Minimally Invasive Spine Surgery (MISS) Part 3: Surgery


(upbeat music) – Before you consider surgery, nearly all patients should
try a conservative course. That might include anti-inflammatories, physical therapy, and various types of injections. It’s really only a small
percentage of patients that actually require surgery. Traditional open procedures sometimes involve incisions
that are several inches long, with lots of muscle dissection. Minimally invasive surgery
involves small incisions. Some are as big as this
19-millimeter tube. That incision is made and then the muscle is dilated, thus sparing the tissues. Then we’ll insert this tube, and then, much like an arthroscopic or endoscopic procedure, we’ll focus things down this tube. It can accomplish many
of the same procedures that are done by these larger incisions. When you’re doing
minimally invasive surgery down a tube that’s only 19 millimeters, I have to use an operating microscope to get the visualization that I need. All of my procedures are done using microscopic magnification. The minimally invasive surgeries can take as little as 30 minutes. Sometimes they take a few hours. Overall, I find that they take less time than traditional open procedures. This is a patient that came in with incapacitating arm pain, for a long time, and she had failed all
conservative treatment. She has some stenosis, or pinching, of C6 nerve that comes out of the C5-6 foramen, or hole. That was causing pain that was radiating down her arm to her thumb and index finger. Her imaging studies confirmed that that was the source
of her discomfort. Now we’re just taking out
some of the disc here. Generally comes out fairly easily. These are little disc fragments that come out. It doesn’t take a lot
to cause a lot of pain. I’m always amazed how much … how small the fragment is relative to the patient’s
pain and complaint. The operating microscope gives me really unbelievable visualization and that provides an element of safety and allows me to do a good job, not miss any fragments of disc or anything that might be causing the patient’s pain. All the nerves are surrounded in bone. That protects them. But when we wanna get down to the nerves, we have to use this drill, to kind of get better visualization of those nerves. (instrument whirrs) What we’re doing is, to get down to that nerve root, we have to take out the disc, and carefully decompress the nerve, using this operating microscope. I’ll take the nerve hook. Once we get the pressure off
the stenosis, or pinching, that nerve is free to try to repair itself and is generally much happier. This helps for arm pain primarily. It’s a great operation. For a lot of patients, I tell them, there’s an 80 or 90 percent chance we can get rid of 80 or
90 percent of their pain. They come in, complaining of … I’ll take that one-millimeter Kerrison. You know, they can’t sleep, they have numbness, some of them are dropping things, some of them have profound weakness. This helps with the pain, primarily, and some of those other things, as well. I think it’s a great operation. It’s not quite painless, but it really is not very painful. The patients don’t need to stay in the hospital for very long, and they’re generally very happy. Nerve hook, please. Today, we’re gonna do a minimally invasive microscopic discectomy in a gentleman who has
incapacitating leg pain and significant weakness. He has an obvious limp when he’s walking, and he’s failed all conservative measures. I think he’s an ideal candidate, and I expect everything to go perfect. We looked at his imaging studies. He has a big free fragment touching the S1 nerve root, which is responsible for that muscle group that allows you to get up on your tiptoes and have a normal gait. (instrument whirrs) Just kind of burr down a
little bit of this bone until we can use a different tool to burr down the last little bit of it, and then take a look at our nerves and the disc. Great. Someone grab a razer. The last little bit of the bone we take away with this tool. It’s great. We can do this all through
a very small incision which helps with pain and blood loss, decreases your hospitalization time. These patients get back to doing things that they want to do a lot faster. This is the collection of
nerve roots right here. This is the S1 nerve root that’s not working for this guy. Usually we can kind of
move this out of the way in this direction, but his is being very annoying. You actually can see it in between here. That’s gonna be the disc right there. It’s right in the axoid, just like our imaging
studies would suggest. I wanna see if I can … See, watch this. Watch this. Elaine, you’re gonna like this. Go ahead, Reese. Go ahead and hold this right here for me. Just real, real gentle. I’ll take the nerve hook. You can actually see this is the dist- Look at this, you see this? You guys seeing the disc coming out there? Wow. Look at that. The pituitary? And that’s, that’s a disc
herniation right there. You can just feel this guy. And just, I’m just gonna
kinda gently rock this back. There it is. Look at that. Relax, Reese. That’s a disc herniation right there. This is a sizable one, and you can see now why
this guy was hurting. I don’t think people realize how much they can hurt when they have a bad disc herniation or a bad spinal stenosis. Sciatica can be completely debilitating. It can affect your
activities of daily living. I have grown men coming in, crying. They tell me, “Cut my arm off. “Cut my leg off.” Oftentimes, a simple
procedure can make this all go away in a matter
of an hour or less, with minimal time in the hospital, minimal blood loss, minimal scarring. As you saw today in the operating room, these patients, I think, are both gonna do fantastic. Both, like everybody,
apprehensive about spine surgery. Everybody is and should be. But these are great procedures, and I think they’re gonna do wonderful. After someone has a
minimally invasive procedure, they’re often out of bed and walking that day, or sometimes, at the latest, the next day. We usually have a physical
therapist work with them, to help them get up out of bed, walk around the hospital before they’re discharged. Typically after surgery,
for the first few weeks, I want my patients to walk every day. I don’t like them doing a
whole lot of physical labor. I want them to avoid repetitive bending, twisting or turning. I want them to avoid picking up more than five or 10 pounds. They just need time to heal. Thereafter, at the
three or four week mark, depending on the procedure that we did, they can get into some physical therapy to help develop those muscles that maybe they lost before surgery and get them back to, returning to, the things that they want to do. Oftentimes, they weren’t good walkers before the operation. We have to build up their strength in both their back, their legs or their arms, so that they can become
a lot more functional. Generally, I tell my patients, “If you have to think, “‘should I ask Dr.
Wagner, can I do this?’, “the answer’s no.” Think about the things
that might cause back pain, shoveling snow, heavy gardening. I wouldn’t do those things. You’re just asking for trouble. Also, just maintaining those
physical therapy exercises we gave you after your procedure, the more you do them, the better your back
and neck’s gonna feel. (upbeat music)

6 thoughts on “Minimally Invasive Spine Surgery (MISS) Part 3: Surgery

  1. thank you for making this video..i may have to have surgery, and im less nervous now..if i do, i hope my dr is as good looking as u 🙂

  2. Have you had experience with someone who has suffered from Cauda Equina Syndrome? I had emergency surgery on 8/4/14 for CES and I am still suffering from a lot of nerve damage. It is rare to find a doctor who has any experience with CES. Thank you.

  3. I just had this exact operation done in Pittsburgh. I said the exact same thing, about wanting to chop my leg off. Lying down to sleep the next night was the most euphoric moment of my life. Its 3 weeks now after my surgery and I am so thankful.

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