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  • Despite enduring real and constant misery, many chronic back pain patients pain hesitate before considering surgery. At our New Jersey back pain practice we do favor a conservative approach that begins with exercise, medication, and other protocols, but when these remedies don’t work and our patients continue to suffer, we often recommend surgery.  Though the type of surgery suggested will depend on the patient’s specific diagnosis and condition, the most frequent recommendation is for minimally invasive spine surgery. We prefer this type of procedure because it relies upon small incisions and using tools to push muscles aside rather than cutting them. The end result is a much shorter recovery time with less pain and bleeding and a faster return to normal activities. A recently published report supports the use of this process, indicating that a common adverse surgical effect is much less likely to occur when the minimally invasive procedure is used.


    According to a presentation delivered at the Global Spine Congress in Paris by Dr. Ayush Sharma of the B.A.M. Hospital in Mumbai, India, a retrospective study that analyzed 420 separate cases of open vs minimally invasive spinal surgery indicated that the latter produced far fewer cases of dural tears and complications. Dural tears can range from nonleaking pinholes to large defects that require reconstruction, and though they can be quickly repaired if spotted during the surgery, revision surgery may be required for tears that are not quickly identified, and the resulting symptoms can range from uncomfortable to disabling. 


    Of the patients included in the study, 156 underwent minimally invasive surgery and the other 264 had open surgery. Most patients were between 41 and 60 years old. Incidental dural tears occurred in 52 of the cases, with the complication occurring in 6.4% of patients undergoing minimally invasive surgery compared to 15.7% of the patients who had open surgery. The incidence of dural tear was almost identical for patients undergoing either decompression or fusion surgery regardless of the technique used, but for those who had discectomy or revision surgeries, the minimally invasive group had significantly fewer occurrences.


    Speaking of his findings, Dr. Sharma said, “The MIS approach during discectomy mainly involved flavectomy or a small laminotomy where a small amount of ligamentum flavum or lamina is removed to approach the disc. In open approach, the amount of laminectomy or flavectomy is comparatively higher. This may explain why the MIS approach had lesser risk of dural tear in cases of discectomy. For revision surgery also, the tubular approach allows the surgeon to skip the midline scar tissue and fibrosis resulting in a lesser chance of incidental dural tear.”


    When surgery is required to address back pain, it is important that you work with a physician who is skilled in the right type of surgery for your situation and the best way to minimize discomfort and complications.  For help finding relief for your symptoms, contact our New Jersey spine specialty practice today.


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