One out of 10 people suffers chronic back or neck pain — the kind of pain that can severely impact a person’s life quality and turn routine activities into unbearable experiences. The extent of the problem is truly global: Back pain is now the leading cause of long-term disability and work absence worldwide.
On the positive side, the past few decades have seen significant advances in surgical techniques and medical instrument technology, bringing dramatic improvements in treating spinal disorders and alleviating back pain. Here is a look at the innovations that have had the biggest impact.
A look back at traditional open spine surgery
Looking back 25 to 30 years, spine surgery was one of the most traumatic medical procedures. Surgery typically required a long hospital stay of one to two weeks, followed by a significant time at home to fully recover.
A typical spine surgery was performed with large incisions of 10 to 15, even 20 centimeters, in order to give the surgeon sufficient visibility of the affected area. After the incision, the surgeon would then have to peel back layers of muscle from the bone to clear a path for the actual repair, which is a major physical trauma for even the healthiest patients.
The extent of blood loss during surgery was also significant — typically about one-and-a-half liters — which meant that patients had to be in very good health to be candidates for the surgery; the high volume of blood loss posed too great a risk for patients with heart or circulatory issues.
The first major step forward came from surgical microscopes. Over time, microscope innovation produced big improvements in illumination and magnification, enabling surgeons to see better, closer, and more clearly — and when you see better, you can cut less. With the better microscopes , we were able to reduce incisions down to about three to five centimeters. That meant a lot less physical trauma patients, greater safety, and more accurate surgery. And that really is the essence of “minimally invasive.”
A microscope provides a view from outside the body. The next phase of innovation revolved around the endoscope, which provides a view from inside the body. An endoscope is a thin lighted tube that has a camera attached at the tip; through the tube we are able to insert tiny surgical instruments. Using an endoscope enabled us to reduce the size of incision even further — no matter how big the patient’s body size is — down to one centimeter or less.
With endoscopic surgery, the goal of the surgery hadn’t changed. We were still pursuing the same goal for the patient, but we were causing much less damage to the patient’s surrounding muscle tissue and ligaments.
Computer-assisted 3D Navigation
For the specific group of patients who need reconstruction of the spine —perhaps due to vertebral collapse, or in the case of a loose joint that requires the insertion of a screw — with earlier techniques, it was quite common for patients to be very fearful about the possibility of the screw hitting a nerve instead of the bone.
At Bumrungrad, we have been using a 3D computer-assisted navigation system for almost five years. The system produces detailed 3-dimensional images in real time, and the navigation component guides the screw to its precise intended location. Since adopting the system, we have been able to achieve an accuracy rate of up to 99.8 percent, and that rate is based on more than 3,000 screw insertions. That high level of accuracy represents a significant improvement from earlier generations of spine surgeries.
About the Spine Institute
The Spine Institute at Bumrungrad International Hospital provides comprehensive medical treatment and state-of-the-art facilities and technology for patients with back and neck problems. For more information, or to make an appointment for a consultation, please call +66 2011 3077, request an appointment through Bumrungrad’s online appointment system , or send your inquiry to us by e-mail.
Written by Spine Institute, Bumrungrad International Hospital