Dr. Leipzig is a board-certified Virginia spine surgeon with over two decades of experience. He treats spinal stenosis, specializing in procedures like minimally invasive lumbar laminoplasty, microsurgical lumbar surgery, robotic spine surgery, disc arthroplasty, and more.
Minimally-Invasive Spine Surgery
Minimally-invasive spinal procedures (less-disruptive spine surgery) have made surgery less painful and far more effective than ever before. Virginia Spine Care is one of only three sites in the state to offer navigated robotic guidance surgery, bringing patients more treatment options and even more precision surgery
One recent case, our 41st robotic procedure, perfectly exemplifies why we invest in these advancements: to greatly improve the quality of lives of our patients.
This is a 56-year-old male patient with both spondylolisthesis and spinal stenosis in his lower back at the L4/5 level. He was experiencing classic symptoms of back and leg pain, with difficulty and limitations with standing and walking. He had failed standard conservative measures of physical therapy, NSAIDS, and epidural steroid injections. His symptoms had progressed to the point where his limitations were unacceptable to him and severely curtailing his activities of daily living.
We’ve discussed spinal stenosis in the past, but briefly, this condition is a narrowing of the spaces within the spine that can put pressure on the nerves that travel through the spine. While some people with mild cases may not have symptoms at all, others may experience pain, tingling, numbness and muscle weakness that worsen over time. Spinal stenosis is most commonly caused by wear-and-tear changes stemming from degenerative changes in the lumbar (or cervical discs). Surgical intervention is directed at enlarging the spinal canal and decompressing the neurologic elements. This is generally referred to as a laminectomy, or posterior decompression.
This patient’s other diagnosis, spondylolisthesis, refers to one vertebral body (not disc) shifted forward relative to the lower vertebral body. Because of this shift, which is generally a consequence of disc degeneration and arthritis, the spinal canal is mal-aligned, therefore narrowing the spinal canal and compressing the nerves. This is a very common condition and is a major reason that people undergo spinal fusion surgery, to address this mechanical instability issue.
Nonsurgical treatments such as, physical therapy, nonsteroidal anti-inflammatory medicine for pain, even epidural steroid injections are accepted initial options, if conservative, non-surgical treatment fails, patients may benefit from a surgical approach. A spinal fusion is appropriate when the symptoms don’t respond to nonsurgical therapies or in the presence of neurologic changes and instability.
In the presented case, conservative measures failed and the patient elected for surgery.
We performed a same-day anterior-posterior spinal fusion. The spine was approached from the front, through a small abdominal incision with the assistance of a vascular surgeon. The disc was removed and the shift was reduced to anatomic position. We then placed a titanium intervertebral spacer and integrated fixation. The patient was then repositioned, and pedicle screws were placed with a navigated, robotic-guidance system through very small incisions. Underscoring the precision and effectiveness of this procedure, our patient was able to ambulate on the same day following surgery and was discharged home the following morning, resulting in a less-than-24-hour stay. Importantly, the realignment of the spine decompressed the neurologic elements in an indirect fashion, and therefore, a traditional laminectomy was not necessary. This is a major advance and results in significantly less-involved and less-invasive surgery.
Spine degeneration, vertebral changes and narrowing of the spinal canal are very common with age. Advanced minimally-invasive techniques, coupled with state of the art robotic guidance have made surgery safer and less invasive. Unfortunately, not all spinal conditions justify surgical attention, and conservative measures are often ineffective.
If you are experiencing any of the symptoms above, would like to learn about treatment options, or are concerned about your spine problems, contact Dr. Leipzig at our spine care office today to schedule an appointment.