Spine

Minimally Invasive Spine Surgery – What to Expect When You’re Expecting

By December 2, 2019 December 4th, 2019 No Comments

Treatment for back pain during pregnancy presents a particular challenge in the medical community due to the complexity of the clinical situation. If an issue is misdiagnosed or treated inadequately, this further complicates the situation and may lead to a lifetime of back issues post-pregnancy. 

While there are many possible solutions to back pain during pregnancy, only those which put the least amount of burden on the woman and her child are viable. Thus, surgical approaches mandate minimal invasiveness due to the physiologic parameters of pregnancy and the effects these stressors may have on the fetus.

Minimally invasive spinal surgery may be a viable option when treating back pain during pregnancy, but there are a host of other options to consider alongside it.

What is Minimally Invasive Spine Surgery?
Minimally invasive spine surgery is a procedure which uses small incisions in order to provide treatment for various issues within the bones of the spine. By using smaller incisions, the tissues surrounding the bones of the spine suffer less harm than they would from conventional open spinal surgery. This can speed up recovery times and lead to less severe post-surgical complications. 

The standard approach to spinal issues involves a long incision made down the back. During these operations, surgeons typically need to move muscles and soft tissues covering the spine, and in some cases may need to remove tissues permanently in order to gain access to the bone beneath. 

Minimally invasive spine surgery, however, involves much smaller incisions than conventional spinal surgery. After an incision is made, the healthcare provider inserts a small device called a tubular retractor into the site of the incision. The tool pushes tissues away gently in order to create a narrow passageway to access the problem area within the spine. 

Once this passageway is created, surgeons are free to use a number of small tools in order to operate on the problem area. In addition to the tools used to operate on the spine, surgeons also use a special microscope to view real-time X-ray images of what they are operating on.

Minimally invasive spine surgery is typically used for cases in which the patient is likely to have an especially severe reaction to standard open surgery, though it may be used by anyone with a doctor’s recommendation. Pregnant women, hemophiliacs, and the elderly and ailing are the most common patients who receive treatment via minimally invasive spinal surgery.

Why Would Minimally Invasive Spine Surgery Be Necessary During Pregnancy?
The majority of back issues will not require surgery. These issues are routinely and effectively managed through conventional treatments such as medicine and physical therapies. But, in cases where the patient’s functional goals are not met or if symptoms become unmanageable, surgery may be recommended by the healthcare provider.

In other instances, conventional treatments may not be feasible. If the body is already under some amount of strain – be it due to some other illness or pregnancy, conventional treatments may cause unwanted side effects. Pregnant women may not find physical therapy possible under their current state and the use of pain-reducing medication is ill advised during gestation.

Additionally, pregnancy is known to cause a range of back issues, such as:

  • Herniated discs
  • Spinal stenosis (narrowing of the spinal canal)
  • Spinal deformities (like scoliosis)
  • Spinal instability
  • Fractured vertebra

In these cases, minimally invasive surgery may be a quick and effective method for back pain relief during pregnancy. 

What Are the Risks Involved with Minimally Invasive Spinal Surgery?
No surgery comes without risk, though if symptoms escalate, surgery may be the only option to protect the health of the patient. Possible risks of minimally invasive spine surgery include:

  • Spinal Infection
  • Excess bleeding
  • Nerve damage
  • Blood clots
  • Complications from anesthesia
  • Leaking of spinal fluid. This may cause headaches or other problems.
  • Minimal results post-surgery

Risks vary due to age, general health, and type of surgery being performed. Pregnancy may elevate these dangers as they could place undue burden on the incubating baby. Though the risks presented may seem substantial, untreated spinal issues during pregnancy could lead to a lifelong battle against the symptoms they present.

What Does Minimally Invasive Spinal Surgery Look Like?
After proper diagnosis and verification of the issue using medical imaging, minimally invasive spinal surgery is performed by a trained medical team working alongside an orthopedic surgeon. While the exact details of the surgery depend on which part of the spine is being treated and how extensive the issue is, most minimally invasive spinal surgeries follow a similar pattern:

  • Anesthesia will be applied to numb the portion of the back being operated on. While sedation may be used on some patients, this is ill-advised for pregnant women. In these cases general anesthesia is preferred. 
  • Before, during, and after the surgery, a healthcare provider will carefully monitor the patient’s vital signs. Heart rate, blood pressure, and general awareness will all be monitored closely. The provider will also keep track of the baby’s condition as the surgery proceeds.
  • Antibiotics will be administered before and after surgery. These are generally harmless to the child and help prevent infection within the operated area.
  • Doctors will make incisions as necessary and use a tubular retractor to allow passage into the affected area. Once the tubular retractor is in place, doctors can pass small tools into it to begin performing the procedures necessary.
  • Using a special X-ray and onboard camera and light, doctors will get a clearer view of the portion of the spine they are operating on.  
  • Once the procedure is complete, doctors will remove their tools through the tubular retractor and seal the wound will staples, glue, or stitches. Bandages may be used in order to reduce exposure to the outside.

While each case of minimally invasive spinal surgery varies based on several factors, the above is a general breakdown of what to expect. Doctors may vary their approach based on several physiologic parameters of each unique pregnancy. 

Though minimally invasive surgery as described above is conventionally prescribed for excessive back pain during pregnancy, it may not be the least invasive, safest option. There exist several alternatives which may be more suited to particular cases. 

One treatment which has seen great success in the last decade are regenerative therapies. By providing relief to the symptoms of back pain as well as helping heal the causal factors, regenerative therapies offer a two-fold solution to back pain during pregnancy while providing the least amount of adverse side effects.

Regenerative Therapy vs. Minimally Invasive Spine Surgery
Many of the issues associated with back pain during pregnancy stem from a single cause – compressed nerves. Nerves within the spine can become compressed due to the breakdown of supportive muscle tissue as well as swelling typically associated with pregnancy.

If a person develops a chronic issue related to swelling or muscle breakdown due to pregnancy, minimally invasive surgery may provide temporary relief, but the post-surgical complications may be enough to dissuade them from attempting such a radical approach during gestation.

Regenerative therapies offer a solution to these issues through a series of injections in simple outpatient procedures. The procedures involve simple blood or fat draws at no harm to the baby followed by materials processing and reinjection into the site of the pain.

These injections not only help amplify the body’s natural healing processes to repair damage and minimize symptoms overtime but have been shown to provide almost immediate relief from most symptoms involved with back pain during pregnancy. 

PRP Therapy
By extracting blood and isolating the platelets within it, doctors create what is known as Platelet Rich Plasma. Mixing this plasma with known growth factors and reinjecting this mixture into key stress points within the back can create an environment suitable for repair as well as attract the body’s natural healing mechanisms to decrease painful swelling and compression around the nerves found throughout the spine. 

Stem Cell Therapy
Similar to PRP therapy, stem cell therapy’s active ingredients come from the patient’s own tissues. Fat and bone marrow can be extracted from a patient in a minimally invasive procedure and be processed into what are known as mesenchymal stem cells – a “pseudo” stem cell which shares many of the qualities of the more commonly known embryonic stem cell.

These stem cells are also mixed with known growth factors and are reinjected into the site of injury or pain in order to call upon the body’s natural healing processes to help restore damaged tissues and provide relief from the symptoms of various back issues created during pregnancy.

While minimally invasive spinal surgery may be conventionally prescribed for chronic back pain during pregnancy, the risks associated with it may be too much for expectant mothers. Regenerative therapies may offer a solution to these worries with less invasive procedures and better results. 

Conclusion
Pregnancy can cause a host of issues throughout the body. With so much strain placed on the lower abdomen, the back can be a particular hot zone for issues to develop. These issues can become chronic as the pregnancy develops and may become immobilizing if left unchecked. 

As the issues progress, so do the treatments for them – deeper issues require more radical treatments. Though minimally invasive surgery may be one option for treating these issues, it is not the safest, most effective option. 

Regenerative therapies may offer similar results with less recovery time and potential side effects. If you would like to learn more about regenerative therapies and how they can help with your back pain during pregnancy, contact the CELLAXYS offices today to set up a consultation.

Dr. Pouya Mohajer

Dr. Pouya Mohajer

Director of Spine & Interventional Medicine
Board certification in Anesthesiology and Interventional Pain Medicine
Fellowship-trained from Harvard University
UCLA Alumni