Surgical Help for Neck and Back Ailments
Most spinal problems of neck and back can be improved without the need for surgery. For some refractory conditions, however, spine surgery may be a practical and definitive treatment option. Sansum Clinic’s board-certified and fellowship trained spine surgeon, Dr. Sean Keem, MD, MBA, FAAOS, offers the latest techniques in advanced surgical procedures.
Minimally Invasive Spine Surgeries (MIS)
MIS is a spectrum of surgical procedures that can be used to treat the full array of spinal ailments including disc herniations with sciatica, spinal stenosis with radiculopathy and myelopathy, spinal deformities such as spondylolisthesis, kyphosis and scoliosis with minimal tissue trauma and significantly improved safety margin. Ongoing technological innovations make it possible to apply MIS to address most spine conditions that used to be treated with traditional open surgeries. MIS includes mini-access lumbar fusion surgery such as OLIF and LLIF (XLIF, DLIF); endoscopic and microscopic laminectomy and discectomy; percutaneous pedicle screw fixation, computer-navigated spine surgery and robotic spine surgery and it enables to address complex spine pathologies with minimal surrounding tissue trauma. Compared to traditional open spine procedures which require larger instruments and more extensive and lengthy tissue dissection, the use of MIS procedures provide the patient a better chance to achieve the desired surgical outcome while greatly enhancing surgical safety. Dr. Keem is well-versed in the entire spectrum of MIS.
Endoscopic Spine Surgery (ESS) and Micro-Spine Surgery (MSS)
ESS and MSS are subsections of MIS. During endoscopic spine surgery, the surgeon makes one or two ½ inch-incisions to insert a video camera and instruments that allow visualization of the disc space and nerve roots in great definition and to address the pathology, while minimizing injury to surrounding muscle tissue and vital structures. Laminectomy, facetectomy, foraminotomy and discectomy are aptly performed with ESS. In some cases, micro-spine surgery may be better suited. During a micro-spine surgery, a ¾” incision is made to visualize surgical area under high-definition microscope to decompress spinal nerves (laminectomy, facetectomy, foraminotomy and discectomy) with minimal tissue trauma. Endoscopic spine surgery and micro-spine surgery may also be utilized for fusion surgeries such as TLIF (transforaminal lumbar interbody fusion) or PLIF (posterior lumbar interbody fusion).
Artificial Disc Replacement Surgery
For patients with severe neck or back pain due to a degenerated or herniated disc, if removing a disc herniation is not sufficient to treat the pain, the entire damaged disc may need to be replaced either with a disc spacer (cage) or artificial disc that resembles the natural disc in function. For younger patients without significant deformity or instability, artificial disc replacement surgery may reduce the pain, improve function and restore the mobility. Both cervical spine and lumbar spine may be treated with artificial disc replacement surgery. Artificial disc replacement surgery can be done with Mini-access cervical and lumbar surgery, an MIS.
Scoliosis Corrective Surgery
Scoliosis is a complex 3-dimensional (front, side and rotational) deformity condition of spine. For minor and non-progressive scoliosis, non-surgical treatment works well. If the curvature of the spine is severe and progressive, it may manifest as intractable pain, neurological impairment as the spinal nerves get impinged in the scoliosis curvature, and impaired function of vital organs such as lungs. Both MIS mini-access surgery and traditional open spine surgery can straighten the curve and create a stable spine using spinal implants. MIS scoliosis correction may be more advantageous because of minimal surrounding tissue dissection, less surgical blood loss, less surgical pain, shorter hospital stays and quicker functional recovery.
Kyphosis Corrective Surgery
Kyphosis is another type of abnormal curvature of the spine. It can produce a rounded or hunched back (compromised sagittal balance) as well as pain and reduced mobility. Most kyphosis does not require surgical treatment unless it is progressively severe deformity that causes intractable pain, compromised function and mobility. Kyphosis correction surgery uses spinal implants to help straighten and stabilize the spine. Both MIS mini-access surgery and traditional open spine surgery can straighten the curve and create a stable spinal column. MIS mini-open correction may be more advantageous because of minimal surrounding tissue dissection, blood loss, shorter hospital stay and quicker recovery.
Spondylolisthesis Corrective Surgery
Spondylolisthesis is commonly known as slippage of spine. Upper section of spinal column moves forward or backwards in relation to the lower section of the affected level of spine. Sponylolisthesis may be congenital (born with it), developmental (occurring during growth), traumatic (sports injury, car accident, horseback riding), degenerative (age-related) or combination of these etiologies. Significant forward slippage (antero-listhesis) can cause intractable pain and neurological dysfunction as spinal nerves get impinged between slipping spinal sections and may require surgical treatment. Surgical treatment aims to relieve pressure on the spinal nerves and prevent further slippage by stabilizing the spinal column with use of implants. Dr. Keem corrects most spondylolisthesis with MIS mini-access surgical technique with OLIF or LLIF and percutaneous pedicle screw fixation, where the slippage is reduced, pressure on the nerves is relieved and spinal column is stabilized, with minimal tissue trauma, blood loss and quicker recovery than traditional open surgery.
Spinal Stenosis Corrective Surgery
Spinal stenosis-a narrowing of the spinal canal (central canal stenosis), side of spinal canal (lateral recess stenosis) and nerve-root exiting area (foraminal stenosis)-due to arthritic spinal joints with bone spurs, synovial cysts, thickened/redundant spinal ligaments and degenerated bulging/herniated discs is a relatively common age-related spinal ailment. It can also occur following a traumatic event. Spinal stenosis can cause pain, abnormal sensation of arms or legs (tingling and numbness), weakness of arms or legs and progressive loss of balance. While most of spinal stenosis can be treated conservatively and symptomatically, if symptoms and functional disability become severe, surgical treatments are available. Some patients with severe spinal stenosis may have difficulty with dressing themselves, writing a simple memo, holding small objects, walking straight, climbing stairs or ambulating any significant distance (for example walking for grocery shopping) as spinal nerves are compressed. Decompression surgeries such as laminoplasty, laminectomy and foraminotomy can relieve pressure from the nerves and/or spinal cord. In some severe cases, an arthrodesis (spinal fusion) may be necessary to stabilize spinal column after an extensive decompression surgery. Dr. Keem utilizes MIS procedures, endoscopic spine surgery (ESS), micro-spine surgery (MSS) for decompression, and mini-access fusion surgery such as OLIF, LLIF and percutaneous pedicle fixation for arthrodesis.
Sacroiliac (SI) Joint Fusion
Up to 35% of people with low back pain may have a painful sacroiliac joint, where the sacrum and ilium pelvic bones meet. Because an MRI scan may be normal, SI joint pain can go undiagnosed for years. Conservative treatments includes physical therapy, SI joint injection or sensory nerve ablations usually work well. If these therapies don’t relieve the pain, you may be a candidate for MIS sacroiliac joint fusion. This surgery is performed through a 1-inch incision, takes less than an hour and involves minimal blood loss. Implants are placed across the SI joint to stabilize the joint, resulting in pain relief in most cases.
For more information or to schedule an appointment with Dr. Keem, please call (805) 681-7584.