Spine Surgery
Kyphoplasty & Vertebral Compression Fractures
A miniature robot to assist during spinal surgery
A less invasive lumbar fusion
Spine Surgery
Only 10 years ago, if you had spine surgery, you could expect it to take as much as one year before you would be able return to normal activities. Less invasive surgical techniques, new technology and advances in bone substitutes, however, are changing the face of spine surgery. What used to result in a week-long hospital stay, a year’s recovery period and a large scar has been diminished to a few days, a few months and a few small scars.
How is minimally invasive spinal surgery performed?
Conventional spine surgery typically requires a long incision, deep muscle dissection, mobilization of the major blood vessels and spinal nerves, all frequently resulting in a prolonged recovery. Minimally invasive spinal surgery can eliminate these issues by;
using specially designed retractors to provide a direct corridor to the spine,
by using a thin, telescope-like instrument known as an endoscope, or even a microscope or magnifying glasses and head lamps, to provide magnified and illuminated views of the spine,
by using navigation systems or robotic assisted computer arms linked to x-rays to guide the surgeon to the correct position,
by using new biologic bone substitutes to grow bone for fusions,
by using new “percutaneous" (through small poke holes) approaches to the spine,
and by using new mechanical devices that can be attached to the spine with more precision, less collateral tissue damage and with greater stability.
Is this technique applicable for all forms of spinal surgery?
No. Nor is it appropriate for all patients. While the field of minimally invasive spinal surgery is changing rapidly, three main types of minimally invasive spine surgery currently are being performed at the Cleveland Clinic:
• Spinal fusion, which often is performed on degenerative disks
• Deformity corrections, such as for scoliosis
• Kyphoplasty and Vertebroplasty
• Repair of herniated disks
What are the benefits of minimally invasive spine surgery?
Typically, minimally invasive spinal surgery allows for the same outcomes as conventional spine surgery. Benefits of minimally invasive spinal surgery include:
• a few tiny scars instead of one large scar
• Shorter hospital stay – a few days instead of a week
• Reduced postoperative pain
• Shorter recovery time – a few months instead of a year – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better after just a short while, you may need to take it easy per your doctor’s recommendation.
How will I know if minimally invasive spinal surgery is appropriate for me?
If performed by experts in this field, minimally invasive spine surgery is as safe as “open” spine surgery in carefully selected cases.
Appointment
To schedule an appointment, please call the Cleveland Clinic Spine Center at 216-444-2225 or Florida campus
954-659-5630
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Kyphoplasty & Vertebral Compression Fractures
The Spine Surgeons at the Cleveland Clinic have been leaders in the development and evaluation of treatment options for painful progressive osteoporotic and osteolytic (due to cancer) vertebral compression fractures Vertebral body fractures lead to the collapse, or compression, of the vertebra, causing the spine to shorten. This leads to pain and a hunched-over appearance. Thinning of bones, or osteoporosis, is the main cause of vertebral compression fractures and these fractures have traditionally been very difficult treat. The Spine Surgeons at the Cleveland Clinic routinely use a very effective minimally invasive technique called “Kyphoplasty” to very successfully alleviate the pain and restore the lost height associated with vertebral compression fractures.
During the kyphoplasty procedure, the patient will lay on his or her stomach. The Surgeon will then insert a hollow needle, called a trocar, through the skin and into the vertebra. A type of X-ray, called fluoroscopy, is used to guide the trocar into position. Once the trocar is in place, an inflatable balloon-like device is inserted into the vertebra through the trocar. As the balloon is inflated, it restores the vertebra back towards its native shape and it opens up a space to be filled with bone cement.
The Spine Surgeons at the Cleveland Clinic have presented their clinical results nationally and internationally as well as published their results in the major scientific medical journals.
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A miniature robot to assist during spinal surgery
Spine Surgeons of the Cleveland Clinic Spine Institute and Engineers from Mazor Surgical Technologies have teamed up under a grant from the Shalom Foundation and the Technion University to develop a robot which offers an innovative approach to satisfy the need to perform precise surgical procedures in the limited space available around the spine without the risk of injuring the spinal cord or nerves. The robot, no bigger than a soda can, attaches directly to the patient’s body while helping the surgeon to determine the exact positioning of tools and implants. The robot will shorten surgical time, increase accuracy and minimize the risk of device failure that may result from misplacement of implants and use of other surgical tools during spine fixation procedures. In addition, it enables the surgeon to perform the procedure through a targeted minimally invasive approach, which translates into a faster recovery and less trauma for the patient.
The system was successfully tested on cadavers at the Cleveland Clinic Foundation, has received full FDA approval and is in full clinical use at a number of centers in the USA, Israel and Korea.
Figure1: The robot
Figure 2: The robot mounted to the spine
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A less invasive lumbar fusion
Spine Surgeons of the Cleveland Clinic Spine Institute were instrumental in developing and adopting a new less invasive approach to lumbar spine fusion. The Axialif® procedure whose equipment is marketed by Trans1 Inc, involves accessing the spine through a small 2 cm incision next to the tail bone. Under fluoroscopic (x-ray) guidance a working tube is docked onto the undersurface of the sacrum. Through a tunnel in the bone, the disc is evacuated, bone graft is inserted and a threaded rod is implanted to stabilize the spine. The procedure and implants have received full FDA approval and have gained clinical acceptance amongst many spine surgeons in a very short span of time. The benefits to the patient include a short hospital stay, minimal disruption of non-pathologic tissue, and a rapid recovery.
Figure 1: Paracoccygeal percutaneous access to the L5/S1 disc
Figure 2: Implantation of the axial fixation rod
Figure 3: Clinical example of Axialif procedure
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