New Physician, Dr. Carson, Talk to us about Spinal Fusion
Dr. Tyler Carson explains the minimally invasive lumbar spinal fusion and who would be a great candidate for this procedure.
Featured Speaker:
Tyler Carson, DO
Dr. Carson was born and raised in Oceanside CA. He attended UCLA where he completed a B.S. in Materials Engineering in 2003. After graduation Dr. Carson spent 5 years at Northrop Grumman Space Technology in Redondo Beach working in development of composite structures for satellite and space systems. Dr. Carson then went on to attend medical school at Western University in Pomona graduating with a D.O. degree in 2012. He subsequently completed a Neurosurgery Residency in 2018 from Riverside University Health System in 2018 and spent an additional year completing a fellowship in complex and minimally invasive spine surgery at University of Tennessee in Memphis, TN. Transcription:
New Physician, Dr. Carson, Talk to us about Spinal Fusion
Melanie Cole (Host): Technological advances have allowed more back conditions to be treated with minimally invasive surgical techniques. Today, we’re talking about minimally invasive lumbar spinal fusion and my guest is Dr. Tyler Carson. He’s a Neurosurgeon specializing in minimally invasive and complex spine surgery. He’s also a member of the medical staff at Palmdale Regional Medical Center. Dr. Carson, I’m so glad to have you join us today. It’s such a pervasive problem in the country today, back issues. What are some of the most common causes of back pain that you see? What is the first line of defense and what are some nonsurgical approaches that you might like a patient to try before you discuss surgery?
Tyler Carson D.O. (Guest): Whenever I see a patient in my clinic and they come for typically low back pain and that’s sometimes with or without radicular pain or leg pain, sometimes called sciatica; the first question I ask them is always what treatment have you tired so far to treat your problem. I like to exhaust all nonsurgical treatment methods before we end up discussing surgery. So, that would be things like physical therapy with lumbar traction, stretching exercises, medications and spinal injections to target the area of possible dysfunction of the spine.
So, those are the methods I look to treat with before we end up discussing any surgical treatments.
Host: Okay so you try these types of techniques first. Then maybe they are not working for the person, so tell us about spinal fusion. Why would you choose this procedure? What goes into that decision making process?
Dr. Carson: Spinal fusion is a tough decision to make for any patient. If anybody has ever researched, it online they’ll hear good and bad stories about spinal fusion. The goal of spinal fusion is to prevent any motion at a particular segment of the spine. And the idea behind it is that by preventing any motion at a dysfunctional segment; that can diminish the pain that the patient is experiencing from that joint in the spine.
I’ll see patients oftentimes with minimal back pain and more of a radicular leg pain and in those cases, fusion is not really the choice surgery if there is no instability noted in the spine. And that’s when we would choose a simple decompression like a laminectomy or discectomy to just remove the pressure off of the nerve roots in the lumbar spine. When I refer to instability of the spine, many times we are talking about mechanical instability. So, when the patient is up and walking around, is their pain getting worse and that is a telltale sign of mechanical instability as opposed to if they have back pain constantly whether they are laying or more standing or sitting.
Host: So, before we talk about who might be a candidate, explain for the listeners what does it mean when we say minimally invasive? What are the benefits to the patient? What does that mean? How do you do a fusion minimally invasively?
Dr. Carson: I’ll first start off by explaining what the traditional or open lumbar spinal fusion surgery would be. And that’s basically where you are making an incision down the middle of the back, you are then cutting the muscles off of the bones in the spine to expose all of the posterior portion of the vertebrae. Once this is completely exposed, and all of the muscle is dissected off of the bones, you would place pedicle screws into the bones along with rods that connect to the pedicle screws to stabilize the spine and then at that point, would place graft material onto the posterior portion of the spine to induce fusion of the bones. That can be alone or sometimes that is combined with removal of the disc and placement of a spacer or cage as well as more bone graft into the anterior portion of the spinal column to fuse that portion of the spine as well.
That’s an open spinal fusion. With a minimally invasive spinal fusion, the goal is to reduce the amount of tissue and muscle damage and thereby improving infection rates, improving healing time and just less destruction to the tissue. Rather than a completely open where we are cutting all the muscle off of the bones and exposing everything; we use a tubular retractor system which is graduated set of cylinders that goes through the muscle and splits the muscle rather than cutting the muscle. Once we have the tube in place; we are able to move it around to look at different portions of the spine and do our work through that tube in terms of decompression.
We will go through the tube and remove the disc and place all of the graft material and the spacer through that tube under view of the microscope. And then place screws and rods as well through the muscle rather than completely exposing the entire spine. The benefit of this is we are not cutting muscles off of the spine; we’re having much smaller incision with much less tissue damage. We’re not removing ligaments which helps stabilize the posterior portion of the spine. And the goal of all of this is to not only allow faster healing, less infection but also to prevent need for future surgeries due to adjacent level destruction which often can happen with an open surgery.
Host: Such amazing technology Dr. Carson so who might be a candidate for minimally invasive spinal fusion?
Dr. Carson: Oftentimes the candidate for this is going to be somebody with a degenerative spinal disease, degenerative disc disease with one to two segments of dysfunction. We can do larger spinal fusions but typically, the most common segments for dysfunction in the lumbar spine are the L4-5 and L5-S1 levels and though we can treat all spinal levels with this method. For single level spinal fusions; the hospital stay can vary but I’ve done this surgery as an outpatient where the patient goes home the same day to spending one to two days in the hospital on average.
So, we are performing a spinal fusion and the amount of time that it takes for the bones to fuse together is independent of whether this is done open or minimally invasive. So, if you’ve ever broken a bone or known somebody who has broken a bone; they are in a cast for typically three months. And that’s about how long it takes for the bone to begin fusing together. By about six months to one year after surgery; it’s completely fused and healed. And you should be returning to pretty much all normal activities about six months after surgery.
Host: That’s great advice. So, Dr. Carson, as we wrap up, give us your best advice for keeping a healthy back and what do you see coming in the future of spine surgery?
Dr. Carson: Something that I’ve learned through my training and that I also say to all my patients as well is to take care of your back to prevent degeneration of the discs in your back. It’s very important to maintain an understanding of what you are doing to your back. So, bending it over at the waist, twisting and lifting heavy objects are all bad news for the discs in your back. We will often tell our patients now BLT, no bending, lifting or twisting. And it will be the best thing to prevent further degeneration of your back.
As far as what I see coming down the pipeline; we’re trying even less invasive techniques, endoscopic spine surgery, smaller openings. One of our things that we are using a lot now is also lateral approaches to the spine to perform corrections of scoliosis and deformities in a more minimally invasive method than has previously be done.
Host: Certainly an exciting time to be a spine surgeon. Thank you so much Dr. Carson for joining us and sharing your incredible expertise and telling us about minimally invasive lumbar spinal fusion surgery. Thank you again. For more information on Dr. Carson and minimally invasive lumbar spinal fusion please visit www.nsica.org or you can head over to our website at www.palmdaleregional.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, as fascinating, please share with your friends and family. If you know somebody with back problems, they need to listen to these kinds of podcasts so that we can all learn from the experts at Palmdale Regional together.
And don’t miss all the other interesting podcasts in our library. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Until next time, I’m Melanie Cole.
New Physician, Dr. Carson, Talk to us about Spinal Fusion
Melanie Cole (Host): Technological advances have allowed more back conditions to be treated with minimally invasive surgical techniques. Today, we’re talking about minimally invasive lumbar spinal fusion and my guest is Dr. Tyler Carson. He’s a Neurosurgeon specializing in minimally invasive and complex spine surgery. He’s also a member of the medical staff at Palmdale Regional Medical Center. Dr. Carson, I’m so glad to have you join us today. It’s such a pervasive problem in the country today, back issues. What are some of the most common causes of back pain that you see? What is the first line of defense and what are some nonsurgical approaches that you might like a patient to try before you discuss surgery?
Tyler Carson D.O. (Guest): Whenever I see a patient in my clinic and they come for typically low back pain and that’s sometimes with or without radicular pain or leg pain, sometimes called sciatica; the first question I ask them is always what treatment have you tired so far to treat your problem. I like to exhaust all nonsurgical treatment methods before we end up discussing surgery. So, that would be things like physical therapy with lumbar traction, stretching exercises, medications and spinal injections to target the area of possible dysfunction of the spine.
So, those are the methods I look to treat with before we end up discussing any surgical treatments.
Host: Okay so you try these types of techniques first. Then maybe they are not working for the person, so tell us about spinal fusion. Why would you choose this procedure? What goes into that decision making process?
Dr. Carson: Spinal fusion is a tough decision to make for any patient. If anybody has ever researched, it online they’ll hear good and bad stories about spinal fusion. The goal of spinal fusion is to prevent any motion at a particular segment of the spine. And the idea behind it is that by preventing any motion at a dysfunctional segment; that can diminish the pain that the patient is experiencing from that joint in the spine.
I’ll see patients oftentimes with minimal back pain and more of a radicular leg pain and in those cases, fusion is not really the choice surgery if there is no instability noted in the spine. And that’s when we would choose a simple decompression like a laminectomy or discectomy to just remove the pressure off of the nerve roots in the lumbar spine. When I refer to instability of the spine, many times we are talking about mechanical instability. So, when the patient is up and walking around, is their pain getting worse and that is a telltale sign of mechanical instability as opposed to if they have back pain constantly whether they are laying or more standing or sitting.
Host: So, before we talk about who might be a candidate, explain for the listeners what does it mean when we say minimally invasive? What are the benefits to the patient? What does that mean? How do you do a fusion minimally invasively?
Dr. Carson: I’ll first start off by explaining what the traditional or open lumbar spinal fusion surgery would be. And that’s basically where you are making an incision down the middle of the back, you are then cutting the muscles off of the bones in the spine to expose all of the posterior portion of the vertebrae. Once this is completely exposed, and all of the muscle is dissected off of the bones, you would place pedicle screws into the bones along with rods that connect to the pedicle screws to stabilize the spine and then at that point, would place graft material onto the posterior portion of the spine to induce fusion of the bones. That can be alone or sometimes that is combined with removal of the disc and placement of a spacer or cage as well as more bone graft into the anterior portion of the spinal column to fuse that portion of the spine as well.
That’s an open spinal fusion. With a minimally invasive spinal fusion, the goal is to reduce the amount of tissue and muscle damage and thereby improving infection rates, improving healing time and just less destruction to the tissue. Rather than a completely open where we are cutting all the muscle off of the bones and exposing everything; we use a tubular retractor system which is graduated set of cylinders that goes through the muscle and splits the muscle rather than cutting the muscle. Once we have the tube in place; we are able to move it around to look at different portions of the spine and do our work through that tube in terms of decompression.
We will go through the tube and remove the disc and place all of the graft material and the spacer through that tube under view of the microscope. And then place screws and rods as well through the muscle rather than completely exposing the entire spine. The benefit of this is we are not cutting muscles off of the spine; we’re having much smaller incision with much less tissue damage. We’re not removing ligaments which helps stabilize the posterior portion of the spine. And the goal of all of this is to not only allow faster healing, less infection but also to prevent need for future surgeries due to adjacent level destruction which often can happen with an open surgery.
Host: Such amazing technology Dr. Carson so who might be a candidate for minimally invasive spinal fusion?
Dr. Carson: Oftentimes the candidate for this is going to be somebody with a degenerative spinal disease, degenerative disc disease with one to two segments of dysfunction. We can do larger spinal fusions but typically, the most common segments for dysfunction in the lumbar spine are the L4-5 and L5-S1 levels and though we can treat all spinal levels with this method. For single level spinal fusions; the hospital stay can vary but I’ve done this surgery as an outpatient where the patient goes home the same day to spending one to two days in the hospital on average.
So, we are performing a spinal fusion and the amount of time that it takes for the bones to fuse together is independent of whether this is done open or minimally invasive. So, if you’ve ever broken a bone or known somebody who has broken a bone; they are in a cast for typically three months. And that’s about how long it takes for the bone to begin fusing together. By about six months to one year after surgery; it’s completely fused and healed. And you should be returning to pretty much all normal activities about six months after surgery.
Host: That’s great advice. So, Dr. Carson, as we wrap up, give us your best advice for keeping a healthy back and what do you see coming in the future of spine surgery?
Dr. Carson: Something that I’ve learned through my training and that I also say to all my patients as well is to take care of your back to prevent degeneration of the discs in your back. It’s very important to maintain an understanding of what you are doing to your back. So, bending it over at the waist, twisting and lifting heavy objects are all bad news for the discs in your back. We will often tell our patients now BLT, no bending, lifting or twisting. And it will be the best thing to prevent further degeneration of your back.
As far as what I see coming down the pipeline; we’re trying even less invasive techniques, endoscopic spine surgery, smaller openings. One of our things that we are using a lot now is also lateral approaches to the spine to perform corrections of scoliosis and deformities in a more minimally invasive method than has previously be done.
Host: Certainly an exciting time to be a spine surgeon. Thank you so much Dr. Carson for joining us and sharing your incredible expertise and telling us about minimally invasive lumbar spinal fusion surgery. Thank you again. For more information on Dr. Carson and minimally invasive lumbar spinal fusion please visit www.nsica.org or you can head over to our website at www.palmdaleregional.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, as fascinating, please share with your friends and family. If you know somebody with back problems, they need to listen to these kinds of podcasts so that we can all learn from the experts at Palmdale Regional together.
And don’t miss all the other interesting podcasts in our library. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Until next time, I’m Melanie Cole.