Minimally invasive spinal surgery involves the use of smaller incisions that minimize damage to the surrounding muscles and ligaments of the spine. Our expert surgeons have successfully performed thousands of minimally invasive surgeries ranging from discectomies for disc herniations, decompressions for stenosis and fusions for spondylolisthesis, degenerative disc disease and scoliosis.
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Former journalist Mike Feinsilber, 78, could barely walk more than a few blocks; 60-year-old Ray Weil, a University of Maryland professor with an active lifestyle, had trouble covering more than a few feet.
The culprit in both cases was years in the making: severe leg pain stemming from a bad back, the cause of misery for so many. At various times, both men tried to stave off pain and disability through a combination of traditional and complementary approaches, including physical therapy, chiropractic and acupuncture. Nothing really worked, or brought relief for very long.
Finally, Mike and Ray found relief—beyond their expectations—at MedStar Georgetown University Hospital at the hands of two of its experts in minimally invasive spinal
surgery: Drs. Faheem Sandhu and Jean-Marc Voyadzis. The two lead the area in performing minimally invasive spine surgery.
“We use minimally invasive approaches whenever we can get equal or better results than in open surgery,” said Dr. Sandhu, director of spine surgery. “In our experience, that’s 80 percent of the time. Thanks to these procedures, we’ve even successfully relieved pain and restored mobility to patients in their 80s and 90s who could never undergo a major open surgery.”
Nationwide, less than 20 percent of spinal surgeries are performed using minimally invasive techniques. However, the procedure is gaining acceptance, as more physicians become acquainted with its benefits.
Minimally invasive spinal surgery preserves as much of the body’s original architecture as possible by splitting muscles and ligaments, rather than detaching or stripping them from the bone. That technique results in smaller incisions, less blood loss and improved recovery overall.
In addition, the approach can decrease potential long-term problems or complications that can occur after open procedures. Equally important are the results, according to Dr. Voyadzis.
“Minimally invasive spinal surgery really only came into its own a decade ago,” he said. “A growing number of studies are demonstrating that these techniques are safe and effective—when compared to traditional approaches, with patients returning to normal activities faster.”
That certainly appealed to Ray, whose severe back pain was a constant companion for 30 years. When it started affecting his legs, Ray reluctantly looked into surgery. The news he first received—from another top-rated institution—was unsettling.
“The other surgeon told me that he’d have to cut muscle, tendon and bone, and fuse three vertebrae,” said the soil scientist. “He also cautioned I could only expect to reduce the pain by about 40 percent in my back and 80 percent in my legs. And that my days of jogging, yoga and digging were probably over.”
So Ray searched for a better alternative and soon had an appointment with Dr. Voyadzis, with great results. Shortly after minimally invasive surgery to stabilize his vertebrae and decompress his spinal nerves, Ray’s pain disappeared. Within two weeks, he was walking a mile or two a day. Now, he does 80 crunches each morning, rides his bike to work, prunes trees and chops wood—just about everything he did before his back pain started.
For his part, Mike Feinsilber already knew about MedStar Georgetown after the “big success” of his quadruple bypass surgery years earlier. After exploring other options for his spinal stenosis, he asked
Dr. Sandhu to tackle it. Through a solitary incision less than 1 inch long, Dr. Sandhu removed the bone and ligaments that were compressing the nerves at two levels in Mike’s lumbar area.
“I found relief right away,” he said. “Recovery was pretty painless: I was on my feet within a few hours and went home the next day.”
With their training, experience and track record, Drs. Sandhu and Voyadzis wrote the book on minimally invasive spine surgery—literally. The MedStar Georgetown specialists have one textbook on the topic to their credit with another in the works. They’ve also co-authored numerous peer-reviewed articles and regularly train physicians in the U.S., Europe and Latin America on the special techniques involved.
“The patient benefits are just so great,” said Dr. Sandhu. “We’re absolutely dedicated to resolving the maximum number of problems with the most minimally invasive techniques.”
“My ‘before’ experience was a bad situation only getting worse,” said Mike. “My ‘after’ situation—and it came immediately after surgery— was great: blessed normality. No pain, no difficulty walking. My back hasn’t felt this good in 20 years.”
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John Alberstadt barely covered a block of his typical four-mile run before it hit him: he couldn't continue without falling.
"It was scary. I was used to running or biking every day, but [now] I was scuffing my feet, losing my balance, tripping."
John had several cervical spinal stenosis - a narrowing of the canal that separated the nerves in the spinal cord from the surrounding vertebrae that make up the bony spinal column. Herniated discs worsened his condition. The combination was squeezing hsi spinal cord, affecting the nerves that controlled his extremities.
" He had the classic telltale symptoms," Dr. Seyed Kalantar says. In addition to numbness and lack of balance, Jon was having trouble grasping things, buttoning shirts and using a pen."
Since Jon was an avid snowboarder, Dr. Kalantar recommended a less invasive option: Laminoplasty. Laminoplasty is a surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. Since no bone is removed, fusion is not necessary and range of motion can be preserved. The day after the hospital discharge, Jon started taking two mile walks; three months later, he was cleared for activities at the gym. He is expected to be back snowboarding in no time.
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An assignment in Iraq is fraught with danger. But it wasn't the fear of a roadside bomb or incoming mortars that interfered with Gavin Helf's work. He shook at the prospect of strapping on his personal protection equipment. Donning his flak jacket and helmet every time he traveled outside the Green Zone was excruciating.
"The back paid I'd suffered for years would flare up under the heavy load of protective equipment," Gavin remembers.
As a diplomat with the U.S. Agency for International Development, Gavin has traveled all over the world and spent long agonizing hours in pain while sitting on airplanes. Standing for long periods was painful as well. For Gavin, this wasn't anything new. His memories of childhood, adolescence and adulthood are peppered with bouts of debilitating back pain. "It was always a part of my life," he recalls.
In 2012, he was fed up.
"I was getting old and crooked! I could change 'old' but I could do something about 'crooked,'" he says.
That March, Gavin sought assistance from MedStar Georgetown Orthopaedist and Spine Expert Seyed Babak "Bobby" Kalantar, MD.
"An MRI showed a severe collapse of a disc in his lower back between the L3 and L4 vertebrae," Dr. Kalantar explains. "The degeneration of that disc had caused his spine to curve. Bone was pressing on nerves causing severe pain."
"Dr. Kalantar explained all of my treatment options," Gavins says. "I had been afraid of surgery because I'd heard horror stories about it. But Dr. Kalantar told me I was a candidate for a minimally invasive procedure. So I scheduled surgery for the day before my 50th birthday."
"I always look for the least invasive treatment alternative for patiens," Dr. Kalantar says. "Many patients will have good results with medication, physical therapy or injections to reduce inflammation. But Mr. Helf's pain was really limiting his life, and he was a good candidate for a spinal fusion procedure called XLIF, or eXtreme Lateral Interbody Fusion."
Rather than cut through all the muscles in the back to get to the spine, in this procedure surgeons make a small 2-inc incisions at the patient's side. "And we make small 'poke holes' in the back for the surgical instruments to reach the treatments site. Using a real-time image as a guide, we place a small synthetic cage at the location of the degenerated disc," Dr. Kalantar says.
"It serves as a kind of scaffold that will hold new bone that body produces over time. Because we're fusing the spine at a single area, patients don't have mobility problems after surgery. In fact, many patients, like Mr. Gaving, move normally for the first time in years."
Gavin sailed through surgery and was discharged the next day. "I was pretty determined to celebrate my birthday at home," he says. "I had to accomplish three things: sit up, walk up stairs and go to the bathroom. It hurt to get up at first, but when I did, I felt oddly different. I felt taller!"
At home, Gavin stood at the wall marked with family members' heights through the years. He was a full centimeter taller.
Now Gavin says he is positively evangelical about the procedure, telling anyone he knows who has persistent back pain to go to MedStar Georgetown. "Dr. Kalantar was fantastic, and the care at the hospital was great. And at my six-month checkup, for the first time in my life my spine looked absolutely normal."
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Mowing the lawn, walking for more than a few steps, standing - these are all things Ed could not do because of severe pain in the backs of his legs. The 76-year-old La Plata resident had been coping with limited mobility for five years. Although he had heard that back surgery necessitated a long and difficult recovery, Ed knew something had to be done.
Ed was suffering from spinal stenosis, the narrowing of the spine's bony canal. When the canal narrows, it squeezes the nerves inside, causing symptoms including back and leg pain, which can be debilitating, as well as leg weakness and numbness.
Imagine Ed's relief when he learned that neurosurgeon Jean-Marc Voyadzis, MD, could treat this disease using minimally invasive techniques and an incision the size of a dime.
"It seemed like a miracle to me," Ed said.
"A number of recent studies have shown that this approach decreases blood loss and post-operative pain, allowing a quick recovery and faster return to work," Dr. Voyadzis said.
Ed can attest to that: his surgery took one hour, and he went home later that day.
"I felt a difference right away," he said. He was up and walking with pain the following day and could resume his normal daily activities immediately. "I didn't even have much discomfort from the surgery itself."
Today, Ed Taylor is back to an active life.
"It's just as if I never had any back or leg problems at all," he said.
Download Ed's patient story.