Challenge of the Week / Spine / 01.14.2022

A 70-year-old male patient presents with increasing pain while walking for longer than 20 minutes. He reports no traumatic events but states that this pain has come on insidiously over the past 1 year. He can walk longer while holding onto a shopping cart, and sitting after walking immediately relieves his pain. Physical examination reveals mildly decreased sensation over his greater toes, and he has 5 of 5 motor strength in his lower extremities. He is interested in minimally invasive surgery. When discussing minimally invasive surgery with the patient, which of the following information should you provide?
    • Patients undergoing minimally invasive surgery have less pain, and these effects are noted at both the short and long-term.
    • Minimally invasive surgery (MIS) has not been shown to be superior to open laminectomy in the long term (i.e., >6-24 months). There is evidence that shows that MIS is associated with less acute pain, shorter hospitalizations, and use of less opioid pain medication; however, these differences are not preserved over time.

 

    • Minimally invasive surgery (MIS) will only delay the need for open surgery at a later time.
    • Minimally invasive refers to the exposure, not the spinal decompression. As long, as the stenosis is relieved, the outcomes are similar for open and MIS approaches, with less pain in the early period following MIS. The rate of incidental durotomy may be higher in MIS.

 

    • Patients undergoing minimally invasive procedures typically have fewer complications.
    • Minimally invasive surgery is associated with similar or more complications than traditional open techniques, especially incidental durotomy.

 

    • Minimally invasive surgery has not been shown to be superior to open laminectomy in the long-term.
    • Minimally invasive surgery has not been shown to be superior to open laminectomy in the long-term (i.e., >6-24 months).

     

Previous Post
Challenge of the Week / Shoulder & Elbow / 12.10.2021

Enter your information below to receive the JBJS Clinical Classroom Challenge of the Week.

 

Menu
%d bloggers like this: