Study to Assess Minimally Invasive vs. Open Spinal Surgery for Lower Back Pain

October 12, 2010 - Rush University Medical Center

Rush University Medical Center is assessing whether minimally invasive surgery to relieve lower back pain differs from open surgery in terms of complication rate, recovery time, outcome and cost.

A total of 50 patients will be enrolled in the study. The group will include people diagnosed with spinal stenosis in the lower back, a narrowing of the spine that causes pressure on the spinal cord, and those with spondylolisthesis, a condition in which a vertebra in the lower part of the spine slips forward and onto the vertebra beneath it.

All of the patients will undergo spinal fusion surgery in which two or more vertebrae are "welded" together to prevent the abnormal movement that is causing pain. Half of the patients will undergo a minimally invasive procedure and half open surgery.

"Minimally invasive back surgery requires new surgical techniques and a steep learning curve," said Kern Singh, MD, orthopedic spine surgeon and assistant professor at Rush, who is leading the study and does about 200 such surgeries a year.

"Once the learning curve has been passed, the data so far suggest that minimally invasive spinal fusion requires less operating time, reduces the chance of infection and shortens recovery time. All of these are advantageous for the patient."

A traditional open spinal fusion is about a two-and-a-half-hour procedure, involving a 5-inch incision in the back to expose the spine, cutting through thick muscles. Typically, bone has to be removed to give the surgeon access to the area where the vertebrae are impinging on the spinal cord. Bone is also removed where it presses on the spinal cord. The vertebrae are fixed in place with screws that attach to a metal rod on either side of the spinal column. Over the six to 12 months after surgery, the bones fuse.

In minimally invasive surgery, which takes a little over an hour, the surgeon requires only a three-quarter-inch incision and maneuvers special instruments in between the muscles, pushing them aside to reach the area of the vertebrae that is pressing on the nerve. No muscles are cut, which reduces postoperative pain. Microscopes enable the physician to view the area in magnification, allowing more surgical precision.