Surgeons with Baptist Health Brain & Spine Care are trained to treat a full range of back, neck and spine conditions, with extensive experience in a range of simple-to-complex procedures. And, whenever possible, they perform minimally invasive procedures to shorten hospital stays, speed up recoveries and improve long-term outcomes.
Michael McDermott, M.D., neurosurgeon and the chief medical executive of Baptist Health Miami Neuroscience Institute.
“What are some of the potential advantages of minimally invasive technique -- in terms of length of hospital stay, time to recovery and long-term outcomes -- compared to some of the older techniques which require big skin incisions and big muscle splitting operations?” asks Dr. McDermott.
Dr. Gomez performs both the traditional and the latest minimally invasive procedures.
“Patients undergoing minimally invasive surgeries, whether it's a minimally invasive posterior fusion (approaching spine from the back) or a minimally invasive lateral fusion (approaching the spine from the side), these patients are typically up and walking around the day of surgery,” explains Dr. Gomez. ”Typically, patients go home the day after surgery.”
Dr. Gomez further explains that he counsels his patients with the following expectations: “The first two to three weeks after surgery are the most uncomfortable. By six weeks, I would say that they should feel about 75 percent recovered. At three months, about 90 percent recovered. And then, at six months, I'd say they ought to feel normal.”
With traditional “open surgery,” there are disadvantages that begin with a longer hospital stay and potential post-operative complications. “When patients have large open incisions -- where we or strip the muscle off the bone -- typically that results in more inflammation, more blood loss, and we use drains to manage any fluid collections between the muscles so that it heals nicely,” said Dr. Gomez.
Michael Gomez, M.D., neurosurgeon and director of minimally invasive spinal surgery at Miami Neuroscience Institute.
Here's more from the Doc-to-Doc podcast:
Dr. McDermott: “So, minimally invasive spine surgery presumably refers to the size of the opening and the use of different instruments. Is that correct?”
Dr. Gomez: “Yes and no. So, typically it does refer to the size of the incision, but we also utilize some alternative corridors to the spine that allow us to generate less tissue damage, but also allows us to accomplish the same things that we typically do with traditional approaches. So, we use a series of retractors that either split the muscle or retractors that help to hold muscles aside -- so that we wind up with less bleeding and less inflammation in patients.”
Dr. McDermott: “How important has bone density become for assessing patients prior to bigger operations or even minimally invasive operations where a lumbar bony fusion is required? And is there any pre-surgical treatment that you recommend in patients with obvious osteopenia and osteoporosis?
Dr. Gomez: “Bone density is a huge deal now, and I think mostly because 70 is the new 60, right? When you have older patients that really want to enjoy retirement, they want to be active and they want to travel and they need a surgery. You have to be able to take care of them while minimizing the risk of surgery. Typically before surgery, we will order a bone mineral density scan, and that allows us to gauge their bone quality. And preoperatively, patients can be optimized with a number of different medications for bone mineral density. And, if really necessary, we would start this about six months before surgery.”
Dr. McDermott: “Intraoperative navigation and intraoperative imaging have become an important part of accurate, efficient, and safe spine surgery using minimally invasive techniques. Can you discuss some of the technology that you're currently using in the operating room to assist with this kind of surgery?
Dr. Gomez: “Intraoperative navigation has just blown minimally invasive spine surgery wide open. When you're doing traditional open procedures, you have all these landmarks that you can guide yourself by. But when you're working through small incisions, you don't have these landmarks. And so using traditional fluoroscopy, or live X-ray, can be quite difficult.
“Now, with intraoperative navigation, we're able to obtain a CT scan of the spine while we're in the operating room, and we send those images to a special computer that lets us navigate in the spine. We’ve been doing this with brain surgery for many years And now this allows us to bring that safety to the spine. And it also allows us to reduce the amount of radiation that patients get.”
