In the world of medicine, the words “minimally invasive” and “spine surgery” don’t usually go together. But for the past decade, the University of Michigan Spine Surgery Program has moved many spine surgeries into the minimally invasive realm—with great success. In fact, U-M is the first program in the state completely dedicated to the advancement of minimally invasive spine surgery.
“A lot of the minimally invasive spine procedures started with ‘basic’ spine procedures such as discectomies, laminectomies and level-one lumbar fusions of the spine,” says Paul Park, M.D., associate professor of neurosurgery and of orthopaedic surgery. The program soon realized success in outcomes as good as or better than the traditional surgery. The surgeries also had the added benefits of smaller incisions, less tissue injury and blood loss during surgery, less postoperative pain and reduced hospital length of stay.
“It’s a constantly evolving field because once we saw success for these more basic spinal surgeries, we started applying them to more complex situations such as tumor resections and deformity.” Although not all complex cases are amenable to minimally invasive surgery, each patient is evaluated for a less invasive approach with the ultimate goal of achieving best possible outcomes.
WHO WE TREAT
Today, the U-M Spine Surgery Program provides state-of-the-art services to individuals whose spinal disorders affect their health and productivity, and whose disorders require surgical intervention. Patients referred to the spine surgery program may suffer from pain and/or neurological deficits due to degenerative spinal disease, scoliosis, spinal tumors, spine cancer, spine infections or traumatic injury.
“We offer treatment options for the whole spectrum of spinal pathologies,” Park says.
Minimally invasive spine surgery is an area in which new technologies matter greatly. Along with the latest state-of-the-art computer-assisted image guidance and operating microscopes, U-M has technologies and resources that few other hospitals have. For example, the University of Michigan was the first hospital in the state to use the O-ARM Multidimensional Imaging System.
Neurosurgeons have the option to use the O-ARM to view patient anatomy in the operative position, monitor the status of the surgery and verify surgical changes with real-time 3-D volumetric images, all before the patient leaves the surgical suite.
“We’re always investing in or trialing new technologies such as the O-ARM for increased patient safety and better outcomes,” Park says. “We also use new technologies in conjunction with newer techniques for improved outcomes as well, such as using the O-ARM for image guidance for lateral interbody fusion, which is an alternative minimally invasive approach for fusion of the thoracic and lumbar spine.”
For Referring Physicians
Dr. Park suggests that it is appropriate to refer patients who have failed nonoperative management, for example, if they have had physical therapy and injections and are still having issues (the most common of which are back pain or leg pain). In patients with neurological deficits such as weakness, referral should be done urgently.
“If you have a patient with a weak foot, for example, I wouldn’t try nonoperative measures; they need more of an urgent surgical evaluation first,” Park says. “But if it’s typically a pain issue, a trial of nonoperative management is typically recommended.”
Multiple clinical trials are ongoing or planned at the University of Michigan Spine Program involving treatments for a variety of spinal pathologies including degenerative disease, infection, trauma and deformity.
One example is our participation in a Phase 2 multicenter clinical trial to study stem cell transplantation in cervical spinal cord injury,
sponsored by StemCells, Inc.
For more information: contact Clinical Trial Coordinator Karen Frisch, 734-936-7469. firstname.lastname@example.org.