MDNews - Long Island

"The truth is that there is really not that much of a difference in outcomes from the less invasive surgeries, but there is better healing time and a quicker return to full functionality," Dr. Sonstein says. "The bottom line is that you've got to do the right surgery. In the end — whether it's minimally invasive or a more traditional surgery — what you end up doing to the spine is pretty much the same." However, some minima lly invasive techniques for spine surgery allow the physician to take advantage of approaches that weren't possible through a tradi- tional incision. ADVANCES IN FUSION SURGERY In some areas, new approaches are trans- forming the surgical landscape. Interbody fusion is one such surgery. " T here's been a rea l ex plosion of su rgeons operati n g t h roug h latera l approaches, and those approaches are generally done to fuse the disc space," Dr. Sonstein says. "This is called an inter- body fusion. The rationale is that this improves on the traditional placement of these interbody fusions of the disc space." This approach has become more pop- ular over the years. "More of the younger surgeons who have been trained in the last 10–15 years prefer employing these techniques," Dr. Sonstein says. "A lot of the doctors in our group offer that minimally invasive interbody fusion." CAREFUL PATIENT SELECTION As long as the surgery is indicated and per- formed correctly, the outcomes between traditional approaches and minimally invasive approaches have a negligible dif- ference, according to Dr. Sonstein. Patient selection can make all the difference in whether the approach — conventional or minimally invasive — will be successful. There are some exclusion criteria for minimally invasive spine surgery. Patients who require revision surgery are typically not good candidates for minimally inva- sive spine surgery, Dr. Sonstein explains. "Patients who have had prior surgery and have quite a bit of scarring — those cases are much more complex and chal- lenging," he says. "They require direct visualization to accomplish what we need to accomplish." With the complexity associated with revision surgeries, minimally invasive techniques may not always allow enough exposure to accomplish the goals of the revision surgery. "Some of these patients have had more than one previous surgery," Dr. Sonstein says. " They need a more traditiona l approach to resolving their problem." The danger of using minimally inva- sive spine surgery is that it limits the visualization of the area the surgeon is operating on, Dr. Sonstein says. It also limits surgical control over the procedure, so the surgeon may not always be able to accomplish the desired goal. "That may in fact predispose the patient more for complications," Dr. Sonstein says. "The physician may not be visualizing the spine in the way it should be properly visualized for the sake of performing the operation through a tiny incision." REVISION SURGERIES Some patients who have undergone prior spine surgery may develop new symptoms and require revision surgery. Problems will emerge at the segment above or below the spinal segment that was previously surgically corrected. NSPC surgeons wel- come consultations for revision surgery, no matter where the patient's original procedure was performed. Revision surgeries can correct the underlying issue, thus alleviating symp- toms and improving stability in the spine. While the success rates of a second sur- gery are not as high as a primary surgery, if the surgery is well indicated and all means of conservative management have failed, the procedure can provide highly satisfactory results, Dr. Sonstein states. "If a patient has had an L4-5 fusion, they can develop problems above at L3-4," Dr. Sonstein illustrates. "They can develop arthritis that narrows the spinal canal and compresses the nerve, and they can Dr. Sonstein uses a spine model to educate a patient about both spinal anatomy and treatment options for a herniated lumbar disc. " We see patients the day we hear from them or the day after — we don't let patients wait." — WILLIAM SONSTEIN, MD, FACS, ATTENDING NEUROSURGEON AND PRESIDENT AT NSPC 0 8❱❱❱❱❱ C O V E R F E A T U R E

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