Many people suffering from lower back pain and from leg pain, numbness, and weakness can obtain significant relief from a procedure that involves a smaller incision, less postoperative pain, and a shorter hospital stay than traditional surgery, according to a board-certified neurosurgeon with IGEA Brain, Spine & Orthopedics.
Anil Nair, MD, FAANS, said that the procedure, known as minimally invasive lumbar discectomy, “involves a spinal surgeon using a small tube to access the area around the nerves of the lumbar — or lower — spine to remove the portion of a spinal disc that is compressing those nerves and causing symptoms.”
“With a minimally invasive approach, we make a smaller incision than we would with a traditional or ‘open’ surgery,” Dr. Nair said. “We then take advantage of natural planes within the body to minimize muscle trauma while still being able to remove a portion of the disc just as well as we can in an open procedure.”
Dr. Nair said that although a minimally invasive lumbar discectomy typically will be similar to a traditional discectomy in terms of operative time, the hospital stay and recovery time generally are shorter.
“Patients often are able to leave the hospital the same day. The next day, patients should expect some mild incisional pain, but this should easily be controlled with medications such as Motrin or Tylenol. We often recommend lighter activity for the first two weeks postoperatively. The patient then will be seen in the office to see how he or she is progressing. Following this, the patient should not have any specific restrictions, and will start a physical therapy regimen, if needed,” he said.
The physician added that while minimally invasive lumbar discectomy often is performed to remove a portion of a disc that is compressing a nerve, the procedure also is employed to treat conditions such as lumbar stenosis, foraminal stenosis, neurogenic claudication and other causes of back pain.
In addition to offering patients an effective alternative to open surgery, the board-certified neurosurgeons at IGEA Brain, Spine & Orthopedics also make use of the latest imaging techniques in performing their minimally invasive procedures.
“In a basic one-level minimally invasive lumbar discectomy, the surgeon will use X-rays to visualize the spine in the operating room,” Dr. Nair said. “In addition, our team now uses high-resolution CT imaging in the operating room for greater accuracy. Guided by this imaging, the surgeon removes a portion of the lamina, which is the back and side portion of the vertebra that overlies the neural elements. The ligament over the neural elements then is removed, and the neural elements are gently retracted to visualize the disc space. A small window is made in the disc, and the portion of the disc pressing on the nerve is removed. Often times in a large disc herniation, the window does not even need to be made because the herniated disc will push out on its own.”
The physician noted that a discectomy entails removal of only a small portion of the disc that is pressing against a nerve. By contrast, in a fusion procedure, the entire disc is removed so that a graft can replace the disc and fuse the bone above and below together.
Dr. Nair said that in addition to discectomy, IGEA Brain, Spine & Orthopedics neurosurgeons also take a minimally invasive approach to performing procedures such as laminectomies and foraminotomies, which may be indicated depending on where the area of compression is located. Sometimes, he added, these procedures are combined to maximize space around the nerve.
While minimally invasive procedures can provide significant relief to appropriately selected patients, Dr. Nair emphasized that many people experiencing pain and other symptoms from lumbar disc problems will not need surgery. “As with most medical conditions, a conservative approach to spinal issues is often the best initial approach. This involves a course of physical therapy and pain management. If a patient has tried these conservative options and continues to have symptoms, that is when we consider surgical treatment. To evaluate the patient’s condition, we review the MRI findings to ensure that the patient’s symptoms correlate with the imaging. Often, we will also have patients undergo a nerve test called an EMG. When planning a surgery, we obtain X-rays of the lumbar spine as the patient bends forward and backward to ensure there is no instability, and to confirm that the patient will be a good candidate for discectomy,” he said.
The neurosurgeon said that the best candidates for minimally invasive lumbar discectomy are men and women whose pain starts in the back and radiates down the leg, and whose symptoms correlate with a lumbar disc herniation seen on MRI and with the results of EMG testing. In many cases, he noted, such patients have short-term improvement with injections but do not achieve long-term improvement until complete decompression of the nerve is accomplished surgically. He added that patients who show signs of instability on X-ray tend not to be good candidates for minimally invasive lumbar discectomy, and more frequently require a fusion procedure, which also can be done in a minimally invasive fashion.
“Today, there is a great deal that we can do — whether with medical management or surgery — to help people experiencing lower back pain and leg symptoms caused by a compressed nerve or similar problem. The key is to select the approach that is best suited to each particular person, and to his or her specific situation,” Dr. Nair said. “Lumbar discectomy is a good option for treating spinal conditions in the right patient. Minimally invasive lumbar discectomy takes this to the next level by shortening recovery and minimizing muscle trauma to improve outcomes. But the tried-and-true open procedures are more appropriate in certain situations. The important thing is to have a surgeon who is well trained in the different techniques so that he or she can offer you the best option for your situation.”
Dr. Nair received his medical degree from the University of Missouri-Kansas City School of Medicine. He then completed a general surgery internship, neurosurgery residency, and enfolded a year of endovascular neurosurgery training at Albany Medical Center before completing a fellowship in neurovascular surgery and endovascular surgery at Jefferson Hospital for Neuroscience in Philadelphia. Along with his IGEA colleague Ciro G. Randazzo, MD, MPH, FAAN, Dr. Nair is among the few neurosurgeons in the country trained in both open neurological surgery and neuroendovascular surgical techniques.
In addition to Dr. Nair and Dr. Randazzo, IGEA Brain, Spine & Orthopedics board-certified neurosurgeons David Poulad, MD, FAANS, FACS, and Adam Lipson, MD, FAANS, FACS, have extensive experience performing minimally invasive procedures to treat lumbar disc problems, other spinal complaints, and conditions affecting the brain, including tumors and vascular issues.
“The four neurosurgeons at IGEA Brain, Spine & Orthopedics have a combined 40 years of experience in minimally invasive spinal procedures. We all are board-certified, and use the latest techniques to optimize surgical outcomes for our patients,” Dr. Nair said.
Beyond the practice’s four neurosurgeons, the IGEA Brain, Spine & Orthopedics’ staff includes board-certified neurologist Charles Gellido, MD; board-certified orthopedic surgeon Arun Rajaram, MD; board-certified neuropsychologist Anthony De Marco PsyD, ABBP-CN, as well as physician assistants and other health care professionals.
With offices in Paramus, Union, Florham Park, Hazlet, and New York City, IGEA Brain, Spine & Orthopedics offers comprehensive, multidisciplinary care to patients experiencing a wide variety of neurologic and musculoskeletal conditions and complaints.
To schedule an appointment with Dr. Nair or one of the practice’s other physicians, or to learn more about IGEA Brain, Spine, and Orthopedics, call (866) 467-1770.