Carlos Bagley, M.D. Answers Questions On: Minimally Invasive Spine Surgery

It’s a matter of risk and reward and making sure we are erring on the side of safety but at the same time exploring new frontiers.

Decompressions are done fairly routinely with minimally invasive techniques, as well as herniated discs, lumbar stenosis, pinched nerves, things of that nature. Spinal fusions – we’re able to do more of those minimally invasively under the appropriate circumstances, and the complexity of the fusions we are able to do with a minimally or less-invasive technique is increasing as our experience grows. There’s no absolute case in which “this” is always amenable to minimally invasive and “that” is not. It’s a spectrum, and it depends on the anatomy, the technology we have, and the technology we’re developing.

The potential benefits are earlier mobility, earlier return to work, earlier return to function, and less pain. The ultimate outcomes are the same no matter how we do the surgery – we want patients to get better and return to function. The real strength of minimally invasive techniques is it allows them to do that quicker.

Experience is important – not just with the particular procedure you need but also with procedures in general. My personal philosophy, and one I think is important in a good surgeon, is that any surgery is the last resort. Rarely is surgery the first or only option. You want someone who is willing to explore all options to achieve the ultimate outcome. It’s about the end more than it is about the means. So whether it’s minimally invasive or not, you want a surgeon who is going to use the appropriate technique for your situation, not someone who uses the same hammer for every nail.

Endoscopic techniques are the latest thing we’re exploring. With the endoscope, similar to what is used for endoscopic knee surgery, you’re able to do your work through a very small port by bringing the visualization inside the body rather than outside the body from a microscope. That allows us to then minimalize even further the incisions, the amount of tissue trauma, and the amount of tissue dissection that we have to do.