There are several
minimally invasive alternatives. A minimally invasive
fusion is good for some patients. An IDET procedure is appropriate for
A minimally invasive fusion uses newly available techniques to replace
a bad disc with bone. A traditional lumbar fusion usually included two
parts. The first was the placement of a metal brace and the second was the
insertion of a bone graft.
The first part of the operation was previously done through a long
incision in the back. The muscles were cut, causing a great deal of pain.
Using newly available devices, this can now be done with two tiny
incisions that spare the muscles. The second part was done from behind or
through a long abdominal incision. From behind it was necessary to retract
all of the nerve roots causing scarring and pain. The long abdominal
incision was also painful. We can now use a very small incision under the
navel to replace the disc with bone. This causes less pain and heals more
An IDET procedure uses a heated wire
which is inserted through a needle. The wire coagulates the disc. This is
thought to strengthen the disc and make replacement unnecessary. The IDET
procedure also deadens some of the nerves that cause pain. It takes about
20 to 30 minutes and does not require hospitalization. If an IDET does not
work, a fusion can still be considered.
Although not all patients are candidates for
minimally invasive surgery
or IDET procedures, common sense would dictate that the least invasive,
least painful, and least risky procedure should be used if possible.