UF doctors pioneer minimally invasive spine surgery<

by: Andrew Ragsdale

Physicians at the University of Florida are the first in the nation to perform computer-guided fusion and fixation of the L5-S1 disc. The new procedure, computer-guided percutaneous interbody fixation and fusion of the L5-S1 disc, allows surgeons to enter the lower vertebrae through “safe zones” in the pelvis and spine to perform computer-guided spine fusion.

Michael Mac Millan, M.D., a UF College of Medicine associate professor of orthopaedics at the UF Orthopaedics and Sports Medicine Institute, and one of the pioneers of the new procedure, says the recent emergence of several technological and biological innovations made the new procedure possible.

“Through a combination of improved modeling capabilities, computer-guided surgical techniques, interbody implants, and advancements in bone morphogenetic proteins, we were able to create a technique that allows surgeons to bypass the large-incision, musculature damage and prolonged rehabilitation times associated with traditional open-back surgery,” Mac Millan said.

Prior to surgery, a team of orthopaedic surgeons and modeling experts create a series of advanced, computerized, three-dimensional models of the patient’s lumbosacral junction. These models are then integrated with pre-operative CT scans, operating room fluoroscopes and computer-assisted surgical navigation systems, which allow surgeons to operate on patients by guiding virtual (on-screen) instruments and tools that mirror and move the surgical instruments used on the operating table. The damaged discs are then removed, replaced with interbody implants, infused with bone-growth hormones, and the discs are stabilized to allow for fusion.

Computer-guided surgery is not new in the operating room. But, until now, Mac Millan said, using a computer to help with back surgery was a bit like using a car’s GPS to get to Winn-Dixie. “Traditional back surgery requires opening the back so surgeons can see everything. While this is excellent for the surgeon, it is not so great for the patient, and results in extensive scarring, muscular atrophy, and denervation of the muscles.”

Working closely with Pat Jacob, M.D., a UF College or Medicine assistant professor of neurosurgery, and Frank Bova, Ph.D., a world-renown expert in computer guidance with the UF department of neurosurgery, Mac Millan was able to perfect the models, which are crucial for the new procedure.

“By referencing the enhanced models with the navigational software, we can guide tools with sub-millimetric accuracy through the pelvis and into the spine through small cannulas to remove and replace damaged discs,” Mac Millan said. “Much like arthroscopic surgery, this “inside-in” approach dramatically reduces damage to the surrounding musculature and significantly reduces patient recovery times.” Mac Millan hopes that within a year-and-a-half, single-level spinal fusion patients at Shands at UF will be seen on an outpatient basis or, at most, with a single night’s stay in a recovery room.

Although having a fused spine has minimal functional impact (as compared to knee or hip fusion), traditional fusion surgery is a major life change and rehabilitation event.

“What we realized is that if having a fused spine is not bad, it must be the way we were doing it,” Mac Millan said. “We know from traditional orthopaedics that we don’t go through the muscle to get to a joint. But until recently, this rule has been somewhat of an exception when working with the spine.”

Apart from this new procedure, traditional spinal fusion or anterior lumbar fusion are the only surgical options for patients with lower back pain as a result of degenerative discs. While traditional fusion results in extensive disruption and trauma to the soft tissue, the anterior approach poses several drawbacks of its o<

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