Author: Luis Lombardi

Before and after images of a patient treated with a Non-Traumatic Back Technique. The picture shows an L4/5 extruded herniated disc; the patient presented with back and leg pain. Notice the important difference only 2 months after surgery. MRI images continue to evolve for 6 months to one year after surgery.

• Due to multiple factors, the pulpy center loses water and becomes bridle
• The disc becomes inflamed and starts producing inflammatory substances
• These substances start eroding the inner aspect of the annulus generating “cracks” called fissures
• As long as the fissures don’t reach the area on the back of the disc where the pain sensitive fibers are, the process is painless and most people don’t even know it already started
• The pulp in the center of the disc can now push through these cracks in the annulus. When the pulp reaches the outer annulus it irritates the pain sensitive fibers and it causes back pain
• When the pulp accumulates, the annulus begin to bulge out and makes contact with the nerve root and hence causes leg pain. This is the so called herniated disc
• If the accumulation of pulp continues, the internal pressure of the disc increases until the annular fibers tear completely and disc material pours out onto the nerve root and surrounding tissues. This phenomenon usually causes sudden increase in leg pain due the mechanical compression of the nerve root. This is the so called extruded herniated disc
• The nuclear material and it’s chemicals irritate the nerve root which becomes very inflamed and the leg pain becomes almost constant
• If the offending disc material is not removed, the surrounding tissue react and in time, scar will form. The process then becomes chronic in nature

• A normal disc is composed of 2 parts: a Pulpy center called Nucleus and a fibrous envelope called annulus. The nucleus provides shock absorbing properties and the annulus provides resistance
• Small pain sensitive fibers are located in the outer third of the back of the disc

• A disc is the shock absorber of the spine
• It lies between the two adjacent bones called vertebral bodies
• The nerves descend behind the vertebrae and discs
• The back of the disc is in close proximity to the nerves
• At each level the nerves give rise to 2 smaller nerves (one on each side) called nerve roots for their similarities to the roots of a tree
• Several nerve roots on each side will converge and form the major nerves that descend to your legs like the sciatic nerve

Even though the following description does not happen in 100% of traumatic spine operations, it is something that could potentially happen to any patient; therefore, it should be considered before making a decision about spine surgery.

In traumatic spine surgery, supporting  structures of the spine are cut or removed which causes instability. Instability is the abnormal movement of that segment of the spine producing back and/or leg pain. This problem will end up most likely with a recommendation of  FUSION;  once you cross that bridge..there’s no return. With fusion the overall patient satisfaction does not exceed 60 % and 40% of the  patient’s condition remain the same or get even worse. Bio-mechanically speaking, fused discs do not carry load;  therefore, the load is transferred to adjacent levels which get overwhelmed; this in turn leads to more disc failures and surgeries.

Multiple spine operations push many patients over the edge. Unfortunately, under these circumstances, patients will most likely have severe pain and very few  solutions other than palliative pain management. This condition is called FAILED BACK SURGERY SYNDROME.

In the past decade the term “Minimally Invasive” has become very popular.

It basically means that a particular surgical procedure causes less “invasion” and therefore “damage” to your body THAN another surgical procedure. Please note that the term is comparative in nature. Following this line of reasoning, a surgical procedure that requires an inch incision to treat the problem is minimally invasive compared to a procedure that requires a 3 inch incision.

MINIMALLY INVASIVE SPINE SURGERY IN A SENSE, IS A TERM THAT COMPARES TWO SURGICAL PROCEDURES OF DIFFERENT SIZE AND THEREFORE THE AMOUNT OF  INVASION AND DAMAGE THEY CAUSE TO THE NORMAL  SPINE

Muscles, bone and joints that surround the spinal units are essential supporting structures of the spine.

CUTTING OR REMOVING THE SUPPORTING STRUCTURES OF THE SPINE MAY CAUSE IRREPARABLE DAMAGE

The term MINIMALLY INVASIVE is being used too liberally and with disregard for the actual anatomical changes a surgical procedure imposes on the normal spine.

NOT ALL MINIMALLY INVASIVE SPINE SURGERIES ARE CREATED EQUAL

WITHOUT A CLEAR DESCRIPTION OF THE TRAUMA TO THE SPINE THE TERM MINIMALLY INVASIVE BECOMES A MISNOMER

A TRULY MINIMALLY INVASIVE PROCEDURE TREATS THE OFFENDING PROBLEM WITHOUT CAUSING ACCESS DAMAGE TO THE NORMAL ANATOMICAL STRUCTURES OF THE SPINE