SPINE PROCEDURES

Percutaneous Pedicle Screw Instrumentation
Minimally Invasive Spinal Instrumentation
By Laurence E. Mermelstein, M.D.

The use of internally implanted instrumentation (screws, rods, plates, etc) is now a universally accepted method of stabilizing the spine in order to repair traumatic injuries and/or achieve a spinal fusion. The instrumentation has evolved over time and now consists of lower profile, stronger instrumentation made out of the most advanced metal alloys. Traditionally, these plates, screws and rods have been placed through standard surgical approaches, some of which necessitated a lengthy post-operative recuperation.

Recently, the surgeons at Long Island Spine Specialists became the first surgeons in the New York Metro area to utilize a novel approach and instrumentation system to implant these traditional spinal implants through a minimally invasive, minimal incision approach.

The use of pedicle screws to stabilize the lumbar spine has become a common procedure in recent years. Medtronic Sofamor Danek, a spinal implant company, in conjunction with leading spinal surgeons, has developed a system whereby these screws and rods can be placed percutaneously - ie. through small incisions just large enough to admit the screws themselves. Long Island Spine's surgeons have been involved through the prototype stage and have been on the cutting edge in the use of this technology and have performed more of these procedures than any other group in the area.

The advantages of this type of approach are obvious. By avoiding a large, muscle stripping procedure to the low back, patients have much less post-operative pain. They mobilize more quickly, spend less time in the hospital and return to activities of daily living faster. By avoiding the large back incision, there is less surgical trauma and less post-operative scarring of the back muscles, which are very important in the eventual post-operative rehabilitation of the patient.

This procedure is usually combined with a fusion procedure, which can be performed through a minimally invasive anterior approach or through a more traditional posterior or posterior interbody approach. The anterior approach refers to an incision in the lower abdomen or flank where the disc is removed completely and a spacer is placed within the disc space. This approach, sometimes performed laporoscopically, also avoids cutting through the back muscles and causing post-operative muscle injury.

Of course not every patient with a disc injury requires these surgical approaches, and not every patient indicated for a spinal surgery is a candidate for these new techniques. The physicians and surgeons at Long Island Spine Specialists have extensive experience in matching the correct treatment for each individual case.

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