About 80% of adults experience low back pain at some point in their lives. And it’s the most common cause for job-related disability and a leading cause for missed days at work.
What can make matters worse is the fact that everyone seems to have their own bad-back baggage or family horror story about treatment gone wrong.
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Dr. Chase Bennett, a spine surgeon at Novant Health Brain & Spine Surgery-Bermuda Run is working to change that perception by introducing a new technique known as a lateral lumbar interbody fusion to the Winston-Salem market. His goal: Improve outcomes through a minimally invasive muscle-sparing approach.
Novant Health also offers this procedure in the Charlotte market.
Removing fear
Bennett says the biggest misconception he hears about back surgery is that patients tend to think that they will end up worse off after the procedure.
“If that were always the case,” he joked, “then our profession wouldn’t be around very long.”
Spine surgery actually has a long history. In fact, the first recorded case has been traced back to Egyptian mummies in 3000 B.C.
“Both our understanding of spinal pathologies as well as our treatment techniques have come a long way over the years,” he said. “Oftentimes the first part of the patient visit is spent addressing any specific concerns or preconceived notions that the patient may have so that we can start at a neutral place and work together to find a solution.”
From there, Bennett discuses symptoms with the patient, conducts a physical exam and reviews image findings. The goal: Develop a plan to make the patient feel better.
Traditional approach
Bennett says that the majority of low back pain can be treated conservatively, often with a combination of physical therapy, medications, and/or injections. In certain cases, however, surgery may be required. The culprit: Age-related wear and tear on the discs between the vertebrae. In these cases the pain can progress and won’t respond to nonsurgical treatment.
Historically, doctors performed a procedure called traditional open fusion, fusing two vertebrae and removing the motion between them.
The downside? An invasive procedure with large incisions, muscle tearing, a higher rate of complications and a long recovery time. But not anymore.
Minimally invasive option
One key surgical treatment option Bennett uses is called a lateral lumbar interbody fusion (XLIF).
This minimally invasive procedure only requires a small incision on the patient’s side – hence the term “lateral” – as well as one or two small incisions on the back. From there, Bennett uses real-time imaging and nerve monitors to guide his surgical instruments to reach the lower spine, or lumbar. At that point, he removes the diseased disc and replaces it with a titanium spacer implant to help improve the alignment of the spine and to take pressure off any nerves that have been pinched. He then places screws and rods through small holes in the back in order to provide additional strength and fixation without compromising the patient’s low back muscle.
Technology in the spacer is used to help stimulate bone growth so that the connecting bones in the spine will grow into and through the implant, making the spine strong and stable. The whole procedure takes about 90 minutes and most insurance companies will cover it.
“This is not your father’s surgery,” said Bennett. “When compared to the traditional approach, the incisions are smaller and we don’t have to peel back all of that muscle to reach the spine. As a result, patients generally have less postoperative pain, a decreased risk of infection and a quicker overall recovery. It is a very specialized procedure and we are excited to be the first center to offer it in our region.”
Most patients are able to walk around immediately after surgery and are discharged within one or two days.
Bennett does caution that this procedure is not for everyone. “There are things we look for in the patient’s imaging that help us to determine whether or not this is the correct procedure,” he said. “We always want to match the right procedure to the right patient to give us the best outcome.”
When to get help
Bennett says that back pain can raise a few red flags that signal the need for a doctor.
“If you are suffering from weakness, falls, or debilitating pain that is just not getting any better, then it is time to ask for help,” he said. “Keep in mind, we reserve surgery as a last resort. In many cases physical therapy, injections or oral medication can help relieve lower back pain.”
