Prakash Chandran (Host):  Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by UM Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the region’s leading spine experts. With convenient locations throughout the state, UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with UM Spine Network physician, you can expect to receive the high quality, evidence-based care that you deserve. Today’s topic is minimally invasive spine surgery techniques. I’m Prakash Chandran and my guests today are Dr. Daniel Cavanaugh, a Spine Surgeon at UM Upper Chesapeake Medical Center and Dr. Khalid Kurtom, a Neurosurgeon at UM Shore Medical Center. Dr. Cavanaugh and Dr. Kurtom, thank you so much for joining us today. So, first of all Dr. Cavanaugh, we’re going to start with you. Why exactly should a patient or potential patient consider minimally invasive spine surgery over traditional open surgery?

Daniel Cavanaugh, MD (Guest):  I think one of the benefits of minimally invasive spine surgery is enhanced recovery time, for certain procedure that we do. Traditionally, spine surgery involved large open incisions and minimally invasive techniques can sometimes decrease the amount of dissection and invasiveness of the procedure allowing faster recovery.

Khalid Kurtom, MD, FAANS, FACS (Guest):  I would add that in addition, there has been a lot of data to show that the overall cost to the patient and the healthcare costs associated with the minimally invasive spine surgery is actually much less due to the enhanced recovery and the rapid discharge from the hospital.

Host:  And Dr. Khalid, staying with you here, as a lay person, I’m curious as to how you would describe what minimally invasive surgery means. Doses that mean that the incision is just a little bit smaller? Maybe talk a little bit about that.

Dr. Kurtom:  Basically, most spine surgery involves decompressing the nerves, and fixating the spine if it is unstable. Those goals still have to be achieved regardless of the open versus minimally invasive surgeries. The difference is rather than cutting all the tissues to expose the spine to get the work done; you are doing it with minimal disruption of the muscles, the ligaments and structures covering the spine.

Dr. Cavanaugh:  I think there are several procedures that have become pretty standard and I would recognize as minimally invasive such as a lumbar microdiscectomy or an anterior cervical fusion; two commonly performed procedures that are done through small incisions and on an outpatient basis.

Host:  And so Dr. Cavanaugh, again, sticking with you here. I’m curious as to the types of conditions or cases that are best suited for minimally invasive spine surgery.

Dr. Cavanaugh:  I think there are a lot of pathologies, a lot of symptoms that can be treated from spine surgery in a minimally invasive fashion; ranging from cervical to thoracic to lumbar conditions. I think the most important point with minimally invasive surgery is individualizing the care to the patient. Because not all pathology is suitable for a minimally invasive approach. Although, frequently it is. I think that your surgeon really has to review your imaging and your symptoms to determine if you would be a candidate for minimally invasive techniques, whether they are in the neck or the lower back.

Host:  So, Dr. Kurtom, I’m curious to learn a little bit more about the most common types of minimally invasive options that a potential patient should know about.

Dr. Kurtom:  So, as Dr. Cavanaugh elaborated earlier, microdiscectomies and single and double level decompressions, both in the neck and in the lumbar spine are indications for minimally invasive spine surgery across multiple specialties. I would say that as you get more involved in minimally invasive spine surgery, the level of pathologies that are involved gets expanded and we are fortunate at the University of Maryland System to have surgeons that have vast experience in minimally invasive spine surgery that can expand those pathologies.

Dr. Cavanaugh:  And I have something to add. There is options for fusions both from the front and the back of the neck, from the front and the back of the lumbar spine that can use minimally invasive techniques. And I think overall, these techniques are becoming more commonplace although certainly you would want your surgeon to have experience performing these types of procedures on a regular basis.

Host:  And three’s something that I’m sure the audience is thinking about, are the potential risks or side effects associated with these minimally invasive techniques. Can you talk a little bit about the risks associated with minimally invasive techniques that aren’t necessarily present in more traditional types of spine surgery?

Dr. Cavanaugh:  So, during minimally invasive surgery, as Dr. Kurtom stated earlier; it involves usually making a smaller dissection with less tissue disruption. And that often means operating through a smaller hole basically. Ultimately, I think it’s very important to understand anatomy and understand that there are very important physiologic structures oftentimes adjacent to the spine that can become damaged. I think that operating through a small hole certainly poses technical risks. I think it can sometimes be more technically difficult, although with practice it becomes very routine. I think that overall, the safety profile of minimally invasive surgery is at least equitable to traditional open surgery in an experienced surgeon’s hands.

Dr. Kurtom:  And I would say past the technical aspect of it, if you look at the standard risks of surgery; which are infection, bleeding, fluid leak, et cetera; those risks are actually demonstrated clearly to be less in minimally invasive spine surgery than they are in open surgeries. Blood loss is minimal, infection is basically reportable at this point. Meaning that it occurs so infrequently that it has to be reported. And when it comes to nerve injury, et cetera; those risks are I would say at the same number as open surgeries in an experienced surgeon’s hands.

Host:  So, Dr. Kurtom, sticking with you for a minute. Based on what you just said, and everything we’ve covered here today; I’m sure patients are wondering how they might evaluate and select a minimally invasive spine program. So, do you have any tips or advice that they might take away from this?

Dr. Kurtom:  I think asking about the volume of minimally invasive spine surgeries that a surgeon does in their practice will be a great start. There are surgeons within our system that clearly have demonstrated experience in minimally invasive spine surgery and I’m sure the same experience can be evaluated in most spine surgeons. The patients, all they have to do is just ask the question of their level of experience of the surgeon.

Host:  Well thank you so much both of you for joining us today. To learn more about the UM Spine Network go to www.umms.org/spine. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again soon.