Walter Eckman, MD, has limited his practice at Aurora Spine Center in Tupelu, Miss., to exclusively minimally invasive spine surgery. For the past 10 years, he has been performing a minimally invasive transforaminal lumbar interbody fusion technique as an outpatient procedure in the hospital setting.
Dr. Eckman's one- or two-level MITLIF technique is performed through a single incision, usually 3 centimeters for single-level procedures and slightly more for multilevel procedures or heavy patients. The procedure is conducted through a 21 millimeter working channel with titanium or polymetric interbody devices. He uses a microscope and limited fluoroscopy to view the patient's anatomy intraoperatively. Either rhBMP-2 or silicated calcium phosphate bone graft substitutes are used to promote fusion. Pedicle screws and rods are inserted through the small working channel under direct vision avoiding more expensive percutaneous screw placement and associated radiation exposure.
"There are several minimally invasive procedures, such as knee arthroscopy, that are accepted by payors and the public as a standard procedure," says Dr. Eckman. "We still haven't achieved this status in spine. We haven't convinced payors that minimally invasive spine surgery is the better way to go and a lot of surgeons haven't applied it in their practices. The surgeons who do understand this and are moving their patients into ASCs are seeing their patients become mobile quicker with better results than the open technique."
Dr. Eckman recently presented the outcomes of 620 MITLIF procedures in 562 of his patients at the Society for Minimally Invasive Spine Surgery annual meeting. The study evaluated 562 patients with single- or two-level MITLIF between 2003 and 2011. Diagnoses included chronic back pain, stenosis, listhesis, segmental instability and central disc herniation. Here are the results:
• Two patients needed a blood transfusion
• No surgical infections
• 12 procedures needed reoperation
• 95 percent achieved interbody fusion
• 95 percent returned to work
• Two patients returned to work the day after surgery
Dr. Eckman also measured the effectiveness of the procedure, showing that 92 percent of patients had improved visual analog scale back pain scores after one year and 94 percent improved after two years. The average patient had 70 percent improvement in VAS back pain scores after one year, and 68 percent improvement after two years. Upper and lower leg pain VAS scores were also improved in 81-88 percent of patients after one year and with average improvement of 87-90 percent and similar outcomes at two years.
Dr. Eckman earned his medical degree and completed a year of neurology training at the University of Pennsylvania in Philadelphia and served as a resident in neurosurgery at the University of Western Ontario, Canada. His additional training includes time at the University of California in San Francisco, Stanford University in Palo Alto, Calif., and a clinical association at the National Institutes of Health.
If there is a spine surgeon leader in your community you would like to see profiled, please contact Laura Miller at laura@beckershealthcare.com.
More Articles on Spine Surgeon Leaders:
Spine Surgeon Leader to Know: Dr. Ara Deukmedjian of Deuk Spine Institute
Spine Surgeon Leader to Know: Dr. Fred Sweet of Rockford Spine Center
Dr. Eckman's one- or two-level MITLIF technique is performed through a single incision, usually 3 centimeters for single-level procedures and slightly more for multilevel procedures or heavy patients. The procedure is conducted through a 21 millimeter working channel with titanium or polymetric interbody devices. He uses a microscope and limited fluoroscopy to view the patient's anatomy intraoperatively. Either rhBMP-2 or silicated calcium phosphate bone graft substitutes are used to promote fusion. Pedicle screws and rods are inserted through the small working channel under direct vision avoiding more expensive percutaneous screw placement and associated radiation exposure.
"There are several minimally invasive procedures, such as knee arthroscopy, that are accepted by payors and the public as a standard procedure," says Dr. Eckman. "We still haven't achieved this status in spine. We haven't convinced payors that minimally invasive spine surgery is the better way to go and a lot of surgeons haven't applied it in their practices. The surgeons who do understand this and are moving their patients into ASCs are seeing their patients become mobile quicker with better results than the open technique."
Dr. Eckman recently presented the outcomes of 620 MITLIF procedures in 562 of his patients at the Society for Minimally Invasive Spine Surgery annual meeting. The study evaluated 562 patients with single- or two-level MITLIF between 2003 and 2011. Diagnoses included chronic back pain, stenosis, listhesis, segmental instability and central disc herniation. Here are the results:
• Two patients needed a blood transfusion
• No surgical infections
• 12 procedures needed reoperation
• 95 percent achieved interbody fusion
• 95 percent returned to work
• Two patients returned to work the day after surgery
Dr. Eckman also measured the effectiveness of the procedure, showing that 92 percent of patients had improved visual analog scale back pain scores after one year and 94 percent improved after two years. The average patient had 70 percent improvement in VAS back pain scores after one year, and 68 percent improvement after two years. Upper and lower leg pain VAS scores were also improved in 81-88 percent of patients after one year and with average improvement of 87-90 percent and similar outcomes at two years.
Dr. Eckman earned his medical degree and completed a year of neurology training at the University of Pennsylvania in Philadelphia and served as a resident in neurosurgery at the University of Western Ontario, Canada. His additional training includes time at the University of California in San Francisco, Stanford University in Palo Alto, Calif., and a clinical association at the National Institutes of Health.
If there is a spine surgeon leader in your community you would like to see profiled, please contact Laura Miller at laura@beckershealthcare.com.
More Articles on Spine Surgeon Leaders:
Spine Surgeon Leader to Know: Dr. Ara Deukmedjian of Deuk Spine Institute
Spine Surgeon Leader to Know: Dr. Fred Sweet of Rockford Spine Center