc between Sandra’s fourth and fifth lumbar vertebra was deteriorated and was causing damage to the nerves going to her left leg.
Sandra Doster & Dr. Deshmukh

Practice neurosurgeon Vinay Deshmukh, M.D., began conservative treatment with Sandra. She tried physical therapy and went to the practice’s pain clinic to receive steroid injections. These treatments provided no lasting relief for Sandra and she asked about surgical options.

“You always hear bad stories about back surgery. That’s why I had put off getting help in the first place,” said Sandra. “The conservative treatments didn’t work. When Dr. Deshmukh told me about a new back surgery that had a shorter recovery time than traditional surgery, I was ready.”

Sandra underwent minimally invasive Posterior Lumbar Interbody Fusion (PLIF), an alternative to traditional, open spinal decompression and fusion. The surgery was performed by Dr. Deshmukh and Mark Smith, M.D. This procedure is also offered in Concord by practice neurosurgeon Mark Redding, M.D. As with most minimally invasive procedures, the primary advantage is faster recovery for the patient. With traditional spinal fusion, a hospital stay of up to five days is needed, and recovery can take up to three months.

“Open decompression and fusion is effective in relieving a patient’s pain, but the procedure and recovery can be very difficult on the patient,” said Dr. Deshmukh. “With minimally invasive decompression and fusion, there is less blood loss and less pain after surgery. This means we can often avoid the use of IV pain medication and therefore the complications that can be associated with it. Patients usually return home within two days after surgery and can return to work in four to six weeks.”

“It’s unbelieveable,” said Sandra. “I had surgery on a Monday, was walking around on Tuesday, and went home on Wednesday. I have not had any pain from my back whatsoever. I can’t get over it!”

The Procedure
PLIF is a surgical technique for relieving compression of nerves and placing bone graft between adjacent vertebrae to achieve a fusion. Typically, screws and rods or other types of spinal instrumentation are used to hold the spine in position while the bone heals. Indications for a PLIF may include leg pain and back pain secondary to degenerative disc disease, spondylolisthesis, or recurrent herniated discs.

With minimally invasive PLIF, bone removal, discectomy, and interbody fusion are all performed through tubes inserted into two, one-inch incisions.
Once the tubes have been removed, pedicle screws are placed through the same small (one-inch) incisions that were made for the insertion of the tubes. The spine is immobilized so the bone grafts can heal and fuse the vertebrae together.

Advantages To The Minimally Invasive Technique
Minimally invasive PLIF achieves the same goals and objectives as the open surgery while minimizing trauma to the patient. The procedure is performed through two one-inch incisions on either side of the lower back. The paraspinous muscles do not need to be stripped from the spine, there is less tissue retraction, and blood loss is minimized compared to the open procedure. Bone removal, a discectomy, an interbody fusion, and pedicle screw insertion can all be performed through the same small incisions. Therefore, tissue trauma and post-operative pain are reduced, hospital stays are shorter, and patients can recover more quickly.

The neurosurgeons of Carolina Neurosurgery & Spine Associates perform minimally invasive PLIF in Charlotte, Concord and Rock Hill. For more information, call 704-376-1605 or 800-344-6716.

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