Microscope Use And Neurosurgical Management Of Surgical Spine Disease

The use of the operating microscope has become the gold standard for neurosurgery and minimally invasive spine surgery. Now commonplace in hospital-based operating rooms and outpatient surgery centers alike, the microscope allows the surgeon to magnify the anatomy and illuminates the field of vision with three-dimensional optics for careful visualization of sensitive structures such as nerve roots and blood vessels in the spinal canal. This level of detail can mean the difference between a successful outcome and a complication.

Historically, the microscope was first introduced into the operating room in 1921. More rapid development over the 1950’s led to the introduction of the microscope in neurosurgery in 1957 and beyond. Since that time, microscopes have kept pace with advances in technology, now allowing the entire operating room staff to see what the surgeon and the assistant see, allowing the entire team to better anticipate the next move in the procedure. Light sources have become brighter while giving off less heat. The surgeon is able to change the magnification, adjust the focus, alter the light intensity, and start or stop video recording of the procedure all with a simple touch of a button while maintaining sterility. Current microscopes are highly technical pieces of equipment, costing up to $750,000. In addition, the use of the microscope requires the use of specialized micro-instruments during the procedure for an optimal outcome.

Microscopes allow the surgical incision to be made as small as possible, minimizing trauma to normal adjacent tissue and to sensitive structures during spinal procedures. These benefits result in fewer complications, less pain, and faster recovery for the patient with less blood loss and lower risk of infection.

Many times patients refer to microsurgery as “minimally-invasive.” To be fair, this is true; using the microscope does allow the surgery to be performed with the least amount of tissue disruption (invasion) possible. However, “minimally-invasive” typically refers to endoscopic surgery. In endoscopic surgery, the visualization is obtained using a camera through a series of tubes placed through the skin to provide access to the spine.

While endoscopic surgery and microscopic surgery are both minimally invasive, microscopic surgery has benefits over the endoscopic techniques. During endoscopic procedures, the surgeon has a two-dimensional view of a three-dimensional surgical site, looking at a monitor fed by a camera at the end of the endoscope. Microscopic spine surgery provides the surgeon with a true three-dimensional view of the anatomy. Because the view is not limited to the scope of the endoscopic camera, the field of view is far greater using the microscope. Some procedures, such discectomy, are considered to have higher complication rates with an endoscopic approach compared to the microsurgical approach (which is still considered the “gold standard.”)

Experience and comfort level with the operating microscope varies from surgeon to surgeon. For instance, neurosurgeons tend to incorporate the microscope from day one of their training. The microscope becomes second nature. Orthopedic surgeons tend to be introduced to the use of the microscope later in their training, or even after starting independent practice. Patients may want to ask their surgeon if they use a microscope when performing delicate spine procedures. When choosing the right procedure and the right surgeon for you, consider the following questions:

“What are my nonsurgical options?'”
At Wascher Cervical Spine Institute, we take the time to educate you about your diagnosis and all treatment options. We recommend nonsurgical measures first, and we collaboratively work with our physiatry (physical medicine) partners and therapists to develop a unique treatment plan for each and every patient. This may include over-the-counter medicine, prescriptions, injections, spine therapy, chiropractic, etc. Only if this plan fails to provide adequate relief will microsurgery be recommended.

“Are you board-certified in neurosurgery?”
Board certification ensures your doctor has the appropriate education, training, and experience to perform neurosurgical procedures effectively and safely. If you are seeking an orthopedic surgeon, make sure he or she is board-certified in spine surgery.

“Do you specialize in microscopic, minimally-invasive procedures?”
Just like board certification, you want someone who has proper training and experience with microscopic techniques.

“How many procedures like this have you performed?”
Go with experience – someone who has a solid reputation in microscopic spinal surgery.

“What are the risks and complications associated with my procedure?”
A specialist will be able to inform you of all the risks and possible complications of the proposed microsurgical procedure. Better yet, choose a surgeon who can discuss his or her own personal complication rates for a particular procedure and ask to compare that to published results of other surgeons so you make can an informed decision.

“What can I do to prepare for my procedure?”
Your surgeon can recommend ways to improve your outcome and reduce the chances of complications by making lifestyle changes, such as exercising, dieting, and stopping smoking.

“What will my recovery entail?”
Your surgeon should not only perform your procedure but guide you throughout your recovery by providing a comprehensive plan at an integrated facility. This should involve the services of a state-of-the-art surgical center, qualified physical therapists to get you back on your feet, rehabilitation specialists, and a range of treatment options that will return you to your active lifestyle.

If it is time to consider surgery to alleviate your spine pain, be sure to choose the most effective procedure, a qualified surgeon that you trust, and an integrated facility with “cutting-edge” technology that will see you through your recovery. Take charge of YOUR healthcare!