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Minimally Invasive Spine Surgery
Back pain affects many Americans. For those with chronic back pain, spinal surgery may be a solution. Dr. Ian Madom discusses minimally invasive spine surgery.
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Learn more about Ian A. Madom, MD, MBA
Ian A. Madom, MD, MBA
Ian A. Madom, MD, MBA cares for a wide variety of conditions related to the cervical, thoracic and lumbar spine. Typically that includes pain that starts in the neck and back, but spreads to the arms and legs. He offers a wide range of options for patients that include non-operative and operative approaches to treat their pain.Learn more about Ian A. Madom, MD, MBA
Transcription:
Bill Klaproth (Host): Back pain which can often be connected to the spine is one of the most widespread health problems affecting four out of five Americans in their lifetime. And non-surgical minimally invasive surgery may be the answer to eliminate some of that chronic pain. Here to talk with us about minimally invasive spine surgery, is Dr. Ian Madom, an orthopedic spine specialist at South County Health. Dr. Madom, thank your your time. So, for someone with chronic back pain, who is a good candidate for minimally invasive spine surgery?
Ian A. Madom, MD, MBA (Guest): Well the folks that are candidates for surgery even just in general, are folks that don’t just have back pain, but also have pain that’s coming from their back and radiates down, spreads down into their buttocks and into their legs. A lot of people refer to that as sciatica and most of those people when they are standing and walking; they have this pain that makes them want to sit down. They typically get some type of relief by bending over or maybe squatting or typically finding some place to sit. They get some relief and then they continue to get up and walk. The back pain is typically associated with the nerve type of pain. Back pain alone tends not to be really responsive to surgical interventions, so, we try to have patients move towards nonoperative treatments when it is just the back pain. So, it’s more of the neurologic symptoms down the buttocks and legs.
Host: Got you. So, for people that have gone through physical therapy and that hasn’t worked, this is then the next logical step?
Dr. Madom: Not always. I mean if it is still just back pain, we try to find other solutions for them. A lot of the patients that I end up seeing maybe at some point in their life they say that they’ve had a lot of back pain, but now this is something new. This is pain that really spreads down the legs and is not getting better. And they have this certain pattern of pain that they really get relief when they flex the spine and that can be either in the seated position or just bending over. So, that’s just in general, who would be a surgical, a really good surgical candidate, somebody that surgery would respond to and surgery has had – spine surgery has had a pretty poor reputation in the past. Primarily because it’s been – we’ve tried to apply it to everybody who has had pain and the literature has shown more definitively over recent years that we are just less reliable at relieving the back-pain symptoms as compared to the symptoms that runs down people’s legs.
Now minimally invasive spine surgery is a technique that’s – there’s a variety of different procedures that can be labeled minimally invasive as surgery. I like to refer it as less invasive surgery because it’s still an invasive procedure and there’s varying degrees of how invasive these minimally invasive procedures are. Minimally invasive surgery has been around for 25 years. The problem with it in the past, is that it has relied on a very limited view of the neurologic structures. So, in a lot of people’s views and mine included, it really limits your ability to get a full grasp of what is going on with the patient in the surgery, you have a limited view to utilize and it’s relied on a lot of radiation using x-rays during surgery. Newer technology that we have, has helped us so that now we can see in certain ways without having to make larger incisions and the incisions have gotten smaller, the amount of pushing and pulling on the soft tissues, the muscles, has become less and that translates into surgery that is done more efficiently with less blood loss. And the upshot of that is that people can recover faster.
Host: And you’ve got a new tool to use when it comes to minimally invasive surgery. It’s called the Excelsius GPS Robotic Assistance. Can you tell us more about that?
Dr. Madom: Yes. So, robotics is something that has been out in medicine for quite some time. The general surgeons and urologic surgeons and gynecological surgeons have been using something called a DaVinci robot for a number of years and then as many people know in this state, at South County Hospital, we do quite a bit of adult reconstruction surgery, hip and knee replacements with robotics. Spine surgery has been a little bit later to the game because of the complexity of the anatomy.
This is a tool that came out about one year ago and we have brought it to South County Hospital over the past month and it allows us to have more precision and precision in placing any instrumentation that’s needed in somebody. If we are performing a spinal fusion on a patient, it allows us to place the screws in a position that is precisely where we want it to be based on a scan that’s performed before the surgery and then, in the coming months, in the next eighteen months, it will allow us to do other parts of the procedure like assist us with taking pressure off of people’s nerves with even more precision than we’ve ever had in the past. If we have all the precision based on planning that we do before surgery on a scan; it allows us to work in smaller windows of muscle and soft tissue and if we are working through smaller windows; that means that patients have less pain after surgery. So, that’s the concept of the minimally invasive approach or less invasive spine surgery.
Host: So, Dr. Madom, it sounds like the real benefit to this is shorter recovery time and better outcome, is that correct?
Dr. Madom: That’s correct. I mean so, the way the spine surgery has been done in the past and I’ve spent ten years doing spine surgery, but we get MRI scans and CAT scans and then we make a plan before surgery but then I have to use my eyes, looking up at a board or a screen where those two-dimensional images are and then look down to the patient in a three-dimensional object and translate that in my head how to get a two-dimensional image to a good result on an actual patient. What we are able to leverage with this technology is taking all of this information, putting it into the robotic assisted arm and then executing a plan. The robot doesn’t do the surgery for us. It’s an additional tool that helps us see in a surgery in ways that we’ve never been able to see before and execute the plan that we have drawn out before surgery to get it exactly right, the way that we want it.
Host: Are there certain people that are better candidates for the Excelsius GPS Robotic Assistance procedure than others?
Dr. Madom: That’s the beauty of this is that there really isn’t. I think that this can be applied – right now it’s being applied only for patients who we are performing spinal fusions and that’s maybe half of the surgeries that we do. There are plenty of patients that don’t need to have their spine fused. We can just take pressure off of their nerves to alleviate that pain. A lot of times, patients come in with either a curve in their spine, scoliosis or they have some instability to their spine, things are out of alignment, that we need to perform a fusion once we are taking pressure off their nerve, otherwise they are going to have even more instability or worse alignment issues. But in the near future, like in the next 18 months; we are going to be able to use this GPS assistance arm to help guide us to take pressure off of the nerves and then even patients who aren’t having spinal fusion can get the benefits of robotic assistance. So, spine surgery is drastically changing. This is a tool that will only help good surgeons become even better.
Host: And as a surgeon, I know advancements in technology are very important. And if you could wrap it up for us Dr. Madom. Is there anything else we should know about minimally invasive spine surgery?
Dr. Madom: No, I think that – I think sitting down with a surgeon and talking about the approach to a person’s care is the first thing. Having a good relationship with your surgeon and really trying to think whether we have minimally invasive or not; we need to try to offer patients an opportunity to avoid surgery. Now sometimes people have neurologic problems such as weakness or there is severe dysfunction to their neurologic system, where surgery really is the approach to try first. But oftentimes, these are chronic conditions that haven’t been treated in a long time and people are – their quality of life is being affected and there are nonoperative treatments than can be offered to help them avoid surgery.
But then, if all of those things fail; this is a great tool now that we have in our bag to help people recover faster, to have these surgeries be less – have less of an impact on people and their quality of life even over the long-term when it comes to their spine care. A lot of people end up having multiple spine surgeries in their life, because of the tools or the lack of tools we’ve had in the past; we are really hoping that this Excelsius GPS helps us reduce the number of people coming back for further procedures. We don’t have that data yet. But it’s something that we are going to look at over a number of years and we are really hoping that that pans out for people.
Host: Well Dr. Madom, that’s a great way to wrap it up. Thank you so much for your time today. We appreciate it. For more information, please visit www.southcountyhealth.org, that’s www.southcountyhealth.org. This is South County Health Talks from South County Health. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Back pain which can often be connected to the spine is one of the most widespread health problems affecting four out of five Americans in their lifetime. And non-surgical minimally invasive surgery may be the answer to eliminate some of that chronic pain. Here to talk with us about minimally invasive spine surgery, is Dr. Ian Madom, an orthopedic spine specialist at South County Health. Dr. Madom, thank your your time. So, for someone with chronic back pain, who is a good candidate for minimally invasive spine surgery?
Ian A. Madom, MD, MBA (Guest): Well the folks that are candidates for surgery even just in general, are folks that don’t just have back pain, but also have pain that’s coming from their back and radiates down, spreads down into their buttocks and into their legs. A lot of people refer to that as sciatica and most of those people when they are standing and walking; they have this pain that makes them want to sit down. They typically get some type of relief by bending over or maybe squatting or typically finding some place to sit. They get some relief and then they continue to get up and walk. The back pain is typically associated with the nerve type of pain. Back pain alone tends not to be really responsive to surgical interventions, so, we try to have patients move towards nonoperative treatments when it is just the back pain. So, it’s more of the neurologic symptoms down the buttocks and legs.
Host: Got you. So, for people that have gone through physical therapy and that hasn’t worked, this is then the next logical step?
Dr. Madom: Not always. I mean if it is still just back pain, we try to find other solutions for them. A lot of the patients that I end up seeing maybe at some point in their life they say that they’ve had a lot of back pain, but now this is something new. This is pain that really spreads down the legs and is not getting better. And they have this certain pattern of pain that they really get relief when they flex the spine and that can be either in the seated position or just bending over. So, that’s just in general, who would be a surgical, a really good surgical candidate, somebody that surgery would respond to and surgery has had – spine surgery has had a pretty poor reputation in the past. Primarily because it’s been – we’ve tried to apply it to everybody who has had pain and the literature has shown more definitively over recent years that we are just less reliable at relieving the back-pain symptoms as compared to the symptoms that runs down people’s legs.
Now minimally invasive spine surgery is a technique that’s – there’s a variety of different procedures that can be labeled minimally invasive as surgery. I like to refer it as less invasive surgery because it’s still an invasive procedure and there’s varying degrees of how invasive these minimally invasive procedures are. Minimally invasive surgery has been around for 25 years. The problem with it in the past, is that it has relied on a very limited view of the neurologic structures. So, in a lot of people’s views and mine included, it really limits your ability to get a full grasp of what is going on with the patient in the surgery, you have a limited view to utilize and it’s relied on a lot of radiation using x-rays during surgery. Newer technology that we have, has helped us so that now we can see in certain ways without having to make larger incisions and the incisions have gotten smaller, the amount of pushing and pulling on the soft tissues, the muscles, has become less and that translates into surgery that is done more efficiently with less blood loss. And the upshot of that is that people can recover faster.
Host: And you’ve got a new tool to use when it comes to minimally invasive surgery. It’s called the Excelsius GPS Robotic Assistance. Can you tell us more about that?
Dr. Madom: Yes. So, robotics is something that has been out in medicine for quite some time. The general surgeons and urologic surgeons and gynecological surgeons have been using something called a DaVinci robot for a number of years and then as many people know in this state, at South County Hospital, we do quite a bit of adult reconstruction surgery, hip and knee replacements with robotics. Spine surgery has been a little bit later to the game because of the complexity of the anatomy.
This is a tool that came out about one year ago and we have brought it to South County Hospital over the past month and it allows us to have more precision and precision in placing any instrumentation that’s needed in somebody. If we are performing a spinal fusion on a patient, it allows us to place the screws in a position that is precisely where we want it to be based on a scan that’s performed before the surgery and then, in the coming months, in the next eighteen months, it will allow us to do other parts of the procedure like assist us with taking pressure off of people’s nerves with even more precision than we’ve ever had in the past. If we have all the precision based on planning that we do before surgery on a scan; it allows us to work in smaller windows of muscle and soft tissue and if we are working through smaller windows; that means that patients have less pain after surgery. So, that’s the concept of the minimally invasive approach or less invasive spine surgery.
Host: So, Dr. Madom, it sounds like the real benefit to this is shorter recovery time and better outcome, is that correct?
Dr. Madom: That’s correct. I mean so, the way the spine surgery has been done in the past and I’ve spent ten years doing spine surgery, but we get MRI scans and CAT scans and then we make a plan before surgery but then I have to use my eyes, looking up at a board or a screen where those two-dimensional images are and then look down to the patient in a three-dimensional object and translate that in my head how to get a two-dimensional image to a good result on an actual patient. What we are able to leverage with this technology is taking all of this information, putting it into the robotic assisted arm and then executing a plan. The robot doesn’t do the surgery for us. It’s an additional tool that helps us see in a surgery in ways that we’ve never been able to see before and execute the plan that we have drawn out before surgery to get it exactly right, the way that we want it.
Host: Are there certain people that are better candidates for the Excelsius GPS Robotic Assistance procedure than others?
Dr. Madom: That’s the beauty of this is that there really isn’t. I think that this can be applied – right now it’s being applied only for patients who we are performing spinal fusions and that’s maybe half of the surgeries that we do. There are plenty of patients that don’t need to have their spine fused. We can just take pressure off of their nerves to alleviate that pain. A lot of times, patients come in with either a curve in their spine, scoliosis or they have some instability to their spine, things are out of alignment, that we need to perform a fusion once we are taking pressure off their nerve, otherwise they are going to have even more instability or worse alignment issues. But in the near future, like in the next 18 months; we are going to be able to use this GPS assistance arm to help guide us to take pressure off of the nerves and then even patients who aren’t having spinal fusion can get the benefits of robotic assistance. So, spine surgery is drastically changing. This is a tool that will only help good surgeons become even better.
Host: And as a surgeon, I know advancements in technology are very important. And if you could wrap it up for us Dr. Madom. Is there anything else we should know about minimally invasive spine surgery?
Dr. Madom: No, I think that – I think sitting down with a surgeon and talking about the approach to a person’s care is the first thing. Having a good relationship with your surgeon and really trying to think whether we have minimally invasive or not; we need to try to offer patients an opportunity to avoid surgery. Now sometimes people have neurologic problems such as weakness or there is severe dysfunction to their neurologic system, where surgery really is the approach to try first. But oftentimes, these are chronic conditions that haven’t been treated in a long time and people are – their quality of life is being affected and there are nonoperative treatments than can be offered to help them avoid surgery.
But then, if all of those things fail; this is a great tool now that we have in our bag to help people recover faster, to have these surgeries be less – have less of an impact on people and their quality of life even over the long-term when it comes to their spine care. A lot of people end up having multiple spine surgeries in their life, because of the tools or the lack of tools we’ve had in the past; we are really hoping that this Excelsius GPS helps us reduce the number of people coming back for further procedures. We don’t have that data yet. But it’s something that we are going to look at over a number of years and we are really hoping that that pans out for people.
Host: Well Dr. Madom, that’s a great way to wrap it up. Thank you so much for your time today. We appreciate it. For more information, please visit www.southcountyhealth.org, that’s www.southcountyhealth.org. This is South County Health Talks from South County Health. I’m Bill Klaproth. Thanks for listening.