Minimally Invasive Back Surgery: Are You a Candidate
Dr. Robert Feldman discusses symptoms of back pain, the different types of treatments, and if you're a candidate for minimally invasive back surgery.
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Learn more about Robert Feldman, MD
Robert Feldman, MD
Robert P. Feldman, MD, specializes in surgery of the brain, spine and peripheral nerves. He has been actively involved in using the latest technologies and techniques in minimally invasive spine and brain surgery. Certified by the American Board of Neurological Surgeons, Dr. Feldman is the Director and Founder of the Florida Institute of Neuroscience. Dr. Feldman has trained in some of the top ranked institutions in the United States for his undergraduate and medical degrees as well as his neurosurgical specialty training.Learn more about Robert Feldman, MD
Transcription:
Prakash Chandran (Host): Being told you may need back surgery can be a really scary thought. But the good news is, there are actually minimally invasive treatment options that are available and today we’re going to learn more about it with Dr. Robert Feldman, a Neurosurgeon at Fort Walton Beach Medical Center.
This is Helmet of Health, the podcast from Fort Walton Beach Medical Center. I’m Prakash Chandran. So, first of all, Dr. Feldman, tell us some of the reasons that people might need to have back surgery in the first place.
Robert Feldman, MD (Guest): There are multiple reasons why someone might need or want back surgery. The number one reason I would say would be pain. And pain from the spine whether it’s the lumbar spine, the thoracic spine or the cervical spine; will typically come from two or three possible sources. One of those would be a mechanical type of pain which is where bones, joints, discs are not working properly, and the excessive movement of those structures leads to pain. And that pain can be an inflammation of those joints followed by muscle spasm which is an attempt to stabilize those joints. And then the other source of pain would be pinched nerves. And that would give you typically sciatica type symptoms which basically means pain, numbness, tingling running down the leg.
And then other sources of pain which are lower on the list as far as how common they are; are things like fractures, infections, tumors and things like that. But pain from worn out joints and pinched nerves is the number one reason someone might consider back surgery.
Host: Okay, thanks for that clarity. So, in order to mitigate the pain, talk a little bit about how back surgery has traditionally been performed.
Dr. Feldman: The surgery that would traditionally be performed for pinched nerves would involve figuring out which nerve is pinched, where it is pinched and then what would need to be done to unpinch it. And typically, that would involve removing bone spurs, removing ligaments that have become thickened with time, removing herniated discs which is when a piece of the shock absorber or disc escapes out from where it’s supposed to be and can put a pinch or push on a nerve. So, the unpinching of the nerve surgery would typically involve finding out where that pinching is occurring and then unpinching it.
The surgeries that would be involved for addressing mechanical back pain from things like bones and joints that are moving around too much would typically involve more invasive surgeries where you have to stabilize those structures. Which would typically involve fusing bones together and immobilizing them with things like screws and rods and clamps.
Host: It does sound like when you get back surgery, some of it can be quite complex. But I have heard about minimally invasive back surgery. So, maybe talk a little bit about what it is and who is the best or ideal candidate for it.
Dr. Feldman: In the old days, you would get what would today be a very small surgery and you would get an eight inch incision in your back. They would have to strip away all the muscles, they would have to count the levels from the tailbone in order to figure out where they needed to be and since the old days where those kinds of surgeries were done; we’ve refined technology and techniques and approaches where we can accomplish a lot of the same goals with much smaller incisions. So, now, instead of opening up the spine and counting; we can use an x-ray to figure out exactly the right spot to start.
Instead of stripping away all the muscles, we can actually go through the muscles in order to put in screws or rods and things like that. Instead of a long incision and using direct vision to do a surgery; the next step was something called loupes, which were these special glasses with magnifiers on them. That would enable the incision to get smaller. The next step in the 50s or 60s was the operating room microscope. That was better than the loupes and that would allow the incision to be even smaller.
And now, the latest minimally invasive techniques are these tubes that you work through using a microscope where instead of an incision, it’s actually done through a tube and the instruments that are used to do the surgery have been adapted to work through that tube. So, the technology that has allowed us to become less and less invasive, has evolved over time. And now the trick is to make sure that you offer that kind of surgery to the right patient.
So, the second part of your question was who is a good candidate for a minimally invasive surgery. So, the person who would benefit from a minimally invasive surgery is typically a patient that has a pinched nerve. In that case, it’s a small spot where the nerve is being compressed and if you can get to that spot through a minimally invasive approach; you can often likely accomplish the goal of unpinching that nerve. And you don’t need a huge incision and you don’t need to strip away all the muscles.
Now someone who has a slow steady buildup of arthritis where the entire spinal canal is compressed, not just a nerve, a single spinal nerve; that would require a much more extensive decompression and minimally invasive approach would not only be inappropriate, but if you tried to do that, it would limit your ability to do the surgery successfully. And then lastly, the kind of surgeries where you are addressing mechanical back pain, where you are trying to fuse bones together; that used to be never even dreamed of as an option for minimally invasive surgery.
But now, you can now fuse the bones together going from the side of the body instead of the back or the front and that all can be done through a one inch incision. You can put in screws and rods for lumbar fusions all through tiny incisions using x-rays instead of using direct vision to put those screws in. So, the type of problem that you have and the kind of solution you are looking for all will determine whether a minimally invasive approach is appropriate.
Host: All right Dr. Feldman, well it’s truly amazing to hear how far technology has come. So, I really appreciate your time today. That’s Dr. Robert Feldman, a Neurosurgeon at Fort Walton Beach Medical Center. Thanks for checking out this episode of Helmet of Health. Head to FWBMC.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): Being told you may need back surgery can be a really scary thought. But the good news is, there are actually minimally invasive treatment options that are available and today we’re going to learn more about it with Dr. Robert Feldman, a Neurosurgeon at Fort Walton Beach Medical Center.
This is Helmet of Health, the podcast from Fort Walton Beach Medical Center. I’m Prakash Chandran. So, first of all, Dr. Feldman, tell us some of the reasons that people might need to have back surgery in the first place.
Robert Feldman, MD (Guest): There are multiple reasons why someone might need or want back surgery. The number one reason I would say would be pain. And pain from the spine whether it’s the lumbar spine, the thoracic spine or the cervical spine; will typically come from two or three possible sources. One of those would be a mechanical type of pain which is where bones, joints, discs are not working properly, and the excessive movement of those structures leads to pain. And that pain can be an inflammation of those joints followed by muscle spasm which is an attempt to stabilize those joints. And then the other source of pain would be pinched nerves. And that would give you typically sciatica type symptoms which basically means pain, numbness, tingling running down the leg.
And then other sources of pain which are lower on the list as far as how common they are; are things like fractures, infections, tumors and things like that. But pain from worn out joints and pinched nerves is the number one reason someone might consider back surgery.
Host: Okay, thanks for that clarity. So, in order to mitigate the pain, talk a little bit about how back surgery has traditionally been performed.
Dr. Feldman: The surgery that would traditionally be performed for pinched nerves would involve figuring out which nerve is pinched, where it is pinched and then what would need to be done to unpinch it. And typically, that would involve removing bone spurs, removing ligaments that have become thickened with time, removing herniated discs which is when a piece of the shock absorber or disc escapes out from where it’s supposed to be and can put a pinch or push on a nerve. So, the unpinching of the nerve surgery would typically involve finding out where that pinching is occurring and then unpinching it.
The surgeries that would be involved for addressing mechanical back pain from things like bones and joints that are moving around too much would typically involve more invasive surgeries where you have to stabilize those structures. Which would typically involve fusing bones together and immobilizing them with things like screws and rods and clamps.
Host: It does sound like when you get back surgery, some of it can be quite complex. But I have heard about minimally invasive back surgery. So, maybe talk a little bit about what it is and who is the best or ideal candidate for it.
Dr. Feldman: In the old days, you would get what would today be a very small surgery and you would get an eight inch incision in your back. They would have to strip away all the muscles, they would have to count the levels from the tailbone in order to figure out where they needed to be and since the old days where those kinds of surgeries were done; we’ve refined technology and techniques and approaches where we can accomplish a lot of the same goals with much smaller incisions. So, now, instead of opening up the spine and counting; we can use an x-ray to figure out exactly the right spot to start.
Instead of stripping away all the muscles, we can actually go through the muscles in order to put in screws or rods and things like that. Instead of a long incision and using direct vision to do a surgery; the next step was something called loupes, which were these special glasses with magnifiers on them. That would enable the incision to get smaller. The next step in the 50s or 60s was the operating room microscope. That was better than the loupes and that would allow the incision to be even smaller.
And now, the latest minimally invasive techniques are these tubes that you work through using a microscope where instead of an incision, it’s actually done through a tube and the instruments that are used to do the surgery have been adapted to work through that tube. So, the technology that has allowed us to become less and less invasive, has evolved over time. And now the trick is to make sure that you offer that kind of surgery to the right patient.
So, the second part of your question was who is a good candidate for a minimally invasive surgery. So, the person who would benefit from a minimally invasive surgery is typically a patient that has a pinched nerve. In that case, it’s a small spot where the nerve is being compressed and if you can get to that spot through a minimally invasive approach; you can often likely accomplish the goal of unpinching that nerve. And you don’t need a huge incision and you don’t need to strip away all the muscles.
Now someone who has a slow steady buildup of arthritis where the entire spinal canal is compressed, not just a nerve, a single spinal nerve; that would require a much more extensive decompression and minimally invasive approach would not only be inappropriate, but if you tried to do that, it would limit your ability to do the surgery successfully. And then lastly, the kind of surgeries where you are addressing mechanical back pain, where you are trying to fuse bones together; that used to be never even dreamed of as an option for minimally invasive surgery.
But now, you can now fuse the bones together going from the side of the body instead of the back or the front and that all can be done through a one inch incision. You can put in screws and rods for lumbar fusions all through tiny incisions using x-rays instead of using direct vision to put those screws in. So, the type of problem that you have and the kind of solution you are looking for all will determine whether a minimally invasive approach is appropriate.
Host: All right Dr. Feldman, well it’s truly amazing to hear how far technology has come. So, I really appreciate your time today. That’s Dr. Robert Feldman, a Neurosurgeon at Fort Walton Beach Medical Center. Thanks for checking out this episode of Helmet of Health. Head to FWBMC.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.