Spring 2011

Spine Surgery Advances Ease Pain, Improve Recovery

Despite the prevalence of nerve-induced back and neck pain, assessing patient needs and deciding on a proper treatment can, in many cases, remain an elusive challenge. But it is a challenge that leading orthopaedic surgeons embrace to the benefit of their patients.

For example, at the UCSF Orthpaedic Spine Service, careful tracking and evaluation of patient outcomes and continuous quality improvement have resulted in 85 percent to 90 percent of patients getting relief from the arm, neck or sciatic pain caused by nerve impingement.

Thorough Diagnostic Process

"Unless there is a significant neurological deficit, the optimal course of action is very dependent on the individual," said Shane Burch, M.D. His colleagues on the Orthopaedic Spine Service — Sigurd Berven, M.D., Vedat Deviren, M.D., Serena Hu, M.D., and Bobby Tay, M.D. — all agree.

"That’s why at UCSF, where we can offer the full gamut of options, we take the time to listen carefully and provide patients with information so they can make the treatment decision that’s best for them,” Burch added.

When the pain is significant enough for a patient to consider an injection or surgery, an MRI helps confirm the right level in the spine to target. Surgeons also combine the imaging with their experience to determine whether a simple herniated disc might be complicated by another condition, like spondylosis, which dictates a different treatment.

And if minimally invasive surgery (microdiscectomy or cervical endoscopic foraminotomy) is the right choice for a patient, advances in tools and techniques for these outpatient procedures, performed at the Orthopaedic Institute at Mission Bay, are easing the patient’s pain and recovery time.

Surgical Advances

Surgeons have been performing microdiscectomies in the middle and lower spine for years, but today's fiber-optic lighting and improved retractors and lenses enable:

  • Smaller incisions
  • Less tissue damage
  • Quicker healing

In addition, for patients with nerve pain in the cervical spine, a cervical endoscopic foraminotomy averts the drawbacks of fusion and open surgeries, such as slower rehabilitation, more pain, longer hospital stays and stiffness. For this newer procedure, surgeons:

  • Make a 16 mm incision
  • Use special instruments to spread the muscles that overlie the spine, rather than stripping muscle, as is necessary with an open procedure.
  • Get a highly magnified view of the spine and nerve roots with a high-density camera to precisely resect the problem-causing bone spurs.

"The technique provides a very effective decompression and gives people a motion-sparing alternative," Tay, who has performed more than 350 such procedures over the past six years, said. "Patients are comfortable enough to go home the same day, the surrounding area remains healthier and patients can typically start physical therapy two weeks after surgery. They often return to normal activities in three to six weeks."

The UCSF Orthopaedic Spine Service can be contacted at (415) 353-7073

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