Spine Surgery Evolved

For patients with spinal deformities, undergoing surgery can be an overwhelming experience. Traditional open surgical approaches involve large incisions and long recovery times. Significant advancements have been made in minimally invasive spine surgery both from the back (posterior) and (front) anterior, but these approaches still have limitations. These can include the size of devices that can be implanted and the need to reposition the patient during surgery. 

At Columbia Neurosurgery, spine surgeons Dr. Andrew Chan and Dr. Dean Chou are experienced in two newer methods for minimally invasive spine surgery: lateral access surgery and single position surgery. Below, Dr. Chan and Dr. Chou discuss these new approaches and how they benefit patients. 

What is a lateral approach to minimally invasive spine surgery, and how does it differ from other minimally invasive techniques? 

For our patients with spinal deformities, surgical repair often involves performing a fusion. During this procedure, we use screws, rods, and interbody cages to stabilize the spine. Traditionally, when we would perform this from the back, we were limited in the size of the cage we could implant due to the various nerves in our way. The other alternative would be to perform the surgery from the front. However, that approach involves a large incision from the sternum to the pubic bone and moving the various organs that sit in front of the spine. While these approaches work, it’s like taking the long road with many detours to reach the final destination. 

We knew there needed to be another option that would allow us to avoid dissecting the muscles and nerves of the back and permit the implantation of larger cages to provide greater stability. That’s where lateral spine surgery comes in. 

When we perform lateral surgeries, we create a one-inch incision on the patient’s side and use imaging technology to guide us. Because we can avoid the muscles and nerves in the back, we are able to insert a much larger cage, restore the height of intervertebral discs, and achieve indirect decompression of the spine at single or multiple levels. The benefits of this approach are significant – shorter recovery time, less blood loss, and improved spinal alignment. 

What conditions can be treated using a lateral approach? Who would not be a candidate for this approach? 

Almost every patient with a condition in their mid (thoracic) to lower (lumbar) spine could be eligible for lateral access surgery, including those with spondylosis, degenerative disc disease, stenosis, disc herniations, and scoliosis. However, patients who have spine conditions in their neck (cervical spine) would not be eligible for this approach.  

What is single position surgery, and how does it relate to the lateral approach? 

Single position surgery is the next evolution of the lateral technique. Historically, even with a lateral approach, we often had to move the patient if screws and rods were also needed for stabilization. First, we would perform the lateral part of the surgery with the patient on their side to place the interbody cage. Then, we would have to reposition the patient onto their stomach to place the screws and rods from the back. This "flipping" of the patient adds significant time to the surgery, increases time under anesthesia, and requires a second sterile setup.  

With single position surgery, we can perform both parts of the procedure—placing the cage from the side and the screws from the back—while the patient remains in the lateral and/or standard prone position. We use specialized operating tables and imaging equipment that allow us to access both the side and the back of the patient without ever needing to move them. This makes the entire operation much more efficient and enables us to keep the support structure of the spine as stable as possible. It’s also much more palatable for patients to think about when they are considering spine surgery. 

What are the main benefits for a patient undergoing single position surgery? 

The primary benefit is a dramatic reduction in operating time. By eliminating the need to reposition the patient, we can shave hours off the procedure. A surgery that might have taken six to eight hours can now be completed in three to four.  

This shorter duration under anesthesia leads to several key advantages for the patient: 

• Faster recovery: Patients often feel better sooner and can get up and walk more quickly. 
• Less risk: Reduced anesthesia time lowers the risk of complications. 
• Decreased blood loss: The procedure is more efficient and less invasive overall. 
• Shorter hospital stays: Patients can often go home sooner after a single position surgery compared to traditional staged procedures, some even the same day. 

Ultimately, it combines the benefits of robust, stable spinal implants with the efficiency and safety of a single, streamlined procedure. It represents a major leap forward in our ability to treat complex spinal disorders in the least invasive way possible. 

What should a patient do if they believe they are a candidate for these advanced procedures? 

The first step is to undergo a thorough evaluation with a spine surgeon who is experienced in these techniques. Every patient's anatomy and condition are unique, and the best treatment plan is always a personalized one. What works for one person may not be appropriate for another. 

During your consultation, we will review your medical history, perform a physical examination, and look at your imaging studies like MRIs and X-rays. We will discuss your symptoms, your lifestyle, and your goals for treatment. Based on this comprehensive assessment, we can determine if you are a candidate for lateral access or single position surgery and explain the specific risks and benefits for you. 

Our goal is to provide the most effective and least invasive treatment possible to help you return to your life with less pain and improved function. 

If you are living with a spinal condition and want to learn more about your treatment options, we encourage you to schedule a consultation with the spine experts at Columbia Neurosurgery. Contact us today to see how our team can help you on your path to recovery.