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Winter 2008

Advanced Techniques for Neurospinal Disorders

According to physicians at the Neurospinal Disorders Program at UCSF Medical Center, advances in en bloc tumor resection, minimally invasive surgical approaches and osteotomies can reduce the risks associated with more traditional spine surgeries.

 

Spinal Tumors

Neurosurgeons Christopher Ames, M.D., and Praveen V. Mummaneni, M.D., co-direct the UCSF Spine Center. Ames, who directs the spinal tumor and deformity program, developed the lateral transpedicular approach to deep midline tumors of e cervical spine, which allows complete resection of difficult-to-access tumors without spinal cord retraction.

He notes that en bloc surgical resection for all regions of the spinal column and sacrum is another technique during which surgeons remove primary tumors in single pieces to prevent the spread of tumor cells in the spinal area. In the hands of experienced surgeons, research has shown that en bloc resection increases survival times and decreases recurrence. The UCSF spinal tumor service is one of the only centers on the West Coast that routinely perform this procedure.

Other situations call for yet another technique. Dean Chou, M.D., a UCSF neurosurgeon, says "Resecting spinal metastases and tumors typically involves both an anterior and posterior approach. Minimally invasive techniques avoid the anterior approach and so minimize complications, especially of the lung and great vessels of the heart." The smaller incisions also can reduce blood loss and hospital stays.

"The challenge is having enough experience to carve out the appropriate margins through the smaller opening and to feed the entire tumor through the tubes," Mummaneni says. Access to state-of-the art instrumentation that has made such procedures possible is also essential.

Deformities and Disc-Related Pain

Spinal tumors are not the only treatments that benefit from advanced diagnosis and treatment modalities. "Spinal deformity surgery for degenerative scoliosis is becoming more common as our population ages," Ames says.

These very large procedures aim at restoring critical spinal balance, so that patients can stand straight again. A multidisciplinary team approach that includes electrophysiology, state-of-the-art anesthetic care, critical care and the latest technology is essential in limiting complications.

Treatments typically begin with electrophysiologists employing advanced spinal cord monitoring techniques. Then, to restore functional capacity and eliminate pain, neurosurgeons draw on a variety of techniques, including pedicle subtraction osteotomies, Smith-Petersen osteotomies, Ponte osteotomies and vertebral column resection to balance the spinal column.

Finally, while spine surgeons have performed minimally invasive discectomies for some time, more recently, this approach has been extended to procedures like fusions and decompressions. "Access to and experience with the latest instrumentation for these procedures enable surgeons to offer minimally invasive techniques that can reduce blood loss, risk of infection and, potentially, length of stay and recovery time," Mummaneni says.

For more information, contact Dr. Ames or Dr. Chou at (415) 353-2348 or Dr. Mummaneni at (415) 353-3998.

A minimally invasive retractor and a 22-mm-diameter tube are used to remove a tumor.

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