Doing More With Less: The Development Of Minimally Invasive Surgery for Spinal Fusion
In the early 1980s, most spinal fusions were cumbersome procedures and painful for patients. But Charles Branch Jr., MD, professor and chair of the Department of Neurosurgery, and his peers—young doctors fresh out of residencies and fellowships—questioned the need for such invasive measures.
While their professors were saying “No,” these new doctors were saying “Yes.” They went against the grain and pushed the belief that spinal fusions could be performed using minimally invasive measures.
“For years, neurosurgeons believed that most spinal interventions just involved decompressing nerves,” said Branch. “We’d take the roof off the spine and a part of the hinge joint off to get the pressure off a nerve. We’d relieve a painful condition, but patients would often come back a few months later after the pain returned.”
With the advent of new imaging technology, such as CT scans and MRIs, it became clear that many patients had unstable spines after standard decompressive surgeries. What was needed, Branch said, was spinal fusion surgery.
“Once we recognized that there was value in spinal fusion and had access to new instruments, such as screws, plates and other devices, the motivation for us was simply how to do it more quickly, safely and less painfully for the patient,” said Branch. “We found that there were ways to do it through a smaller incision that caused less disruption to our patients’ muscles.”
Posterior and transforaminal lumbar interbody fusions (PLIF and TLIF) were developed 70 years ago to help bones grow between vertebral elements. The surgeries provided much needed relief for patients with unstable spines. However, PLIF and TLIF were so complex and painful for patients that most neurosurgeons had no interest in performing the operations.
“In the early 1990s we developed simpler ways of doing those operations that made it easy to teach our colleagues,” said Branch. “All of a sudden, spine surgeons embraced the concept of interbody fusion as a reasonable, safe and effective treatment method. We took something that was effective but difficult and made it easy, straightforward and less painful for patients.”
Branch and his colleagues at Wake Forest Baptist’s Department of Neurosurgery were part of the group of pioneers that developed minimally invasive strategies for spinal fusion surgeries.
Today, Branch and his colleagues hold 13 U.S. and 11 European patents developed for use in their early interbody fusion operations. These techniques, which were once just ideas in the minds of young doctors, are now the standards of care for ensuring greater clinical success and less pain for patients worldwide facing surgery for unstable spines.