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Taipei City Hospital


Spinal Decompression Fusion Surgery: Minimally Invasive or Traditional?

With the ageing of Taiwanese society, more and more people suffer from lumbar and spinal degenerative diseases. Medication and rehabilitation can achieve very good therapeutic effect in low back pain or slight sciatic neuralgia. However, if nerve compression is involved, symptoms such as severe numbness, throbbing pain, foot drop, limping and even urine or fecal incontinence will occur, making surgery imperative.

The first objective of the surgery is to relieve the nerve compression by removal of the intervertebral disc, bone spurs or even the vertebral arch. However, the greater the area of decompression, the greater the damage caused to the linkage between the vertebrae. Here is where “spinal fusion” comes into play as the essential remedial measure. It generally adopts bone nail fixation on top of the fusion of two or more adjoining vertebrae, sometimes even involving posterolateral fusion.

Traditionally, decompression fusion surgery usually makes an incision at the median line of the back, pulling open the muscle on both sides to completely expose the section of vertebrae to be treated; the bigger the incision, the easier the surgery. However, patients typically suffer from heavy blood loss, wound pain, long bed stay, long-term hospitalization and back muscle atrophy. Therefore, the minimally invasive decompression fusion surgery has come into being.
Hsu Shao-yuen, attending doctor of the neurosurgery division at Heping Fuyou Branch of Taipei City Hospital, said that according to a systematic review published in an international journal this November, the minimally invasive surgery is obviously better than traditional surgery, with advantages such as less intraoperative bleeding, ability to get out of bed earlier and shorter hospitalization period. However, there is no difference between the two in terms of surgery duration, complications, fusion success rate and reoperation rate. Macroscopically speaking, the therapeutic effect and safety of the traditional surgery is similar to that of the minimally invasive surgery, but the latter allows patients to return to their normal life and work as early as possible.