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Minimally Invasive Procedures for Spine Problems
Dr. Oren Blam leads a discussion on when it is appropriate to consider minimally invasive procedures for the spine, and what are the potential benefits are.
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Learn more about Oren Blam, M.D.
Oren Blam, M.D.
Dr. Blam earned his medical degree at Washington University School of Medicine in St. Louis, Missouri. He completed his general surgery internship at Pennsylvania Hospital in Philadelphia and his orthopaedic surgery residency at Thomas Jefferson University Hospital, also in Philadelphia. He then completed a spine fellowship at Mount Sinai Beth Israel Medical Center in New York City, New York.Learn more about Oren Blam, M.D.
Transcription:
Minimally Invasive Procedures for Spine Problems
Caitlin Whyte (Host): Minimally invasive surgery decreases the stress on your body and reduces recovery time, scarring and more. Minimally invasive options are even available for spine surgeries. Here to tell us more about that is Dr. Oren Blam, an Orthopedic Surgeon and Spine Specialist at the Centers for Advanced Orthopedics Orthopedic Associates of Central Maryland Division, in practice for over for 50 years.
Hello, I'm Caitlin Whyte and I've Got a Bone to Fix With You. So, Doctor starting us off here, what does minimally invasive mean when we're talking about spine surgery?
Oren Blam, M.D. (Guest): Well, minimally invasive means using smaller cuts to achieve the same goals of standard open surgery, but try to get less deep tissue disruption, less bleeding, less pain, and easier recovery than standard open surgery.
Host: Now, when is it appropriate to consider minimally invasive procedures for the spine?
Dr. Blam: Well, I consider minimally invasive procedures anytime I'm thinking about different surgical options. It's always important for achieving success with surgery to first get the diagnosis right. So, we always go through a very careful history and physical exam, various diagnostic testing. We always, almost always try nn-operative treatments first, but when surgery becomes the option needed, then I always think about minimally invasive options to try to reduce the pain of the surgery.
Host: What are some of the potential benefits for minimally invasive spinal surgeries?
Dr. Blam: Well, if we can reach the spine through a small cut or through a small tube placed under x-ray guidance without having to cut open big, thick muscles, without having to disrupt too much of the patient's anatomy, then we can try to achieve the same goals of surgery, taking pressure off nerves, stabilizing the spine, taking away patient's pain and improving their function. We can achieve those same goals, but avoid a lot of blood loss, a lot of pain and difficult recovery.
Host: So, can you break down some of the technology with how this procedure works? You know, if we're not cutting through muscle and tissue, how are we getting things done?
Dr. Blam: Right. Well, I think spine surgery shines when it takes a surgery that will otherwise be bigger, for example, an open lumbar spinal fusion of the low back. And we can achieve that with smaller cuts. The standard open technique for lumbar fusion involves making a cut and opening up the sides of the back of the spine. That requires cutting deep thick muscles off to the side.
Instead we can do, what's called a minimally invasive interbody fusion from a small cut on the side of the body, or maybe far off to the sides. Not completely off of to the side. These small cuts allow a surgeon to insert a tube or small thin retractors that are placed under x-ray guidance into the disc space. The disc is the shock absorber between the vertebrae. And if we can reach that disc through a small tube, we can cut out disc and cartilage, insert bone graft, or chips of bone. And that's what achieves a fusion through a very small cut, as opposed to having to open up the sides of the back of the spine and scraping away a whole lot of muscle in order to place bone graft that way.
So, if we can do a minimally invasive lumbar fusion, it saves a lot of pain and potential bleeding, and easier recovery.
Host: And how does this minimally invasive option compare to, I guess what we had before, when we're looking at things like time in the hospital and recovery time after?
Dr. Blam: These minimally invasive procedures, for example, for lumbar fusion I mentioned can be done on an outpatient basis. So, or maybe just with a one night stay in certain situations, as opposed to having a patient stay in the hospital for three days. We cut down on the number of times we have to send the patient to an inpatient rehab facility. Sometimes folks who get a big open lumbar surgery, need to go to a nursing home essentially for two or three weeks before they feel ready to be independent. But with these minimally invasive techniques, sometimes it can be done on an in and out basis.
Host: Great. Well, Dr. Blam, is there anything else you'd like for us to know about minimally invasive options for spinal surgeries?
Dr. Blam: I guess I would suggest people to always consider it. There are different kinds of minimally invasive procedures. I mentioned earlier lumbar spine surgery, minimally invasive options, but there are minimally invasive options in the cervical spine. There are minimally invasive options to stabilize the sacroiliac joint, a joint in the pelvis. So, there are different kinds of options all with the idea of minimizing the degree of surgery and the pain and bleeding. It's not always the appropriate option. Sometimes standard open techniques are better in some cases, but it always should be considered. What is the easiest way to achieve the goal of reducing pain and improving function.
Host: Well, Dr. Blam, we thank you so much for joining us today. That was Dr. Oren Blam, an Orthopedic Surgeon and Spine Specialist at the Centers for Advanced Orthopedics Orthopedic Associates of Central Maryland Division. Find more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. That's all for today. I am Caitlin Whyte and That Was a Bone That's Fixed.
Minimally Invasive Procedures for Spine Problems
Caitlin Whyte (Host): Minimally invasive surgery decreases the stress on your body and reduces recovery time, scarring and more. Minimally invasive options are even available for spine surgeries. Here to tell us more about that is Dr. Oren Blam, an Orthopedic Surgeon and Spine Specialist at the Centers for Advanced Orthopedics Orthopedic Associates of Central Maryland Division, in practice for over for 50 years.
Hello, I'm Caitlin Whyte and I've Got a Bone to Fix With You. So, Doctor starting us off here, what does minimally invasive mean when we're talking about spine surgery?
Oren Blam, M.D. (Guest): Well, minimally invasive means using smaller cuts to achieve the same goals of standard open surgery, but try to get less deep tissue disruption, less bleeding, less pain, and easier recovery than standard open surgery.
Host: Now, when is it appropriate to consider minimally invasive procedures for the spine?
Dr. Blam: Well, I consider minimally invasive procedures anytime I'm thinking about different surgical options. It's always important for achieving success with surgery to first get the diagnosis right. So, we always go through a very careful history and physical exam, various diagnostic testing. We always, almost always try nn-operative treatments first, but when surgery becomes the option needed, then I always think about minimally invasive options to try to reduce the pain of the surgery.
Host: What are some of the potential benefits for minimally invasive spinal surgeries?
Dr. Blam: Well, if we can reach the spine through a small cut or through a small tube placed under x-ray guidance without having to cut open big, thick muscles, without having to disrupt too much of the patient's anatomy, then we can try to achieve the same goals of surgery, taking pressure off nerves, stabilizing the spine, taking away patient's pain and improving their function. We can achieve those same goals, but avoid a lot of blood loss, a lot of pain and difficult recovery.
Host: So, can you break down some of the technology with how this procedure works? You know, if we're not cutting through muscle and tissue, how are we getting things done?
Dr. Blam: Right. Well, I think spine surgery shines when it takes a surgery that will otherwise be bigger, for example, an open lumbar spinal fusion of the low back. And we can achieve that with smaller cuts. The standard open technique for lumbar fusion involves making a cut and opening up the sides of the back of the spine. That requires cutting deep thick muscles off to the side.
Instead we can do, what's called a minimally invasive interbody fusion from a small cut on the side of the body, or maybe far off to the sides. Not completely off of to the side. These small cuts allow a surgeon to insert a tube or small thin retractors that are placed under x-ray guidance into the disc space. The disc is the shock absorber between the vertebrae. And if we can reach that disc through a small tube, we can cut out disc and cartilage, insert bone graft, or chips of bone. And that's what achieves a fusion through a very small cut, as opposed to having to open up the sides of the back of the spine and scraping away a whole lot of muscle in order to place bone graft that way.
So, if we can do a minimally invasive lumbar fusion, it saves a lot of pain and potential bleeding, and easier recovery.
Host: And how does this minimally invasive option compare to, I guess what we had before, when we're looking at things like time in the hospital and recovery time after?
Dr. Blam: These minimally invasive procedures, for example, for lumbar fusion I mentioned can be done on an outpatient basis. So, or maybe just with a one night stay in certain situations, as opposed to having a patient stay in the hospital for three days. We cut down on the number of times we have to send the patient to an inpatient rehab facility. Sometimes folks who get a big open lumbar surgery, need to go to a nursing home essentially for two or three weeks before they feel ready to be independent. But with these minimally invasive techniques, sometimes it can be done on an in and out basis.
Host: Great. Well, Dr. Blam, is there anything else you'd like for us to know about minimally invasive options for spinal surgeries?
Dr. Blam: I guess I would suggest people to always consider it. There are different kinds of minimally invasive procedures. I mentioned earlier lumbar spine surgery, minimally invasive options, but there are minimally invasive options in the cervical spine. There are minimally invasive options to stabilize the sacroiliac joint, a joint in the pelvis. So, there are different kinds of options all with the idea of minimizing the degree of surgery and the pain and bleeding. It's not always the appropriate option. Sometimes standard open techniques are better in some cases, but it always should be considered. What is the easiest way to achieve the goal of reducing pain and improving function.
Host: Well, Dr. Blam, we thank you so much for joining us today. That was Dr. Oren Blam, an Orthopedic Surgeon and Spine Specialist at the Centers for Advanced Orthopedics Orthopedic Associates of Central Maryland Division. Find more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. That's all for today. I am Caitlin Whyte and That Was a Bone That's Fixed.