How risky is spinal surgery?

Many people suffer from the pain of a slipped disc, which can cause back and leg pain and, in severe cases, mobility problems. However, they would rather suffer than go to hospital for surgery because they are afraid that the operation will require a large incision.

In fact, this is a misunderstanding of the treatment of herniated discs, because with the development of medicine, herniated disc surgery has entered the era of "minimal trauma, precise treatment, good efficacy, rapid functional recovery, high cure rate".

Moreover, in middle age, the quality of life in the 20 years between 50 and 70 is definitely higher than in the 20 years between 60 and 80. So why not have the operation now, so that the 50-70 year olds can live those 20 years in their own style? Mr Fu, aged 52 in the video, has suffered from back pain for many years. Over the past six months, his low back pain has become increasingly severe, with pain and discomfort in his hip and right lateral calf, and his toes have become slightly numb and uncomfortable, so he was admitted to our hospital for minimally invasive spinal surgery. Ye Xiaojian's team performed the surgery according to his actual situation, and he healed well after the surgery. He has resumed his normal life and is able to drive to and from work, as Mr Fu himself said, "I feel like I'm alive and kicking now".

01 What is minimally invasive spine surgery?

Minimally invasive surgery, as the name suggests, is to minimise damage to normal tissues and minimise the impact of surgery on the function of the whole body system, and has been described as one of the directions of surgery in the 21st century since the moment of its birth.

Minimally invasive spine surgery is the use of surgical microscope or high magnification, enlarge the surgical field of view for surgical operations, through the smallest possible skin incision to perform "endoscopic surgery", so that spinal surgery with the minimum of medical damage to the implementation of the most effective treatment.

In the field of spinal surgery, with the continuous development of minimally invasive technology, minimally invasive treatment of spinal diseases will become the future trend.

02. What conditions are suitable for minimally invasive spine surgery?

Currently, most degenerative diseases of the lumbar spine can be treated with minimally invasive surgery, the most representative of which is lumbar disc herniation.

Lumbar disc herniation is a pathological condition caused by degenerative changes and injuries to the lumbar intervertebral discs, which results in the nucleus pulposus and part of the annulus fibrosus protruding into the surrounding tissues and compressing the corresponding spinal cord or spinal nerve roots.

The main symptom is compression of the nerve roots or spinal cord, which manifests as chronic low back pain, radiating pain or numbness in the lower limbs, and sometimes muscle spasm or even muscle wasting in the paravertebral region and lower limbs, activity limitation and a positive nerve traction test.

Lumbar disc prolapse is the most serious form of lumbar disc herniation; if not treated in time, the prolapsed nucleus pulposus will worsen, lumbar spinal nerve compression will worsen, and even cauda equina syndrome will cause irreversible nerve damage. In clinical practice, lumbar spondylolisthesis is also one of the main causes of lumbar and leg pain, which greatly affects middle-aged and elderly patients and makes treatment more difficult. Therefore, we suggest that patients should go to the hospital for a clear diagnosis after the onset of symptoms.

In terms of treatment, for lumbar disc herniation not associated with lumbar spondylolisthesis or lumbar spine instability, minimally invasive intervertebral foramenoscopic surgery can be considered first, although there is a certain recurrence and residual rate, the probability of occurrence is still relatively low. For disc prolapse with a high degree of free displacement of the lumbar herniation, you can also choose minimally invasive intervertebral foraminoscopic surgery, although the operation is a little more complex and difficult, but you can still give yourself a chance to minimally invasive, after all, open fusion surgery is the ultimate treatment option.

03. Challenges of minimally invasive spine surgery for physicians

Compared to open spine surgery, minimally invasive spine surgery poses two challenges for doctors.

The first challenge is the skill of the surgeon.

Minimally invasive surgery has a very small field of view compared to traditional surgery, and the field of view is relatively limited. Minimally invasive surgery is similar to carving a soya bean and performing a very delicate operation in a very small space. Therefore, minimally invasive surgery requires a very high level of technical and professional training for the surgeon himself, who should have a strong anatomical knowledge and judgement, especially the ability to perform surgery in a very small space. For example, the intervertebral foramenoscopy procedure requires a skin incision of only 7 mm. Going from a traditionally large incision to such a small one requires overcoming many psychological, skill and technical difficulties.

Another challenge is the surgeon's commitment.

When I first started practicing minimally invasive spine surgery, I had to take an x-ray to confirm that each step of the operation was successful. During the operation, it was impossible for the doctor to leave the room, as he had to stand next to the patient and be X-rayed together.

We had statistics that when we first started doing minimally invasive laminectomies, we had to get almost 200 scans in a single operation. The more operations you do, the more radiation you get. Doctors really are "X-Men".

Radiation from X-rays during a minimally invasive procedure is very harmful to both the surgeon and the patient on the operating table. How can radiation be reduced when protection and equipment cannot be optimised fast enough? Reduce the damage to the patient? The solution is to continually improve surgical standards and skills.

After relentless efforts to research and accumulate experience and technology, we have finally been able to ensure that patients receive as little X-ray radiation as possible during surgery, and we hope that we can truly practice humanistic care for each patient with practical measures.

Article reproduced from: Shanghai Tongren Hospital