A NEW APPROACH TO THE SPINE

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Endoscopic spinal fusion can relieve chronic back pain By TARA PARKER-POPE - The Wall Street JournalDate: 04/01/01 22:15 Chronic back pain stopped 40-year-old Dishinger from even bending over to tie her daughters' shoes for two years. After medications and various treatments failed to relieve the pain caused by a collapsed disk, the Yorktown Heights, N.Y., mother faced spinal-fusion surgery. The prospect was scary. Friends who had undergone a similar procedure had warned her of a long recovery and recurring pain. But only one day after her recent surgery, Dishinger was walking, needing only a cane. Today she can take long walks, give her daughters a bath and is even considering taking up horseback riding again. How did Dishinger go from chronic pain to pain-free in a matter of days? She credits a new endoscopic spinal-fusion procedure that to date has been performed on less than two dozen patients. "It has changed my life," Dishinger says. Each year an estimated 100,000 lower-back-pain sufferers undergo traditional spinal-fusion surgery, in which the troubled part of the spine is locked in place with screws, allowing the bones to eventually fuse. The theory is that stopping the movement in the spine will stop the pain. But while spinal-fusion surgery is effective in correcting the initial problem, it often can trigger new back problems because of the extensive damage done to back muscles. To perform the surgery, doctors make a large incision down the back and strip the muscles off the bone so they can reach the spine. Patients are hospitalized for as long as 10 days, and recovery can take months. The Food and Drug Administration recently approved an endoscopic fusion device from Endius of Plainville, Mass. The device allows surgeons to perform spinal fusion through two small incisions in the back. A 3/4-inch diameter tube is inserted, the end of which opens to push just enough muscle tissue out of the way to make room for the fusion procedure. Surgeons can see the spine directly through the incision, and a camera in the tube gives them a close-up view on a video monitor. Goodwin, attending orthopedic surgeon at the Hospital for Special Surgery in New York, was the first surgeon in the country to use the technique. Goodwin says he was interested in the technology because it doesn't change the basics of a 40-year-old, tried-and-true surgery. "But post-operatively, it was like an entirely different operation from the open-spine fusion," he says. Goodwin says his patients didn't need spinal drains, could get out of bed the next day and lost only a minuscule amount of blood. The typical spinal-fusion patient loses 800 to 1,200 cubic centimeters of blood, often requiring blood transfusions. Meanwhile, his endoscopic surgical patients lost so little blood he had to squeeze out the surgical sponges to measure just 30 ccs of blood loss. One concern is that long-term results of the endoscopic procedure aren't available, although surgeons say it stands to reason that patients undergoing endoscopic fusion will fare better than those having the more traumatic spinal surgery. Larry , a surgeon at Crestwood Medical Center in Huntsville, has performed the endoscopic spinal fusion. He says he is pleased with his patients' fast recoveries, but he says many patients, depending on the extent of their back problems, won't be good candidates for the technique and will still need the open-spine surgery. The endoscopic technique is only for lower-back problems and isn't approved for use on patients with spine pain around the neck or middle back. Those patients account for about half of the 200,000 spinal fusions each year. As with traditional spinal fusions, many patients who undergo the endoscopic technique still need another incision in the pelvic area so surgeons can harvest a sliver of bone for use in the fusion procedure. Other doctors say it's important that patients continue to view any spinal surgery as a treatment of last resort. Vijay Vad, sports-medicine specialist at the Hospital for Special Surgery, is presenting research to the American Academy of Orthopaedic Surgery showing an 84 percent success rate using a combination of steroid injections and physical therapy for patients with back pain. Vad says that while the combination treatment required a significant effort and time investment by the patient, it's far more desirable than surgery, even a less invasive one. "The more we do nonsurgically for the back, the patients win out," Vad says.

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