Big Back Pain? Try Small Holes.

Almost as certain as death and taxes is back pain. One particular type of aching back -- lumbar spinal stenosis -- occurs in almost every adult at some point, as a part of the aging process. Stenosis is, essentially, chronic pain caused by a narrowing of the spinal cord. The resulting pinching of the nerves causes persistent pain in the lower backs, buttocks, or legs; sometimes it also causes limping and other mobility problems.

However it manifests, lumbar spinal stenosis hurts, and it also gets in the way of day-to-day living. It’s the most common reason for back surgery among people ages 60 and older -- and surgery is the only treatment proven to provide long-term relief for lumbar spinal stenosis, though it is recommended only after conservative therapies (such as anti-inflammatory medications, physical therapy, or steroid injections) fail.

For most of us, back surgery itself conjures some pretty painful images -- long incisions, long hospital stays, long recoveries. But a new approach to back surgery is taking over, says Rob Isaacs, MD. A Duke neurosurgeon, Isaacs performs stenosis decompression procedures and other spine surgeries through minimally invasive techniques. By using endoscopic equipment and microsurgical techniques to perform surgeries through very small incisions, he can send most stenosis patients home from the hospital within 24 hours -- and without heavy pain medication.

Isaacs says that spine surgeons at Duke use minimally invasive techniques for everything from spinal stenosis to tumor removal, scoliosis corrections, and trauma surgeries. Though these types of operations generally take longer to perform, the payoff is a drastic reduction in post-surgical problems, pain, and complications: Infection rates are dramatically lower than that of open surgeries, and the need for blood transfusion for some surgeries can approach zero (whereas the same procedure done in the traditional fashion requires a transfusion in one of every six cases).

“There are few spinal surgeries that we don’t do in a minimally invasive way,” Isaacs says. “The more complicated the surgery, the more a patient can benefit from a smaller incision. In terms of less time spent in a hospital bed and fewer surgical risks and complications, our patients get more bang for their buck from these [tiny] techniques.”

Too Old for Back Surgery? Says Who?

Can a person past a certain age fully recover from back surgery? Will she have to take dangerous pain medication? Most important, can she tolerate the physical stress of surgery and anesthesia? Conventional wisdom has been that minimally invasive operations -- which take longer than open ones -- put an older patient in too much danger.

Rob Isaacs says otherwise. “We’ve shown that for someone who is 80 years old and healthy, there is no difference in the rate of complications than for a patient who is 60.” In fact, he says, minimally invasive surgeries for spinal stenosis consistently result in shorter hospital stays, minimal requirements for narcotic pain medications, and a low rate of readmission and complications. “Ninety percent of our stenosis surgery patients 80 years and older go home within 24 hours.”