Robotic Spine Surgery
Cutting Edge Surgical Technology
The use of a robotic surgical system is the newest and most advanced technique to ensure safe and accurate anatomic precision during spinal surgery. By combining the processing power of a computer and advanced imaging, exact trajectories for spinal instrumentation can now be performed through small and cosmetic incisions. Read about the Mazor Robot-Guided Spine System I use at Hackensack University Medical Center here.
The minimally invasive transforaminal lumbar interbody fusion is a surgical technique which allows the surgeon to achieve appropriate neural decompression and also provides rigid stability to allow for fusion. It can be used to treat a variety of spinal conditions such as spondylosis, spondylolisthesis, and spinal stenosis. Through small cosmetically appealing incisions, the patient will experience relief from radiating pain down into the lower extremities as well as localized low back pain. Recovery time from an MIS TLIF is commonly much quicker than older more traditional approaches, with patients home from the hospital within a day and back to their usual activities by 6-8 weeks. For a video of the technique I use with the Nuvasive MAS system, please click here.
sCIATICa & sPINAL sTENOSIS
Sciatica is a common medical diagnosis that refers to pain attributed to dysfunction of the sciatic nerve, which is composed of multiple nerve roots from the lumbosacral spine. The sciatic nerve is responsible for providing motor and sensory function to the lower extremity. Compression and irritation of this nerve can lead to not only pain, but weakness, tingling, or numbness as well. The pain from sciatica can be transient or constant, and typically arises from the low back and buttocks, traveling down the back of the thigh and sometimes into the leg and foot. It is commonly described as a burning and shooting pain that can be worse with sitting. Many times the pain can be severe and debilitating, limiting one’s activities of daily living.
A common cause of sciatica is spinal stenosis, characterized by narrowing of the spinal canal. This results in less space available for the spinal cord and nerve roots that provide critical function to the entire body. Stenosis at the lower levels of the lumbar spine can occur both centrally within the spinal canal as well as laterally in the foramen that the nerve roots exit, explaining the potential for both bilateral or unilateral symptoms respectively. Stenosis frequently results from degenerative arthritis of the joints within the spine (spondylosis), degradation of the intervertebral discs (degenerative disc disease), or slippage of one vertebra on the adjacent one (spondylolisthesis).
Medical professionals will commonly assess patients suffering from sciatica with a thorough neurologic physical examination and xrays to examine the bony alignment of the spine. MRIs are commonly obtained to examine the spinal anatomy in greater 3-dimensional detail. Early treatments include anti-inflammatories, physical therapy, weight loss, and oral steroids. More invasive procedures such as epidural, foraminal, or facet injections can many times relieve the symptoms of sciatica. Failing these conservative attempts can ultimately result in consultation with a spine surgery specialist. Other more urgent reasons to see a spine surgeon include progressive weakness in the extremities or loss of bladder or bowel control.
The good news for patients with debilitating sciatica and spinal stenosis is the advancement of minimally invasive surgical techniques to address spinal stenosis and degenerative conditions of the lumbar spine such as disc disease and spondylolisthesis. Using smaller incisions and microsurgical techniques, surgeons can remove offending pathology and provide more space and stability for the spinal nerves with less disruption of the surrounding tissues. Furthermore, these procedures many times can be done on an outpatient basis. Recovery from these procedures is usually rapid, with full return to activity within days to weeks of the surgery.
I have been privileged to work at some of the most prestigious hospitals in the country, particularly for Orthopaedics, as ranked by US News & World Report. Thomas Jefferson University Hospital, Yale-New Haven Hospital, and the #1 hospital overall Hospital for Special Surgery, have all been stops in my career. I am now proud to perform my surgeries at one of the top hospitals in all of New Jersey, Hackensack University Medical Center.
History of Orthopaedics
Pioneers in Spinal Surgery
Orthopaedics is derived from the Greek words orthos, meaning straight, and paes, meaning child, hence "straighten child". The term was coined by a French surgeon named Nicolas Andry in 1741, utilized as his book title describing human anatomy, skeletal structure, growth, and instructions for correcting deformity. The picture to the left was the first page of his manuscript, illustrating a curved tree lashed to a straight post, the current symbol of our discipline. The xray to the right illustrates a classic case of idiopathic adolescent scoliosis, notable for the curvature of the spine matching Andry's tree. Dr. John Cobb, a pioneer in scoliosis surgery from the early years of the Hospital for Special Surgery, has written that Andry had in mind spinal deformity when devising the picture to describe Orthopaedics. Today, many of the surgeries we use to address spinal pathology were first performed and described by orthopaedic surgeons.
Fancy marketing with little practical use
The concept of laser spine surgery has been much publicized in the mainstream media as a hi-tech means of treating spinal pathology. A better descriptor, however, might be hype, as there is minimal practical use for a laser during spinal surgery. An acronym, the word laser stands for light amplification by stimulated emission of radiation. In essence, a laser is a focused beam of light that can be used to burn or cut soft tissues in the body, such as the eye or skin where it is commonly used appropriately. As spinal surgery necessitates removal of the bone or ligaments like the intervertebral discs, the use of a laser is impractical and not commonly done by legitimate spine experts. It is a powerful marketing tool since patients are looking for the newest, most technologically advanced treatments, and as such a number of self-styled spine experts will claim to perform laser spine surgery. I would advise caution and further reading on the topic before trusting a provider that offers the service. The North American Spine Society sponsors this review on the topic, highlighting the limitations in evidence-based research and concluding that it "may be more effective in attracting patients than in treating them."
A compression fracture is the vertical collapse of a vertebra in the anterior portion of the spine. It is commonly due to minor trauma in the setting of weakened bone, frequently in patients with osteoporosis. Thus VCFs can be described as fragility fractures, a specific subset that occurs in the elderly. Bone diseases, cancer, and infection can be other contributing factors. In the acute setting, VCFs can cause significant pain and dysfunction, with ultimately the potential for a kyphotic deformity to manifest. Treatment is many times conservative with bracing and anti-inflammatories, although a kyphoplasty can be performed to restore alignment and alleviate pain in select patients. There is currently a large focus of research in Orthopaedics on preventing further fragility fractures with comprehensive patient workup and appropriate treatment of osteoporosis.
vertebral compression fracture
A minimally invasive approach for bulging or herniated intervertebral discs
The microdiscectomy is a surgical technique used to alleviate neural compression from a bulging or herniated disc in the lumbar spine, which is commonly diagnosed with a MRI. Although the significant majority of intervertebral disc herniations can be managed conservatively with physical therapy, oral medications, corticosteroids, or even epidural injections, some patients can develop worsening pain, sensory disturbances, or even weakness, and as such may benefit from this surgery. After surgery, patients will typically notice an immediate improvement in their radiating lower extremity pain, and some patients even report improvements in their low back pain. Recovery from numbness or weakness as a result of nerve compression depends on the severity and duration of the symptoms, and can take weeks to months in some cases to recover.
A microdiscectomy consists of a small 3cm incision in the midline of the lumbar spine over the corresponding lumbar disc space. I use an intraoperative microscope to ensure excellent visualization of the critical anatomic structures. A small laminotomy is performed to allow access to the disc space, and the herniated disc material is removed relieving the compression of the nerve root. This procedure is frequently an outpatient one, with patients going home and returning to normal activities immediately, and full strenuous activity by 6 weeks. For a video illustration of the surgery, please click here.
SETON HALL UNIVERSITY SCHOOL OF MEDICINE
Dr. Long is proud to serve as an Assistant Professor of Orthopaedic Surgery at the newly formed college of medicine at Seton Hall University, teaching the next generation of doctors during their training as medical students. He firmly believes in the importance of giving back to the medical field by volunteering his years of experience and expertise in treating the patients of our community.