Today's surgeons can nick out your gallbladder via your belly button and excise your thyroid gland without cutting your neck. Now some doctors have added one of recent history's most grueling operations to the ranks of minimally invasive surgeries.
These surgeons say there is a safer way to surgically correct scoliosis -- curvature of the spine -- than the current ordeal, which requires opening an incision that may extend from the shoulders to the pelvis and then stripping back muscles off the vertebrae to reach the bones that must be fused. Multilevel fusions -- those that involve shoring up vertebrae all along the spine -- are often seven-hour marathons followed by a stay in intensive care.
There is some debate about whether surgery is a wise procedure for scoliosis, and most often the condition is treated with bracing when it begins in childhood or adolescence. Because adults have skeletally mature spines, bracing can improve pain but won't really correct the problem. In children and adults, surgery usually isn't considered unless the sideways curve has reached 45 degrees or more, although sometimes surgeons intervene earlier if symptoms such as pain or shortness of breath develop.
Brenda McInnis of Midland, Mich., was diagnosed at a middle-school screening and lived with scoliosis much of her life. Though she was happy that her doctor and parents hadn't forced her to wear a brace, by age 47, her midback curve had grown to 50 degrees from less than 20. A compensating curve in her lower back sent severe pain into her hips. Most days she could tolerate only two hours at her job as a cashier in a hospital cafeteria. Eventually she had to use an inhaler to breathe.
In November, McInnis became one of fewer than 100 patients at four pioneering centers nationwide to have minimally invasive surgery to correct her scoliosis. Dr. Frank La Marca, a University of Michigan neurosurgeon, inserted dilating tubes through a series of small incisions up and down her spine. The tubes spread apart her muscles rather than ripping through them, providing a path for screws drilled into the sides of every vertebrae composing the curve.
As in the open procedure, metal rods were guided through the heads of the screws along both sides of the spine, straightening it. The screws and rods were placed without direct visualization, using CT and fluoroscopy (real-time X-ray) to guide the surgical team.
