Selected Podcast

Minimally Invasive Spine Surgery

For some patients with spine conditions, minimally invasive surgery may be an option.

Learn more about which patients may be candidates for minimally invasive surgery from a UVA specialist in spine surgery.
Minimally Invasive Spine Surgery
Featured Speaker:
Dr. Hamid Hassanzadeh
Dr. Hamid Hassanzadeh is an orthopaedic surgeon whose specialties include minimally invasive spine surgery and complex spinal deformities.

Learn more about UVA Spine Center
Transcription:

Melanie Cole (Host):  For some patients with spine conditions, minimally invasive surgery may just be an option. My guest today is Dr. Hamid Hassanzadeh. He’s an orthopedic surgeon whose specialties include minimally invasive spine surgery at UVA. Welcome to the show, Dr. Hassanzadeh. Tell us a little bit about the difference between minimally invasive surgery and traditional spinal surgeries. 

Dr. Hamid Hassanzadeh (Guest):  Thanks very much for having me. Minimally invasive surgery is a newer technique which has been promoted or been evolved over the last decade. The benefit over classic open surgeries is that you don’t need to get cut through the muscle, so it’s a muscle-sparing procedure. By just dilating the muscle, we get an area we want to work and we perform the work we want to do without creating new damage to the muscle and the soft tissue down the spine. You have to know that a lot of related complications of the spine is related to the soft tissue coverage of the spine. We try to minimize that complication with approaching the spine through minimally invasive, not only skin incision, also muscle-sparing procedure. 

Melanie:  As back problems and spinal pain are such a huge problem in this country, what patients might be candidates for this type of minimally invasive surgery to help them with their problems? 

Dr. Hassanzadeh:  This is a very good question. Unfortunately about 80 percent of the population will have experienced some type of back pain in their lives. Not every back pain requires surgery. That’s a good thing. The first line of treatment for every back pain is actually non-operative management, but in a patient who has stenosis, disc degeneration or some stability, minimally invasive procedures are very good approach or technique to address the problem, and usually the recovery is a little bit faster, actually much faster. They don’t need that much rehabilitation to return back to work and to activities of daily living. 

Melanie:  How do you determine whether somebody is a candidate? When they do have this pain, it’s not really working to use anti-inflammatories or whatever else that they’ve tried, then what’s the next step? 

Dr. Hassanzadeh:  The indication for a spine surgery, few things have to speak the same language. The clinical presentation, the complaints you have, should show the same problem in the imaging of spine in MRI and so on. Once we have the same problem and we know we can help it with a surgical procedure, then it’s usually surgery indicated. In a case where we exactly know we would do this, then the patient will improve significantly, 90 percent chance or higher than 90 percent chance. The first line of treatment is always activity modification. We try to do it non-operative and anti-inflammatory medication and also core muscle strengthening is a huge part of prevention and also treatment of the spine problem. There’s also a point that non-operative management just aren’t enough to provide enough relief, then the next step is obviously after having the appropriate imaging to perform the appropriate surgery. 

Melanie:  With minimally invasive spinal surgery, how long usually is somebody in the hospital and then what is it like afterward? How soon can they return to activity? 

Dr. Hassanzadeh:  All this will depend on the extent of the surgery. For just the decompressive surgery for stenosis or discectomy, patient leaves the same day. Patients are able to leave the same day. Eighty percent of all my decompression or discectomy patients will leave the same day and they’re back to work within the week if they’re having just light duty job. In cases of heavy duty job, then it takes about six weeks to return to work. 

Melanie:  Then how soon should they see results? I know it depends on the type of surgery and what their problem was to begin with, but generally, how soon can people feel a reduction in pain or the shooting pains that go down their legs or whatever reason that they came in to see you? 

Dr. Hassanzadeh:  This is a very good question. It’s a question asked a lot by my patients. As you said, the pathology differs in outcome. In terms of acute disc herniation and having a disc problem, compression on a nerve, it’s immediately. This is really the patient wakes up and they have no pain really. It’s a very gratifying moment for us as physician to see the patient being pain-free and so very grateful for that. There are some other pathology that would take time. Usually you see the majority of benefits first six weeks to three months, and a complete recovery is about six months. In larger cases, the deformity cases where multilevel fusions are involved and very long surgery, then recovery could take up to a year. 

Melanie:  Is there physical therapy needed after this type of surgery? 

Dr. Hassanzadeh:  Again, it depends on the type of surgery and it depends on the patient’s activity levels. When patients are very active to start with, yes, especially after fusion surgery we send them back to rebuild their core muscles to prevent further problems in the future. 

Melanie:  Let’s talk about some of that prevention and strengthening. You’ve mentioned the core. What do you like people do to keep a really good, strong spine? 

Dr. Hassanzadeh:  I think working out is very important. It’s not only the back muscles. It’s abdominal muscles, chest muscles, hip muscles, they’re all important to keep a stable core. What I mean by that is you can divide. There’s so much pressure we have when we walk, when we run, when we do things. You can drive the entire pressure to the spine and will have back pain or you can divide the pressure through your muscles and spine. By having a very strong core muscles, then the muscle will take a lot of that pressure or force away from the spine, so it’s a divided work, so you will see less pain as a result. Also as to degeneration, you can decrease the rate of degeneration of the facets, joints, and discs, and so on. 

Melanie:  Dr. Hassanzadeh, tell us about what’s going on in the horizon picture for minimally invasive spine surgery. What’s really exciting that you’re doing there at UVA? 

Dr. Hassanzadeh:  I think the beauty of the spine surgery is that we can transfer this to other fields. One of the major advances we have here by collaborating with other teams, not only within orthopedics but also outside the orthopedics department, we start treating some of the complex factors through minimally invasive techniques, and that’s a huge advantage we are currently studying and could affect bio-mechanic study to prove that it’s really as stable as a local procedure. We’re convinced that it’s going to be the future. I think the future will be less soft tissue damage, more precise surgery through small incision. Having the technology behind us, it makes our work much easier. This is the exciting part, to be in UVA, it’s a great place because of the resources that UVA has as a lead institution. Also, people are around… medicine is always a multidisciplinary teamwork. If you have the right people in the right positions, the work is easy and patients benefit the most. 

Melanie:  Great information. Thank you so much. For more information on the UVA Spine Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.