Rick Chaney – The Surgeon’s Perspective

Rick Chaney: Minimally Invasive Lumbar Fusion (also called Minimal Incision Lumbar Fusion)

In the Q and A below, Max W. Cohen, MD, FAAOS, discusses this procedure and how it can help patients.

Q: Your patient Rick Chaney was among the first in the county to have a procedure called a minimally invasive posterior lumbar fusion (or minimal incision spine surgery). What is this?

A: A minimally invasive posterior lumbar fusion is a surgical procedure that allows for a shorter hospital stay, less post-operative pain, a quicker recovery, a smaller risk of infection and a faster return to work than a traditional spinal fusion. It also avoids damage to the paraspinal muscles, which are important for the back to function normally.

Q: I understand you were one of the first surgeons in the country to begin performing this procedure.

A: Yes, I was one of the first to actually do this type of fusion, and I taught other surgeons how to do it from about 2005 through 2008. Today, I don’t do as much training because the procedure is much more common.

Q: What do you do differently with this surgery than with a traditional lumbar fusion?

A: The difference is, with traditional back surgery, we have to cut through muscle as we make an incision in the middle of the spine area. With minimally invasive spine surgery, we make small incisions off to the side of the spine, and then we work in line with the muscle fibers, so we sort of spread the muscle fibers but don’t cut them.

Q: Why is it better if you can avoid cutting the muscle?

A: In the early days of spine surgery, we didn’t worry about the muscle. We just did our work on the spine and then we wondered why many people still had back pain. We know now from MRI scans after surgery that muscle that has been cut develops scar tissue. That’s not good. The muscle is no longer functioning, so that can lead to more pain. We now recognize that the muscle itself is important in the patient’s recovery. So now we pay more attention to preserving the muscle – not only fixing the problem underneath the muscle, but trying to preserve the muscle itself so it is healthy when we are done.

Q: Have studies proven better results long-term for patients who have the minimally invasive procedure?

A: Studies have shown that at least initially patients do better. There’s less blood loss and the hospital stay is shorter. It’s much harder to prove whether the long-term results are better, because there are so many variables between patients, and it’s difficult to prove that patients had comparable, equally bad problems to start with.

Q: Can all fusion patients benefit from this type of surgery?

A: No. It depends on the patient’s individual case. Patients who are having a single-level fusion (where we are fusing only two vertebrae) are the best candidates for the minimally invasive lumbar fusion. However, all patients are benefiting from our increased understanding of the muscle’s importance in recovery. Even in traditional fusions, we are now using techniques that allow us to minimize muscle trauma.