Benefits of minimally invasive spine surgery

Narrator: He again is with The Polyclinic, Dr. Sean Keem, orthopedic spine surgeon and Shannon O'Kelley talking about minimally invasive spinal surgery. 

Shannon O’Kelley: Dr. Keem how are you doing today?

Dr. Sean Keem: I am doing well and yourself?

Shannon O’Kelley: Doing great, thank you. Last time you came on we talked about, I believe it was Tony Romo and he had this back problem and you kind of talked about what happened with him and his injury and kind of outcomes and stuff like that. Stuff like that. I wanted you to come back because I want to talk to you about your specialty which is spine surgery, but more importantly minimally invasive spine surgery. We hear about minimally invasive surgery a lot in the world of medicine, particularly in shoulders and knees and those types of uh areas. But what about the spine? So tell us about minimally invasive surgery of the spine and your take on it. 

Dr. Sean Keem: Sure. Well first thank you for having me back and great to be here. So basically minimally invasive spine surgery is doing a spine surgery utilizing a special technique, creating minimum tissue disruption in the surrounding tissue. That is what it’s all about. It may employ endoscopy, tubing system, special retractors and whatever we do, we create minimally invasive, we take a minimally invasive route to minimize soft tissue trauma around the spine.

Shannon O’Kelley: Ok, so if you go back 20-25 years or even 15 years, maybe 10 years even. If you had back surgery, a lot of times you'd end up with a 3 to 4 inch incision in your back, um, fairly long incision when you're considering the spine. And what you're talking about that incision there'd be a lot of moving tissue around muscles, tendons, etcetera. Now you're talking about a much smaller incision minimally invasive, less trauma to that tissue, is that correct?

Dr. Sean Keem: That is correct. Actually it is not time matters and even in the same, even in this current era 95% of spine surgeries being done utilizing traditional spine surgery.

Shannon O’Kelley: Oh, I didn't even know that. 

Dr. Sean Keem: By doing minimally invasive spine surgery you have a much better chance to create a better outcome for the better of the patient.

Shannon O’Kelley: Is your access, because you know when you hear about the spin, we talk about cervical, or the neck, or the lumbar spine, or the low back. A lot of times you talk about a posterior approach or there might be an anterior approach. I mean is there any ah special approach when you talk minimally invasive surgery. Is there a best or something you like to do? Something you prefer?

Dr. Sean Keem: There are many ways of doing minimally invasive spine surgery. Long as the surgical technique creates minimum tissue disruption to the surrounding tissue and as long as it is done through a small incision and it is considered minimally invasive spine surgery. That could be done posterior from the back, that could be done anterior from the front, or it could be done from the side, lateral, or it could be done oblique lateral. And uh what I've been doing lately for the lumbar spine is oblique laterally incision and minimally invasive spine surgery.

Shannon O’Kelley: So on the oblique, tell our listeners when you say oblique lateral you're going through the area almost if the area you remember back as a kid if you had a side ache maybe where you used to get a side ache. You're going through that area, kind of right there?

Dr. Sean Keem: That's exactly right, the area you're describing right now with your hand.

[laughs]

Shannon O’Kelley: Yeah, yeah, on radio, right here. Right here.  

Dr. Sean Keem: So middle in between your umbilicus, belly button and the side. In between, that's the direction I usually approach the lumbar spine now a days. That's called oblique lateral lumbar fusion surgery or decompression. 

Shannon O’Kelley: Fascinating stuff. I love talking to folks like yourself because I'm just trying to picture that and the technique. And I'm trying to understand and let our listeners more importantly understand because they are on the radio obviously, not looking at us touch our sides. But you're going through the side there and you're doing surgery in the back and through a tube. Tell us about the instruments because you're doing it through a scope, if I'm understanding this, watching on a TV and doing the surgery through a tube going into the spine. 

Dr. Sean Keem: That is correct. So usually it is done incision between 4 to 6 centimeters long depending on the patient’s body size and uh I go in the area called your peritoneum from the front. And I place special retractor in there and that will take me to front part of the spine. And front part of the spine is where those load barring it happening and there I clean up whatever I need to clean up and place whatever I need to place to decompress the spinal canal, to correct the spine alignment and stabilize the spine. 

Narrator: Back with Dr. Sean Keem after this timeout on KOMO.

Shannon O’Kelley: Dr. Keem, thank you again for coming down and sharing minimally invasive surgical techniques for the spine. You were just describing the technique and I just wanted to review this because again I think this stuff is really fascinating and I know our listeners on the radio are trying to get a visual on this. You are basically inserting a tube and you’re inserting a scope to that tube going into the spine and doing all the work you need to do on the spine through that little incision that you described is 3 to 5 uh millimeters or centimeters.

Dr. Sean Keem: Well actually 4 to 6 centimeters. 

Shannon O’Kelley: Oh yeah, 4 to 6 so say.

Dr. Sean Keem: It’s a little bigger than 3 to 5 millimeters.

[laughs]

Shannon O’Kelley: yeah, yeah, good. I’m still trying to get the metric system down. 

Dr. Sean Keem: Sure, sure. 

Shannon O’Kelley: But here’s the deal, as a physical therapist, I can tell you I think the majority of the things we see following back surgery is really the recovery time. Not so much from the surgery, but back in the day it’s moving the muscles, it’s cutting muscles, and moving tissue. And it’s that trauma that the patient experienced accessing the surgery site. So you’re telling me you’re doing through a scope which I’m thinking as a therapist, the outcome must be really incredible for these people. 

Dr. Sean Keem: Absolutely, and enjoying a great outcome. And again when you touch that area you were just grabbing, not long ago, that’s the one area that you don’t have a lot of muscles. 

Shannon O’Kelley: Right.

Dr. Sean Keem: That’s the area that the muscles are rather pliable and I can usually kind of split open instead of cutting it all. 

Shannon O’Kelley: Right. 

Dr. Sean Keem: Then I can put my retractor in there so there is no muscle cutting. Because there is no muscle cutting there is no bleeding really.  Recovery is phenomenal, often a lot of my patients, if it’s just a single area problem, they go home the next day, and even for a scoliosis correction, people usually go home within the middle of three to four days. And the quality of recovery is much better. It doesn’t hurt that much. 

Shannon O’Kelley: Right, yeah. 

Dr. Sean Keem: So you don’t have to take a lot of narcotic pain medication. And I’m sorry that you’re a physical therapist, often obviate the necessity of having to have a prolonged physical therapy.

Shannon O’Kelley: Well we’re good with that. We’re good with that.

[laughs]

Shannon O’Kelley: We really like to see that, this is great stuff. From a physical therapist standpoint, when we can get right into the movement and function and not have to spend the uh uh the majority of our, remember most of our patients are only going to get 12 visits in a calendar year sometimes, so if we can get into the functional exercise and education and home program and make that patient independent quicker, that’s better for you and me and more importantly it’s better for the patient isn’t it. 

Dr. Sean Keem: there’s a great synergy between you and me. 

Shannon O’Kelley: Right. That’s what it’s all about and the outcome for the patient is incredible I mean minimally invasive surgical uh, you’re getting them moving faster.  They’re recovering, they’re getting back to work, getting back to activity. Back surgery sometimes can take a little bit of time. 

Dr. Sean Keem: Tell me about it. Not only that, you know people have this saying that once you have someone touch your back, you’re going to have to do surgery over and over again. So because we are minimizing the surrounding tissue trauma, having to bring the patient back for more surgery, it’s very rare. 

Shannon O’Kelley: You’re right. 

Dr. Sean Keem: So we don’t have to do a lot of revision surgery. And uh I like to do the surgery, but I like to offer my service to new patients, rather than bring the same old patients that I did surgery on a year ago and three years ago and keep having to fix it. So I don’t do that anymore. I rarely do it. 

Shannon O’Kelley: Well once again, thank you so much for your time. Great information, I’m sure our listeners are really interested in minimally invasive spine surgery. Thank you. 

Dr. Sean Keem: Thank you very much for having me. Have a great afternoon. 

Narrator: Pretty amazing stuff Shannon. The minimally invasive spinal surgery, I guess maybe was the knee was kind of the first to get the arthroscopic surgeries. Where you could just go in using that scope, you could look at the camera and clean up what had to be done, now similar stuff with the spine. 

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Shannon O’Kelley: Now the spine, knee, shoulder, and even the hip today. You can scope the hip. Which you go back 25 years and you just lived with that impingement of the hip you know.  So advances, advances, advances.

Narrator: Pretty amazing stuff. You can get more information on this at polyclinic.com.