Less invasive spinal surgery pioneered by UPMC neurosurgeon helps patients recover quicker
July 23, 2012 4:00 AM
Dolores Grandizio, 83, floats in her pool in Valencia. Ms. Grandizio, who has had surgery on her spine to correct scoliosis, said swimming and dancing are her two favorite ways to exercise.
Dolores Grandizio's x-rays shwoing the curvature of her spine.
By Sanjena Sathian Pittsburgh Post-Gazette
Lorrie Bungo's legs used to go numb when she sneezed.
Ms. Bungo, now 51, found out a year and a half ago that she had scoliosis, an abnormal curving of the spine that can affect nerves along the body and be painful. When orthopedic doctors told Ms. Bungo she might have to get a rod placed in her back to straighten her spine, she worried she might not be able to keep working and traveling. But last May, Ms. Bungo underwent a new method of spinal surgery, and she left the hospital 24 hours later, pain-free.
The "minimally invasive" surgery, an innovation in this area, involves fewer incisions than traditional spinal surgery. Adam Kanter, the neurosurgeon at UPMC pioneering the technique in Pittsburgh, said this kind of surgery involves less blood loss and possibility for complication, allowing patients to leave the hospital earlier to begin recovery and getting them pain relief more quickly.
Two years ago, if Ms. Bungo took a day trip from her home in Clearfield County to Philadelphia, she said she would spend eight hours recovering the next day, soaking in a bathtub and taking painkillers.
"I haven't bought Tylenol or painkillers in over a year," she said.
Normal spinal surgery involves making multiple incisions, and the operation moves through a larger muscular area. Bone areas have to be removed, and there can be more than a liter of blood loss, said Dr. Kanter. With the new technique, which approaches the spine with a "lateral" incision from the patient's side below the ribs, patients lose about 2 percent of that amount. Patients do not have rods placed along their spine, and they don't wear a brace afterward.
The recovery time is also a big change. Normally, patients take as long as six months to recover from spinal surgery -- including extensive time in rehabilitation centers. Ms. Bungo said she had a few physical therapy leg exercises to do at home after the surgery. But she was walking mere hours after the procedure and back at work three weeks later.
Patients like Ms. Bungo are able to get out of surgery and then the hospital faster -- something that matters even more the older patients are. Dolores Grandizio, now 83, had the lateral surgery done for her scoliosis nearly two years ago. She's active and has been since the surgery, going dancing and walking -- and she loves that most people can't guess her age.
Dr. Kanter came to Pittsburgh in 2008 and began performing the surgeries here soon after. To treat patients such as Ms. Grandizio, Dr. Kanter pairs up with David Okonkwo, a deformities specialist at UPMC. Dr. Okonkwo said the new approach changes the way he can treat patients over the age of 70 who have scoliosis. For older patients, "it's a completely different sport," he said, explaining that elderly patients may already have medical problems and can't always risk going through a complicated medical procedure.
"There's no substitute for youth. A 20-year-old who gets a major operation is far more likely to go through without major problems than an 80-year-old," he said.
Fifteen years ago, any spinal surgery would have been a major procedure. But since 2003, when the technique first came to the U.S., the way doctors think about surgery on the spine is changing. Luiz Pimenta, a neurosurgeon in Brazil, developed the technique before it spread internationally.
"The population is getting older and older, and the patients need and want to be active in their 70s and 80s," Dr. Pimenta said. "We are able to do surgery until 90 and 90-something."
And he said although the procedure can and will be applied to younger patients, it's older patients who reap the true rewards: The pain that older patients face, in particular, can be disruptive. Ms. Grandizio, for instance, took to sitting on her leg every time she sat in a chair to muffle the pain in her back, and she said she was unable to be as active as she would have liked. And Dr. Okonkwo said scoliosis patients often adapt to build their lives around their "severe, unrelenting, life-altering" pain.
"The most common thing that I hear from our patients ... is that their daily life has become a struggle, and that they start feeling hopeless about the future because they don't know if they can go on like this," Dr. Okonkwo said.
Still, the technique hasn't yet been widely adopted in the United States. Dr. Kanter, who was trained in the traditional method, said "the learning curve is significant" for the new procedure. He said some neurosurgeons might be resistant to learning how to operate in a new area of the body. And the technology required to monitor the nervous system during the operation doesn't come cheap, he said -- another barrier to its spread. Doctors use electrodes, which are connected to an external computer, to track the patient's nerves during surgery; the system, called neuromonitoring, substitutes for the full visual doctors usually have of a patient's back during an operation.
"I never took a pain pill or anything," said Ms. Grandizio from her home in Valencia. "I just started doing things like normal and moving, and I just take my vitamins now every day."