University Of Florida Physicians Use Minimally Invasive Techniques To Correct Spinal Problems

GAINESVILLE, Fla.---Sam LoPalo had suffered back problems for years, but nothing prepared him for the day he bent over and couldn't straighten again.

Excruciating pain radiated down his leg. For days afterward, he barely could hobble from his bed to a recliner. Once in the chair, he'd stay there for hours.

LoPalo took pain-relievers on a regular basis, but nothing -- not even physical therapy -- brought him relief. Tests revealed two fragments of a lumbar vertebral disc were pressing on a nerve root.

"If you want to put one word on it, I was miserable," said the 60-year-old Gainesville resident.

Conventional surgery would have been a lengthy procedure, involving a long incision and a long hospital stay. Risks would have ranged from significant blood loss to infection.University of Florida neurosurgeons and orthopedists offered LoPalo an alternative: a minimally invasive approach to back surgery that helps patients with many kinds of spinal conditions, from slipped discs to scoliosis.

In February, using tiny incisions and guided by a small video camera, they operated on LoPalo at Shands at the University of Florida. The next day, he walked down the hospital hallway. Twenty-four hours after surgery, LoPalo no longer needed pain medicine.

Through procedures like this one, also known as endoscopy, UF neurosurgeons are revolutionizing back surgery.

While endoscopy has been commonplace in general surgery for several years, only recently has it been adapted for spinal surgery, said neurosurgeon Richard Fessler, a professor in the departments of neurosurgery and neuroscience at UF's College of Medicine, the UF Brain Institute and the UF Shands Neurological Center. He also is medical director of the Shands Spinal Cord Injury program and co-surgical director of the SpineCare Center. The development of specialized instruments and refinements in video camera clarity have led the way for new and improved minimally invasive approaches to spinal surgery, he said.

Thanks primarily to smaller incisions, benefits to the patient include decreased blood loss and risk of infection, reduced postoperative pain and recovery time, shorter hospital and intensive care unit stays, a quicker return to normal activities and lower health-care costs.

"Most patients return to completely normal activities within two weeks," Fessler said. "Patients have far less pain, their hospitalization is about half as long and the cost tends to be about half as much overall.

"Some of these techniques are very new and very ground-breaking," he added. "We are among the first in the nation to use this approach for such a wide selection of procedures."

For example, surgeons can now avoid making a large incision and splitting the chest to operate on the thoracic spine, widely exposing the operative area. Instead, they use a tiny camera called a thoroscope and a series of small incisions. Using probes equipped with light-emitting diodes, information is relayed back to a computer and displayed on a video screen, showing surgeons what they might not otherwise be able to physically see.

"The camera gives us an excellent ability to see exactly what we're doing but without directly exposing the area," Fessler said.

The method also can be used to remove infections or to fuse the spine to strengthen it after previous failed back surgery.

"Not all patients can opt for a minimally invasive technique, but a large percentage with isolated problems can be helped," said Dr. Michael MacMillan, an associate professor of orthopedics at UF's College of Medicine and co-surgical director of the SpineCare Center.

For LoPalo, the decision was easy.

"To me, this was a no-brainer," he said. "This was definitely the way to go. I'm really grateful. It was a very positive experience."

Founded in 1958, Shands at the University of Florida is a 576-bed not-for-profit tertiary- and quaternary-care facility that serves as one of the Southeast's leading treatment and referral centers. Shands offers a full complement of medical, surgical, pediatric, obstetrical and psychiatric services.

Shands was recognized among the top hospitals in the United States and Canada in the most recent edition of "The Best Hospitals in America." A recent issue of U.S. News & World Report listed Shands as one of "America's Best Hospitals," specifically in the areas of neurology, gastroenterology, cancer and otolaryngology.

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