As with many other procedures, however, minimally invasive techniques have spread into spinal fusion back surgery.
Dr. Michael Campanelli and Dr. James Spence Jr. began doing small-incision fusion as a team in October at Lakeland Regional Medical Center. Dr. Mark Greenberg now works with them. All are neurosurgeons.
"It's a real revolution in spinal surgery," Campanelli said. "People just do extremely well."
Spence and Greenberg are with Watson Clinic. Campanelli is in the Lakeland office of Winter Haven-based Neurology and Neurosurgery Associates.
The new method had been done six times at Lakeland Regional by early April.
Campanelli, who participated in all of them, said he expects to use it for half of the 40 or 50 fusions he does each year.
Patients getting spinal fusion need to have specific conditions causing their back pain.
Some conditions, such as osteoporosis-related compression fractures, are better treated with other procedures. (See related article on page 14).
Glenn Yarbrough, 54, had the minimally invasive surgery on Jan. 16. His back pain had become so bad he could not continue his job as a truck driver.
A magnetic resonance imaging exam, recommended by his family doctor, showed that a disc had worn completely away.
"I had the surgery on Monday," he said. "I was up and walking by myself on Thursday."
He was at LRMC five days.
Their first patient was discharged after two days, Campanelli said, with an average stay of two or three days.
Two vertical cuts, less than an inch long, are made parallel to the spine on each side. A third one, shorter and horizontal, goes above the vertebrae that rods and screws will hold together.
Tubes of gradually increasing size, from pencil width up to a one-inch diameter, are slid through the incisions into the body, pushing aside muscles to reach the affected area.
With traditional surgery, large bands of back muscle are stripped free of the spine and drawn back out of the way.
"There was a lot of back pain in the post-operative period and healing took quite awhile," Campanelli said of that method.
With minimally invasive surgery, the tubes create tunnels that separate muscles to allow access, which is less invasive.
Screw extenders, long metal shafts, deliver and attach the screws to the vertebrae. They extend outside the body to let surgeons join them together.
That lines up the screw heads inside the body and lets the rods pass through the heads without being obstructed, he said.
Surgeons attach an arc-shaped arm that delivers a pre-cut rod into the heads of the implanted screws, according to Medtronic Sofamor Danek, which makes the system Lakeland doctors use.
Although neurosurgeons are the ones doing this in Lakeland, orthopedic spinal surgeons can do it after receiving the training.
With either type, it is important to have someone experienced in doing the traditional, open method, Campanelli said.
With the small cuts, doctors cannot look directly at the area where they put the screws and rods. A fiberoptic light at the end of a tube illuminates the interior. Continuous X-ray images are transmitted by fluoroscopy onto a TV screen monitor.
Two rods and four screws, the same number and size as in the traditional procedure, are used. They keep the vertebrae rigid until enough bony re-growth occurs to create fusion.
Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558.
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