With a dramatic increase in the number of advertisements and social media discussions, the concept of “minimally invasive surgery” – especially spine surgery – has become a hot topic. Experts in back surgery such as Dr. Michael Hisey of Texas Back Institute know that in many cases the hype is more about marketing than about medicine.

What is Minimally Invasive Surgery?

In a recent discussion, Dr. Hisey noted that the trend toward less invasive procedures in surgery has always been a guiding principle of Texas Back Institute for the past 35 years. “However over the past 10 to 15 years, this term – minimally invasive – has gained popularity,” he said.

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Since the first efforts to correct injuries or disease of the spine were made, over 50 years ago, surgery was recognized as potentially destructive to the structures of the spine. However, this was a necessary means to an end.

In order to gain access to the spine to complete procedures such as decompressing nerves, removing herniated discs, thickened ligaments, cysts and bone spurs, back surgeons are required to dissect muscle off the vertebrae.  While this can cause damage to joints and muscles and cause scarring around the nerves, it was necessary to address the patient’s problem.

Other collateral damage resulting from surgery were risks as well, such as  the spine being weakened when ligaments that hold the vertebrae together needed to be removed. Vertebral bones, including parts of joints, were removed in order to allow the surgeon access to the spine. This also weakened the spine and often caused scarring which led to further irritation and compression of the nerves.

Michael S. Hisey, M.D.

Every physician at Texas Back Institute is dedicated to pursuing minimally invasive surgery, in every phase of a patient’s treatment. Why? It’s one of the core philosophies of our practice. While there are many techniques and approaches, along with many high-tech tools used for minimally invasive surgery, all are centered around the core philosophy, to always perform the least invasive procedures possible

In fact, the surgeons at Texas Back Institute have pioneered many of the minimally invasive techniques which are used today. “Our physicians are always looking for avenues to advance minimally invasive spine surgery, ” says Dr. Hisey.

Common Misconceptions about Minimally Invasive Procedures

With all of the marketing noise about this minimally invasive surgery, what challenges do physicians and back surgeons face with patient expectations? Dr. Hisey says, “Many patients believe minimally invasive surgery can fix bigger problems than it really can. Unfortunately, not every back injury or pain from degenerative disease can be corrected with this type of surgery.”

“Patients are also surprised when we discuss the procedure and they learn there may not be a laser involved in the surgery. There are many techniques, but the use of a laser is not always a part of the procedure. Plus, this surgery is not less expensive to perform than traditional surgery. It takes a great deal of training and often specialized equipment for a surgeon to be able to perform minimally invasive surgery. This is often reflected in the expense of the procedure,” Dr. Hisey noted.

What Types of Back Problems Are Best Treated by this Surgery?

There are several conditions that lend themselves to minimally invasive surgery. Dr. Hisey notes, “Patients who have been diagnosed with a herniated disc are good candidates for this type of procedure.”

The American Academy of Orthopedic Surgeons notes that “a high percentage of back pain and leg pain is caused by a herniated disc.” The discs in the spine act as “shock absorbers” for the vertebrae and when wear and tear or injury causes them to herniate, intense pain in the back or legs occur.

“Spondylosis can also be treated effectively with minimally invasive surgery,” Dr. Hisey said. “This condition is the result of degenerative osteoarthritis of the joints between the spinal vertebrae. When it’s severe, it can put pressure on the nerve roots causing pain and muscle weakness.”

Advantages/Disadvantages of Minimally Invasive Procedures

Because there is less damage to muscles, tendons and ligaments around the spine during a minimally invasive procedure, the recovery time for surgery is much quicker. Additionally, there is less blood loss and tissue damage” Dr. Hisey noted.  However, there are also disadvantages to this procedure. “It might not be able to remove or correct all of the damaged tissue.”

Why Choose Texas Back Institute for Back Procedures?

With so much marketing information and often unreasonable claims about minimally invasive surgery, many people with back pain are trying to research every option. Basing a potential life-threatening or, at the very least, life-altering decision such as spine surgery on a Google search should be done with extreme caution.

Dr. Hisey concludes, “For more than 35 years, our practice at Texas Back Institute has been based on doing what is best for our patients, not what currently popular procedure is featured on a TV spot. When it’s appropriate, and based on the expert diagnosis of our spine  specialists, minimally invasive surgery will be advised. However, this decision will never be based on ‘what’s hot’ in the media.”

When searching for a procedure to eliminate chronic neck or back pain, the Latin expression – caveat emptor which translates to “Let the buyer beware” – is appropriate. The spine specialists at Texas Back are constantly researching surgical methods which are minimally invasive. For us, this is not a fad. It’s the foundation of our practice.

Keith roberts collage

Two years ago, Keith Roberts was relocating his office. He began to feel immediate pain in his lower back after lifting a table. The pain became progressively worse from that point. His doctor told him it was just a sprain, but he soon learned more about his diagnosis.  After a regimen including rest and anti-inflammatory medications, he didn’t get better. “I’m a fairly active person and I knew there was something more to this,” he said. His first doctor ordered an MRI and the scan revealed a herniated disc. “My wife and I did a lot of research and we decided to try Texas Back Institute,” Keith said. “It was the best thing we’ve ever done.”

Keith made an appointment with Dr. Jessica Shellock and hasn’t looked back since. Texas Back Institute helped him navigate through the sometimes laborious paperwork involved with a worker’s compensation claim. “Without Dr. Shellock’s medical expertise and Tonya’s help with everything, I have no idea where I would be today.”  The Tonya he is referring to is Dr. Shellock’s medical assistant, Tonya Edwards. Medical Assistants are imperative to the delivery of healthcare for the providers at Texas Back Institute. They help obtain information about the patient including vital signs, medication, and their medical history.  They also assist the patient with future testing and appointments. “If it wasn’t for them, I wouldn’t have been able to get the surgery that I really needed to get better.”

After failing to respond to conservative treatment and without sustained relief following a microdiscectomy, Keith ultimately underwent a L5-S1 fusion in November 2012 with Dr. Shellock.  It was after progressive worsening of his symptoms at this point that I recommended the fusion,” said Dr. Shellock.  “He has done fantastic. “

He took three months off of work to recover properly and is now attending outpatient physical therapy sessions at TBI. He went from being very active to no activity and is now making a comeback. In April, he was able to complete his first 6-mile bike ride and this summer, his plans include a 12-mile hike in the Ozarks with his wife.  He and his wife are avid photographers and have donated art work for Dr. Shellock’s patient rooms.

“It’s amazing to go from being able to walk less than a half a mile and having so much pain to this,” said Keith. “I missed out on 2 years of my life and I would be missing more if it weren’t for Dr. Shellock.”

On a plain in Africa while on a photo safari, Lisa Oatman’s right foot went numb. Once again, she was experiencing the painful side effects of spinal stenosis, this time far away from her home near Waco, Texas.

 “I was surprised to have back pain at my age, 50. I always had a back issue but three years ago, it really became a problem with my left leg,” Lisa said. “I compensated by the way I stood and would lean on things. I couldn’t walk long distances, and I was fidgety because I couldn’t sit still for a long time.”

After putting up with the pain for several months, she went back to her family doctor who referred her to the Texas Back Institute. Rather than having a laminectomy (which is one of the more common surgical procedures for stenosis) Dr. Scott Blumenthal informed Lisa she was qualified to participate in an investigational study of the Superion Inspinous Spacer, a minimally invasive procedure.

Despite concerns over her responsibility to throw a party for 400 students at her son’s school in a mere four weeks, she readily accepted. Dr. Scott Blumenthal performed the minimally invasive procedure in April 2010 and within hours, Lisa was walking and the pain was gone. In just over 24 hours, she was discharged with instructions to avoid certain activities for two weeks.

Three months after surgery, Lisa was once again far way from home, this time on a trail deep in the Andes. Although not able to carry a pack, she hiked for 10 days to see the ancient ruins of Machu Picchu then went on to snorkel off the shores of the Galápagos Islands. Lisa was far from home and even further away from pain.

Do you have spinal stenosis? Let us know.  We’d be happy to help you put your pain in the past.  

For more information on this trial please call 972-608-5006.

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