Failed Backs Treated with Minimally Invasive Techniques

Max Lee, M.D., Neurosurgeon, Columbia St. Mary’s

Posted: June 1, 2007

The term failed back generally refers to patients who have had spinal surgery and continue to have unresolved symptoms such as back pain, numbness, tingling or weakness of the spine. Although there are many instances where these lingering issues cannot be resolved, other times the symptoms associated with failed back can be improved through surgical intervention—and more specifically, minimally invasive spinal procedures.

Minimally invasive spinal surgery can be helpful in resolving five categories of failed back, including recurrent lumbar stenosis or disc herniation, incomplete surgery, adjacent segment disease, spinal deformity and pseudarthrosis.

• Recurrent lumbar stenosis/disc herniation – a condition that usually occurs as a result of aging and normal “wear and tear,” which may cause bulging or herniated discs or slipped discs leading to compression and pressure on the spinal nerve.
• Incomplete surgery – inadequate treatment may result in a continuation of symptoms.
• Adjacent segment disease – a complication that may occur following initial spinal surgery in which the area above or below the surgical site is effected.
• Spinal deformity – often results when too much bone, soft tissue or ligament is removed in previous spinal surgery. Can result in the weakening or collapse of the spine.
• Pseudarthrosis – a term which refers to an attempted fusion that has not been successful, either because the bone graft did not take or because the metal hardware, including screws, rods or plates, break.

The main goal of any spinal surgery is to provide pain relief and resolve associated symptoms. In recent years, minimally invasive spinal procedures have been developed to help decompress the spinal cord and nerve roots, stabilize the spine and correct spinal deformities. The two most common minimally invasive spinal procedures concentrate on decompression of the nerve roots or spinal cord, which may result from arthritis, work injury or other back trauma, and mechanical stabilization, in which surgery is used to strengthen a weakened spine as a result of aging, arthritis, tumor or back trauma.

Traditional spinal surgery typically involves the surgeon making a midline incision along the back and retracting or pulling aside muscle, which can cause additional trauma or damage. Minimally invasive surgery is performed using a telescope-like instrument called an endoscope that is inserted through tiny incisions. With minimally invasive spinal surgery, the back muscles are dilated, which causes less damage and trauma. Because minimally invasive techniques focus on a targeted area of the spine, the risk of additional trauma to other parts of the spine is greatly reduced.

Other common minimally invasive surgical techniques used to treat spinal conditions are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). In PLIF, small incisions less than three centimeters in length are made in the patient’s back and a bone graft is performed to help stabilize the spine, reduce spinal deformity and promote successful fusion.

A extreme lateral lumbar interbody fusion (XLIF) procedure accomplishes the same goals as PLIF, however in XLIF, the surgeon performs the procedure through incisions made in the patient’s side rather than his or her back. Using this method may result in the nerve roots being moved less during the procedure and may reduce the risk of scarring or damaging the nerve roots.

Another minimally invasive spinal procedure is kyphoplasty, a technique used to strengthen a patient’s weakened bone structure. Kyphoplasty involves inflating a tiny balloon into the vertebrae to restore height and shape. The balloon is then removed, and bone cement is inserted to help provide increased stability.

Minimally invasive spinal procedures offer several benefits including shorter hospital stays and a quicker return to work and daily activities. Patients also typically experience reduced post-operative pain and therefore require less post-operative pain medication.

Although minimally invasive procedures may impart less trauma, patients should realize they are still undergoing spinal surgery and as with all surgeries there is associated risk.


Max Lee, M.D.
Neurosurgeon
Columbia St. Mary’s
414-326-1745

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