When a Little is Just Right
On a mild day in late April a middle-aged woman with severe back problems was brought into an operating room at Mary Greeley Medical Center.
Dr. Gregory Brandenberg was to perform surgery to relieve the spinal instability that caused the woman so much pain. But this wasn't to be traditional back surgery. The patient, though she might not have known it, was to be the first to experience all the components of an exciting new surgical technique now used at the medical center.
Those components included the technique, itself, as well as cutting-edge surgical navigation equipment recently acquired by the medical center.
The technique is called minimally invasive spinal surgery (MISS), which is the central focus of Brandenberg,M.D., Ph.D., a neurosurgeon who joined the medical center staff last year. The technology is the O-Arm Imaging System, which creates three-dimensional CT scans during surgery, and the StealthStation, which a surgeon can use to view the 3-D images that will help guide him as he works on a patient.
Mary Greeley Medical Center is the second hospital in Iowa to acquire the O-Arm. (University of Iowa Hospitals and Clinics was the first.)
A Local Advantage
"The benefits of intra-operative navigation have been known for a while but they're not always available in all hospitals-community hospitals in particular," says Brandenberg. "You usually see them in academic hospitals or in larger metro areas. It's unusual for a hospital of Mary Greeley Medical Center's size to have the system."
The O-Arm and Stealth systems make MISS possible. The O-Arm does multiple slice scans of a patient's spine, generates a 3-D model of the spine and downloads these images to the StealthStation. The technology makes the surgery safer because it replaces fluoroscopy, a common imaging technique that requires the use of radiation.More importantly, it enables a surgical team to accurately navigate a surgical target.
"For example, we can use these images while placing screws and rods used during a spinal fusion procedure," says Brandenberg. "The O-Arm also has CT capabilities, so after you've placed the screws and rods you can scan the area intra-operatively to make sure everything is where it's supposed to be and correct them immediately if there are any problems."
MISS techniques provide even more benefits for patients. Traditional back surgery requires incisions that can be 6 inches long or more. It also involves stripping muscle from the spine, which can lead to more pain for the patient.With MISS an incision could be less than 2 inches and there is no stripping of the muscle. There's also less blood loss. All this should mean less post-operative pain for a patient. This, in turn, means that a patient can return to normal activities quicker and have less need for pain medication. MISS also can shorten hospital stays.
"The advantages of it still amaze me when I see patients in follow-up," says Brandenberg.
To get a sense of the impact Mary Greeley Medical Center's new capabilities are already having, just talk to Donald O'Connor and Joseph Murray.
O'Connor, who is from Lake City, has coped with rheumatoid arthritis since being diagnosed with the disease in 1957 when he was in his late 20s. The condition contributed to progressively worsening back problems. In December those problems began seriously eroding O'Connor's ability to walk.
In late January, following the review of a MRI and other test results, O'Connor was immediately scheduled for surgery with Brandenberg. He had multiple procedures to correct severe lumbar stenosis, which is a narrowing of the spinal canal, and a lumbar compression fracture.
The O-Arm was used for a kyphoplasty, a MISS procedure used to repair compression fractures. The O-Arm allowed Brandenberg to visualize the fracture and then aided as he guided long needles into the vertebral body. The needles were used to inflate tiny balloons that restored the height and shape of the vertebral body. Once the space was restored, bone cement was injected.
"If he (Brandenberg) hadn't done what he did, I'd be being pushed around in a wheelchair right now," a grateful O'Connor says. Because MISS is less stressful to a patient, the technique can be particularly helpful for elderly patients.
"Compression fractures are usually seen in the elderly, particularly in women because of osteoporosis," says Brandenberg. "I never thought I'd be doing procedures on people in their 90s, or their 80s for that matter."
In the meantime, O'Connor is getting around just fine with the aid of a walker. In early April, he and his wife visited their daughter for Easter dinner. O'Connor drove.
Joseph Murray, also of Lake City, had back pain for years. He got only temporary relief from drug treatments, epidurals and chiropractic.
"I was getting to a place where my lifestyle was being directed by the pain," says Murray. "I started doing some research and learned about less invasive surgical techniques."
Discussions with several doctors eventually led Murray to Brandenberg. "Our conversation was going for about 10 minutes or so when he started giving me some hope," says Murray. "He'd seen my MRI and everything. He was frank but low-key. He told me what was available and how it might help. He made it clear that I was the decision maker."
For Murray, the decision was easy. In early February, Brandenberg performed surgery on Murray to remove a herniated disc. Murray spent just one night in the hospital. His incision is less than an inch long and he now enjoys a significant reduction in the pain that had plagued him for years. He encourages anyone with persistent back pain to consider the surgery. Brandenberg's "techniques are new and they work," says Murray.
A New Direction
Brandenberg came to Mary Greeley Medical Center from Kettering Medical Center in Kettering, Ohio, where he first used the O-Arm. He also used surgical navigation devices during a residency at the University of Missouri-Columbia Hospital and Clinics.
At one point in his career, Brandenberg decided not to do spinal fusions anymore. He was concerned that he wasn't providing enough relief to his patients. The surgery was essentially "trading one kind of pain for another," he says. But he reconsidered after discovering MISS.
"The number of patients that can be helped has expanded because you're not putting them through a huge operation and you're leaving their anatomy as near normal as possible," he said. "For people worried about spine surgery, minimally invasive surgery is a more comfortable option."
While the benefits of MISS and surgical navigation technology have already been proven in spinal surgery at Mary Greeley Medical Center, the applications for brain surgery are just as thrilling. Read about those in the fall issue of Health Connect Magazine.