(upbeat music)
- My name is Dr. Saifi
and I'm an orthopaedic spine surgeon,
at the University of Pennsylvania.
- And I'm Dr. Yoon.
I am a neurosurgeon specializing in complex spine surgery.
Today we're going
to discuss what the right type
of surgery is for you.
- I have many patients who come
to me both through Penn
or from outside institutions
who have significant pain.
Often these patients will have leg pain
or arm pain, and or back pain.
We also treat many patients
with severe spinal deformities.
And for these patients,
we often have a conversation in depth
about whether they're a candidate
for minimally invasive spine surgery
or traditional open surgery.
- There are types of conditions
where it becomes more urgent that the decision
for surgery needs to be made fast.
But for elective procedures,
you want to talk
to all the specialists, have all the options
and understand the risks and benefits
of each one.
Once you get to the point
where you need a spine surgery,
there are multiple options.
One option is having an open,
where midline incision is made,
and you can address a more complex disease.
And there's another type
of surgery that can be done
that's the minimally invasive option,
where the surgeons can make a smaller incision
and a more targeted approach
to address a pathology
and that really depends
on the type of pathology the patients have.
- Certain conditions, such as herniated discs
are often best treated
with minimally invasive approaches
in which an incision less than 20 millimeters
is typically made
and the patients go home the same day.
There is also another option, Dr. Yoon
performs endoscopic surgery.
Can you tell us a little bit about that?
- So the endoscopic surgery
is a special type
of MIS operation where the surgeons
uses a endoscopy camera to
Remove a piece of disc
or open up a opening
for the nerves.
So instead of using a tubular,
which is a little bit larger diameters about 20 millimeters,
we use about eight millimeter tubular ports
and then the camera is passed
and then the disk can be removed
or the framing can be opened.
Now not everybody is a candidate
for endoscopic surgeries,
but it is a type
of minimally invasive surgery
that can really minimize any collateral damage,
so the patient has less pain post-operatively.
- Certain surgeries however,
such as complex spinal deformities,
which I often treat,
are not amenable to minimally invasive,
but some spinal deformity surgeries
are amenable to minimally invasive surgery.
It's just important that you discuss
with your surgeon,
those specifics and your interest,
in minimally invasive surgery.
- Traditionally the surgeries are done
from the back
when the patient is laying down
on the table
and you approach the spine
from the back making an incision this way.
The side operation, direct lateral interbody fusions,
are done to the side.
So instead of making an incision from the back,
we make an incision on the patient's flank.
And then we can get directly down to the disc.
And this is a very,
very powerful operation that's minimally invasive,
where the patient has an abnormal curvature,
we can approach the spine from the side
and really correct their deformity
and then also not disrupt all their muscles
to do that.
- I agree, I've had many patients who
we've done this minimally invasive fusion option
who go home the same day from surgery.
Typically, our patients
for an open fusion stay in the hospital three,
maybe even four days.
But with the minimally invasive option,
they can go home either the same day
or the next day.
With patients who have a severe curvature
of the spine or scoliosis,
they sometimes are a candidate
for minimally invasive but sometimes not.
And so we have to discuss that
with the patient.
Sometimes it's just a risk benefit discussion
of whether the patient feels that
they want minimally invasive
and we discuss how that would benefit them
versus an open approach.
So it's really a discussion
with the patient about
what they feel is best for them.
- If their disease really involves multi-level,
meaning that it's not just one side
of the herniated disc,
it's from entire lumbar spine,
then the risk and benefit
of doing the minimally invasive spine surgery goes down.
So in that case,
an open approach may be a better option
for that patient.
There are two different types
of spine surgeons, like Dr. Saifi,
who's an orthopaedic spine specialist,
and myself, a neurosurgery spine specialist.
We both perform minimally invasive surgery
as well as the open traditional surgeries but
we both have different training,
but we work with each other.
So for the patient,
you want to go to a place
where you can have both representations,
and you have experts
from both neurosurgery and orthopaedics.
- Often at the Spine Center, Dr. Yoon
or myself will send each other
our patients to have a discussion about that
with other providers here.
- For example, in our center,
we have a weekly spine conference
where, not just two surgeons,
but we have both orthopaedic department
and the neurosurgery department.
All the doctors get together
and review a case so you get opinions
from at least 20, 30 providers,
who offer their opinion
and really formulate the best individualized
and, sort of customized, treatment plan.
And you can get that
at the Penn Medicine Spine Center.
(upbeat music)
Please go to the Penn Medicine Spine Center website
for more information.