Minimally Invasive Spine Surgery…Is it Really Better?
By Randall Pruitt, DC, DACNB, DAAPM, MUAC, FACFN, CES-NASM
Living in Arizona and being in the back pain profession I can’t help but notice any publication or advertising associated with back and neck pain. As research comes out describing the less than optimal results of spinal surgery it seems that this specialty is always on the lookout for something a little more palatable to the pain sufferer looking at surgery as an option. I have to admit, I am not a fan of spine surgery, in my practice that is exactly the opposite of what we do. We help people avoid surgery if at all possible and I am happy to say in the majority of cases we are successful. However, there are those that no matter what we do, surgery seems inevitable and being of the mindset that non-invasive is best, minimally invasive is obviously second best, or is it?
In the past I have always recommended minimally invasive surgery to my patients that needed surgery, however with what I have seen in recent years, this may change. You see all to often in my experience the rate of additional surgical intervention has increased after a minimally invasive procedure. I can recall 3 very distinct cases where I sent the patient for surgery, they had the minimally invasive procedure only to have no change in symptoms. A new MRI is ordered and the disc herniation is still there, how can that be? In my opinion working through such a small scope, you can only take out what you can see, so if the herniated disc is outside the visual field of the scope you can’t see it and therefore it isn’t removed. In every case an “open” surgical procedure was then performed to remove the additional disc material, putting the patient at additional risk.
Recently a large randomized trial evaluating minimally invasive surgery was performed and my observations were confirmed. Mark Arts MD, and a group of spine surgeons from seven hospitals in the Netherlands decided to do an independently financed randomized controlled trial comparing standard discectomy with one of the most popular minimally invasive techniques, tubular discectomy.
The results were as follows: The minimally invasive patients had a slightly worse outcome in terms of back and leg pain, function and overall recovery and they had more recurrent disc herniations requiring repeat surgery. An even larger study performed by the same researchers led to the same conclusion, the results of that study showed at one year follow-up 69% of the patients assigned to the minimally invasive procedure reported “good” recovery vs 79% of those that underwent the traditional form of discectomy. Patients in the minimally invasive group had more intraoperative and postoperative complications, a slightly higher proportion of the minimally invasive group also had a recurrent disc herniation and a greater proportion had repeat surgery within a year.
So what we can take from this? Well first of all it’s better to avoid surgery altogether and opt for a non-invasive treatment like spinal decompression. Secondly, regardless of what some of these large minimally invasive centers advertise 2 separate randomized clinical control trials have showed that this approach isn’t necessarily better and in fact can lead to more complications.
