Evo Terra (Host): What is ultra-minimally invasive spine surgery, and what conditions does it treat? Let's find out with Dr. Kamran Parsa, a neurosurgeon and member of the staff at Southwest HealthCare Palmdale Regional Medical Center.

This is Palmdale Regional Radio. And today, we are discussing ultra-minimally invasive spine surgery. Joining Dr. Parsa is one of his patients, Marie. Thank you both for joining me. Dr. Parsa, let's have you answer the question I started off with. What is ultra-minimally invasive spine surgery, and why, even though that name sounds nice, am I still worried about it?

Kamran Parsa, DO: Hi Evo, thank you for inviting me for this chat today. The term ultra-minimally invasive spine surgery is a very recent term that is being used in the spine community. Initially, spine surgeries were quite morbid, meaning there were larger incisions, a lot of muscle dissection that led to longer recoveries. The techniques were always good and the outcomes were good, but it just took a long time for patients to get back to their lives. So, the spine community tried to be less and less invasive.

And one of the first innovations historically was the invention of the microscope for neurosurgery that allowed the incisions, which used to be long for a one-level laminectomy down to eventually get to about two to three centimeters. Then, the next step came, so this was called microneurosurgery. The next step in the minimally invasive category came out was a tubular microneurosurgery, where they realized the retractors were too large to make these incisions smaller. So, we started using dilatory tubes in order to perform surgery. So, that was called minimally invasive spine surgery. That's last generation.

Now, the newest generation is called ultra-minimally invasive spine surgery. And at this point, we're doing it through cameras, where the incision is now you're looking at the size of my little pinky. And for decompression surgeries and for fusion surgeries, multiple of these smaller incisions on your back.

So, that is what ultra-minimally invasive spine surgery is. It's sort of the latest generation of minimizing muscle dissection in patients, and achieving the same outcomes as the large incisions. Therefore, we're allowing our patients to have wonderful outcomes, at the same time get back to their lives within the same day or the next day or at least within a week compared to what used to take sometimes up to four or five to six months. So dramatically improving recovery and time and improving patient outcomes, that is the goal of minimally invasive spine surgery.

Host: That's a very remarkable difference between recovery time. So, does that mean most of the recovery time in spine surgeries has to do with the muscular damage of going in, and it's less about the work done on the spine itself?

Kamran Parsa, DO: Absolutely. Most surgeons are well trained and are safe. Therefore, it comes to the second issue, which is the dissection. Getting down to the patient's spine and performing the surgery, and then closing up that opening. And now, that closure of that opening is becoming less and less, or to now, with ultra-minimally invasive spine surgery, actually, you don't really even have a closure of muscle anymore. The muscles are barely disrupted in this type of surgery.

Host: That really is amazing. We have Marie with us as well. And Marie, you've had this procedure. How are you doing? Are you glad you went this route and not the traditional route?

Marie Paul Pedroza: Oh yes, I'm doing very well. Really happy with it.

Host: How long was your recovery time?

Marie Paul Pedroza: It was about two months. I was up and about though as soon as I got out of the hospital, which I was there for three days. It was great.

Host: That's amazing that it can work so well. Dr. Parsa, I'll ask you a question about candidates for this. Is this every spine surgery should be going through ultra-minimally invasive? Are there certain candidates that are not good candidates for this surgery? Talk to us about that.

Kamran Parsa, DO: Well, one thing I missed about spine surgery, there's the two sort of branches of spine surgery. One is decompression alone, which is not what Marie had. And the other is a fusion approach, which it changes your anatomy significantly more compared to decompression. Each one has its own indications. And Marie, to have the good outcome that she's had, she needed the more sort of anatomically invasive surgery, which is the fusion.

For the fusion in Marie's case, we approach it through a technique called the OLLIF, O-L-L-I-F. Actually, myself, our practice probably, we by far have the highest numbers in Western United States. We're probably getting close to having the highest volume in the country next to the person who brought this procedure in the country. So, we have a high volume, and the outcomes are phenomenal. And the question was whether all surgeries can go through this route. I can tell you most, yes, probably 80-90% of surgeries can. There's still a select few that the equipment is not advanced enough to accommodate what we need to do, let's say, scoliosis surgery or some of the other more very complex reconstruction surgeries. Those probably still need to have an opening to do so, for now. I'm sure in the near future, the equipment and the technology will catch up.

Host: That's excellent news. Marie, I want to turn back to you again. You had something called spinal fusion, which is done, which I don't know if we need to get too terribly detailed in what that is. But I'm curious if the prospect of having that done through this ultra-minimally invasive procedure, as opposed to the traditional procedure, did that make you more likely to have the procedure done? Would you have put it off?

Marie Paul Pedroza: I'm not sure about that. I was really happy when the doctor did explain that to me, you know, because I did need it and they wanted to do it as soon as possible because of my age. Age is a big factor on any surgery. So, yes, I'm very happy that I had it done right away.

Host: Can you tell me a little bit about how things have changed for you after you've had this procedure?

Marie Paul Pedroza: Not much, because I was in a lot of pain before the surgery. And now, I'm walking more and, doing physical therapy and getting my body really in physical. So, I feel great. I really do.

Host: That is very good news. Dr. Parsa, are there any considerations that patients should know about before they have, well, not just ultra-minimally invasive surgery, but I guess any sort of spine surgery? What should they look for?

Kamran Parsa, DO: Pain and dysfunction affecting your quality of life. I think those are key points. Really, that's the only time you need surgery. If have enough pain that's affecting your functionality, you have tried conservative measures via either physical therapy, chiropractic, spinal injections, giving your body time to allow it to heal on its own, all of these things. And that generally takes a minimum of about three to six months' timeframe. And if those methods do not help you, and you're still in just pain really and suffering, then, if indicated, surgery is a very good option.

Host: And obviously, taking the ultra-minimally invasive surgery approach is an even better option because your recovery time is that much quicker, right?

Kamran Parsa, DO: It is. And just to clarify, recovery, to give you an idea, Marie had a one-level lumbar fusion. She is now 78 years old. In the past, the open fusion surgery, she would not even be a candidate for the surgery, because of the dissection, the trauma that the body would endure for this type of surgery. So, she wouldn't even be candidate in the first place.

Now, microscopic neurosurgery or prior generation, yes, she would what we would say, the regular minimally invasive surgery, yes, she would be able to endure it. Her hospitalization would probably have been longer, and her recovery would probably be longer as well. Now, recovery is not having complete getting back to full activity. We're talking recovery getting up and walking, getting to the bathroom, being able to do some daily function on your own. What I'm seeing with this OLLIF or the ultra-minimally invasive surgery is that, depending again on age, Marie falls on the far end. Most of our patients are going home the same day or the next day. So, she was in the hospital for two nights, which is still very, very faster than the prior approaches, but it's still at the slower end of what we're seeing with this approach. And as far as recovery, with the fusions, we would generally have patients now go back to work one to three, sometimes four months out.

Now routinely, they're back at desk jobs by about two to four week timeframes, because they're comfortable enough. Now, you're still recovering, you still have some pain. So, you know, you're not going to be pain-free, but you're significantly to a point that it's tolerable and you're getting back to being productive and getting back to it, which is very, very, very different compared to prior generation approaches.

Host: Yeah. It sounds like a great treatment, because now we can treat more people. We can get them back to be more productive quicker. Everything's better, it sounds like, with these new ultra-minimally invasive surgical techniques, especially on the spine. So, Dr. Parsa, I want to thank you for all the information. And also you as well, Marie, thank you very much for chatting with us today.

And that concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. For more information please visit swhpalmdaleregional.com/services/neurology or just visit the website at palmdaleregional.com for more information and to get connected with one of our providers.

Please remember to rate and review and even subscribe to this podcast and all the other Palmdale Regional Medical Center podcasts. For more information, health tips, updates, follow us on your social channels. And if you found this episode helpful, please share it on your social media and be sure to check out all the other interesting podcast episodes 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 the actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if surgery is right for you.

I'm Evo Terra. This has been Southwest Healthcare Palmdale Regional Radio with Palmdale Regional Medical Center. Thanks for listening.