Major advances in spine surgery — from minimally invasive techniques to complex spinal deformity procedures — have opened the door for a much wider group of patients suffering from the often-debilitating pain associated with spinal conditions to receive care at specialized centers. Through a multidisciplinary collaboration of specialists in neurosurgery, orthopaedics and physiatry, the UCLA Spine Center is optimizing the care of patients who might not have been eligible for spinal surgery in the past.
Minimally invasive spinal surgery has become an increasingly important part of the armamentarium over the last decade, says Langston Holly, MD, professor and vice chair of clinical affairs for the UCLA Department of Neurosurgery and codirector of the UCLA Spine Center. Minimally invasive spine surgery was initially developed for patients with degenerative disc disease. But over time, minimally invasive techniques have evolved for patients with other spinal pathologies, including tumors and trauma.
“Just as general surgery took large, fairly morbid open procedures and turned them into laparoscopic procedures with fewer complications and shorter hospital stays and recovery times, we have been able to do that with spine surgery through techniques that have improved every year,” Dr. Holly says. Often, patients are able to go home within a few hours after a surgery that would have previously required one or more nights in the hospital.
Minimally invasive spine surgery aims to reduce the amount of soft-tissue dissection and disruption of anatomical structures. “The larger the surgery, the longer the injury takes to heal, and in some cases there can be permanent muscle injury related to the approach to getting down to the spine,” Dr. Holly explains. “We are now able to make much smaller incisions, and in most cases we can go between muscle fibers, using a device to create a pathway through a small access corridor down to the spine. Once that device is removed, the muscle falls back into place, and it usually takes just one or two stitches to close.”
Dr. Holly notes that the minimally invasive approach is particularly important for spine patients because many have been on pain medications and may be more sensitive to postoperative pain. “We can decrease their medication use after surgery and get them back to work quicker, and the outcome is often better,” he says. Another benefit of the minimally invasive approach is that it allows the surgeon to preserve supporting structures and maintain the integrity of the spine, reducing the chances of the patient needing additional surgery at a later time.
“With more people wanting to maintain an active lifestyle into their 70s and 80s, we’re seeing much greater demand for spine surgery in older patients,” Dr. Holly says. “Many of these patients have comorbidities and might not be able to tolerate an open procedure, but if we can do it minimally invasively, it makes many of these older patients eligible.”
The UCLA Spine Center also includes expertise in highly complex adult and pediatric spinal deformities, such as scoliosis, iatrogenically caused deformities and tumors.
Post-operative photograph shows incisions from minimally invasive approach to correct severe spinal deformity due to osteoporosis and multiple fractures. Using advanced surgical technology, intraoperative navigation and minimally invasive techniques, the curvature is able to be corrected without a largescale open deformity surgery. Images: Courtesy of Dr. Andrew C. Vivas
“The quality-of-life impact that adult spinal deformity and degenerative conditions of the spine have on patients is huge, and it is underappreciated,” says Andrew Vivas, MD, an assistant professor of neurosurgery who subspecializes in complex spine procedures.
The surgeries performed by Dr. Vivas and his colleagues have a low margin for error. Historically, Dr. Vivas notes, spinal deformity corrections had unacceptably high rates of complications, including paralysis, and so the surgeries were mostly avoided. But over the past three decades, the technology has greatly improved — in particular, the ability to closely follow the function of the spinal cord during surgery through intraoperative neuromonitoring and various minimally invasive techniques used to augment the deformity surgery.
“These are challenging cases, and in order to have good quality-of-life outcomes, it’s critical to minimize the amount of blood loss and the potential for neurological injury,” Dr. Vivas says. “But if we’re able to do these surgeries safely and with low perioperative morbidity and rates of complication, we can dramatically improve patients’ quality of life, with significant improvements in pain, selfimage scores, patient satisfaction, mental health scores and overall function.” The significant advances in safety and outcomes have changed the eligibility calculus, to the point that large-scale spinal deformity surgery is being performed on many patients well into their 70s and 80s, Dr. Vivas notes.
Dr. Vivas’ practice also includes a substantial number of revision spine surgeries, another highly specialized procedure for patients who have in many cases suffered for years with their spines fused in a painful position. As with the other procedures, successful surgery requires the type of multidisciplinary approach featured at the UCLA Spine Center. “We offer state-of-the-art care for every subdiscipline of spine surgery,” Dr. Vivas says. “And we work together as neurosurgeons, orthopaedists, anesthesiologists and physiatrists, all in close consultation, to take care of patients every step of the way.”