Surgeon sees minimally invasive spine surgery as way to mitigate postoperative pain

SAN FRANCISCO — Minimally invasive surgical techniques may aid in pain prevention and management for patients who must undergo spine surgery, according to a presenter at the North American Spine Society Annual Meeting, here.

Minimally invasive spine surgery has little to do with the incision size and more to do with preserving and respecting the paraspinal structures; it is about saving the multifidus, according to Choll W. Kim, MD, PhD.

“At least with the posterior lumbar spine, there is convincing evidence there is less blood loss, less postoperative pain, shorter hospital stay [and] decreased infection,” Kim said, adding that it is likely there is classic recovery of function with minimally invasive surgery (MIS).

Choll W. Kim

He noted the multifidus can be spared from the surgical trauma that may lead to pain if the surgeon avoids the use of powerful retractors.

The difference in retractor pressures was 4.7 kPa with open spine surgery and 1.4 kPa with MIS spine procedures, according to Kim.

“Avoid unnecessary tissue displacement,” he said.

Posterior L4-5 decompression with a midline exposure involves massive tissue displacement and this results in pain; therefore, it should be avoided, Kim said. — by Susan M. Rapp

Reference:

Kim CW. Focused discussion: Advancements in the management of postoperative pain with or without opioids. Use of minimally invasive surgical techniques to minimize postoperative pain. Presented at: North American Spine Society Annual Meeting. Nov. 12-15, 2014; San Francisco.

Disclosure: Kim receives royalties from Globus, has stock ownership in SpineView, is a consultant to Medtronic, Globus, Synthes and Joimax and has speaking/teaching arrangements with Medtronic.