Ask Dr. Strothman: What Do I Need To Know About Minimally Invasive Spine Surgery?

There’s cachet in describing surgical techniques as “minimally invasive.” But what does this phrase really mean? Spine surgeon Dr. David Strothman describes how the benefits of this surgical approach can vary with the surgeon performing it.

Minimally invasive surgery is characterized as an approach that does less damage to healthy tissues during an operation. But “how much” less damage is done can vary widely, depending on how a surgeon defines “minimally invasive.”

“During my fellowship, I trained with the surgeon who was the president of the Society for Minimally Invasive Spine Surgery,” says Dr. Strothman. “He was at the vanguard of minimally invasive surgical techniques for spine. I was fortunate to learn from him; the minimally invasive approach he taught me became the foundation of my practice.

“Today, most surgeons characterize their approach as minimally invasive, but that can mean different things,” Dr. Strothman cautions. “If a surgeon makes a 5-inch midline incision for a fusion surgery instead of a 7-inch incision, it may be called minimally invasive because the incision is smaller. But through that 5-inch incision, the surgeon is still using the traditional surgical technique: going through a midline incision, cutting tissue, and stripping the muscle from the spine to perform the procedure. The incision may be shorter, but the overall traditional technique is the same, and does a lot of damage to the layers of muscle that protect the spine.

“I can tell you what happens when you use this approach because I’ve seen it when I’ve had to do a revision surgery later,” says Dr. Strothman. “That muscle is dead; it’s been replaced by scar tissue.”

Dr. Strothman incorporates a more comprehensive approach to the minimally invasive concept in his surgical approach: markedly smaller incisions and surgical tools designed to minimize collateral damage to the muscles and other tissues around the spine.

“My typical skin incision for a minimally invasive procedure is only two centimeters long,” he explains. “Then, I insert small tubular retractors through the incision so I can move muscle aside without cutting or tearing it. We use sequential dilators to carefully move down to the surgical location. This allows me to go down between the muscle planes, pushing them apart and holding the muscle away from the surgical site so I don’t’ have to cut or damage that muscle. I perform the entire operation through a very small tube. It is an important advance because this technology enables us to do fusion, discectomy, and decompression operations while significantly limiting collateral damage. Using these techniques, we can do a laminectomy surgery in 20 minutes instead of an hour, with 5 ccs of blood loss versus the 100 to 200 ccs of blood loss common with the traditional approach. If we have to come back for a revision surgery later, we are going to find muscle that is still alive and contracting. It’s a drastically different intervention.”

Today, Dr. Strothman performs 450 spine surgeries annually, using his minimally invasive surgical techniques for approximately 70 percent of them. “A comprehensive minimally invasive approach enables us to do the exact same operation that you’d otherwise have and achieve exactly the same goals, but without destroying muscle attachments,” he explains. “Some conditions require a traditional open surgery. But when we can use a minimally invasive approach, we do.”

 

  • David H. Strothman, M.D.

    “Spinal disorders are complex and disabling. As your surgeon I will explain your diagnosis and treatment options, both operative and non-operative, in a way that you can understand thereby allowing you to make informed decisions. I am rewarded daily by improving the quality of life of patients receiving my care.”

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