Minimally Invasive Orthopedic Surgery
Minimally Invasive Spine Procedures
A herniated disk in the lower back that pinches a nerve may cause severe leg pain, numbness, or weakness. To surgically relieve these symptoms, the disk is removed. This procedure is called a discectomy.
For the surgery, the patient is positioned facedown and a small incision (sometimes less than one inch long) is made over the location of the herniated disk. The surgeon inserts the retractor and removes a small amount of the lamina bone. This provides the surgeon with a view of the spinal nerve and the disk. The surgeon carefully retracts the nerve, removes the damaged disk, and replaces it with bone graft material.
This minimally invasive technique can also be used for herniated disks in the neck. The procedure is done through the back of the neck and called a minimally invasive posterior cervical discectomy.
A standard, open lumbar fusion may be performed from the back, through the abdomen, or from the side. Minimally invasive lumbar fusions can be done the same way.
A common minimally invasive fusion is the transforaminal lumbar interbody fusion (TLIF). Using this technique, the surgeon approaches the spine a little bit from the side, which reduces how much the spinal nerve must be moved.
In a minimally invasive TLIF, the patient is positioned facedown and the surgeon places one retractor on either side of the spine. This approach prevents disruption of the midline ligaments and bone. Using the two retractors, the surgeon can remove the lamina and the disk, place the bone graft into the disk space, and place screws or rods to provide additional support.
Approaching the spine slightly from the side does not provide the surgeon with a full view and it is often a challenge to remove the disk completely. This may make fusion healing more difficult. Sometimes the surgeon will use additional bone graft besides the patient's own bone to improve the likelihood of healing.
This minimally invasive procedure treats spine fractures caused by osteoporosis. It is designed to provide rapid back pain relief and help straighten the spine.
Kyphoplasty can be performed using general anesthesia (which puts you to sleep) or with a local anesthesia (which numbs your body around the fracture). In this procedure, the patient lies face down on the operating table and the surgeon accesses the spine from the back.
After surgery, patients can go back to all their normal activities of daily living as soon as possible, with no restrictions.
Vertebroplasty is a technique similar to kyphoplasty, but a balloon tamp is not used to create a space for the cement. Instead, the cement is injected directly into the narrowed vertebra. Like kyphoplasty, this procedure is performed while the patient is lying face down so that the surgeon can access the fractured vertebra from the back.
After this surgery, patients are encouraged to return to their normal, day-to-day activities as soon as possible.
Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint.
The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint."
In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.
By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee. This lets the surgeon see the cartilage, ligaments, and under the kneecap. The surgeon can determine the amount or type of injury and then repair or correct the problem, if it is necessary.
Why is arthroscopy necessary?
Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as magnetic resonance imaging (MRI) or computed tomography (CT) also scan may be needed.
Through the arthroscope, a final diagnosis is made, which may be more accurate than through "open" surgery or from X-ray studies.
Disease and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found duri
ng arthroscopic examinations of joints are:
Acute or Chronic Injury
- Shoulder: Rotator cuff tendon tears, impingement syndrome, and recurrent dislocations
- Knee: Meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability
- Wrist: Carpal tunnel syndrome
- Loose bodies of bone and/or cartilage: for example, knee, shoulder, elbow, ankle, or wrist
Some problems associated with arthritis also can be treated. Several procedures may combine arthroscopic and standard surgery.
- Rotator cuff surgery
- Repair or resection of torn cartilage (meniscus) from knee or shoulder
- Reconstruction of anterior cruciate ligament in knee
- Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle
- Release of carpal tunnel
- Repair of torn ligaments
- Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist.
Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As advances are made in fiberoptic technology and new techniques are developed by orthopaedic surgeons, other joints may be treated more frequently in the future.
How is arthroscopy performed?
Arthroscopic surgery, although much easier in terms of recovery than "open" surgery, still requires the use of anesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anesthetic, depending on the joint or suspected problem.
A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Several other incisions may be made to see other parts of the joint or insert other instruments.
When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.
The surgeon inserts miniature scissors to trim a torn meniscus.
For instance, most meniscal tears in the knee can be treated successfully with arthroscopic surgery.
After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications.
Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.
The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The extensive "open" surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.