Ask the Spine surgeon
The Truth about Minimally Invasive Outpatient Spine Surgery
March, 2016 - Issue #137

Hi Dr. Moza. I'm writing today to complain. It seems like every surgeon is saying that they now do "minimally invasive" spine surgery. Is that really true? I'm scheduled for surgery next month and I'm wondering if all "minimally-invasive" surgeons are the same or if there's any difference between methods and results. Thanks!

Yes, you're onto something. Not all "minimally invasive" surgical procedures are created equal - just like not all spine surgeons are created equal.

First, an explanation. Minimally-invasive spine surgery utilizes a device which allows spine surgeons to see inside a patient's body. It is inserted through small incisions, generally half an inch wide, and the spine surgeon sees exactly what needs to be corrected without the conventional spine surgery complications.

In my practice, I typically utilize an operating microscope with retractors to dramatically improve my visibility. This three-dimensional visualization allows me to perform true microsurgery. With substantially-smaller incisions and improved visibility, patients experience less pain and less recovery time thanks to greater precision.

Reducing the operative field is the specialty of neurosurgeons; we're trained beginning in our first year of residency - literally on Day One - to perform microsurgery, as it's integral to the educational process of neurosurgical training. This is in contrast surgeons who use an endoscope, which only provides one dimension of visibility.

Once a procedure has been completed, the incisions are sealed with sutures and covered with medical tape. The benefit of minimally-invasive spine surgery is, primarily, the healing process. After a few months, the surgical wounds are hardly noticeable, as compared to a traditional spine surgery with a large, noticeable scar. In my practice, the benefits extend beyond "just" healing. Because my patients are not operated on with the assistance of residents who are training to become adept at spine surgery, my procedures are done much more rapidly - which further reduces the risk of infection and complications.

Other benefits of minimally invasive spine surgery include a shorter stay in the hospital. My patients are released in less than 24 hours and are up and walking only a few hours after surgery. Done correctly, minimally-invasive surgeries result in significantly-less postoperative pain. While many surgeons still have patients who much rely on prescription narcotics up to a month after their procedure, my patients usually can manage pain with a simple over-the-counter anti-inflammatory after the first day or two. Lastly, "minimally-invasive," when performed by an experienced spine surgeon, means that your recovery time will be remarkably shorter - a few weeks to a few months, depending on the procedure, versus up to a year. My patients return to their daily activities faster than they ever thought possible.

Here's how to get away from the "fluff" of a phrase that is now being used more frequently. Ask your surgeon about quantifiable results that will help you weigh their abilities and experience against others in the same field.

Here's a start:
With what frequency do your patients require additional surgery for the same problem?
What is your rate of post-surgical infection?
How long do your patients stay, on average, in the hospital after surgery?
What is your rate of complications for procedures like the one I require?
How long have you been performing minimally-invasive procedures?

For comparison's sake, per the March 2014 issue of Frontiers in Medicine, in an article titled, "Surgical Site Infections Following Spine Surgery," out of 108,419 patients studied nationally, 6.7 percent experienced post-surgical infection. For context: my
post-surgical infection rates are well below 1 percent, as is my rate of complications. Remarkably, I haven't had a single patient infection in over three years - and I have the lowest complication rate and highest patient satisfaction scores, coupled with the best outcomes, state wide. I'm also among the highest-ranked spine surgeons nationwide.

What it all comes down to is this: While a good number of surgeons offer "minimally-invasive" procedures, your ultimate success is dependent on your surgeon's ability to fix your problem the first time; to substantially reduce the likelihood of infection or complication; and to have you back up and doing what you love as quickly as possible.

Kapil Moza, MD FACS
Diplomate, American Board of Neurological Surgery

Dr. Moza's Santa Clarita office is conveniently located in Valencia. 805-497-3622
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