Case Study: How a New, Minimally Invasive Spine Surgery Improved a 67-Year-Old Woman's Life

April 25, 2023 — When a 67-year-old woman came to the EvergreenHealth Neuroscience Institute with worsening back and leg pain she was eager to find relief and get back to her passions of traveling and hiking. Unfortunately, conservative approaches weren't effective – but she was a good candidate for a minimally invasive surgical approach that is transforming the lives of many patients. The newer technique has shorter hospital stays and faster recoveries than traditional spine surgery.

The approach, called prone trans-psoas interbody fusion (PTP), enables surgeons to complete complex procedures through a small incision while a patient is in a single prone position throughout the procedure. Brian Dial, MD, used this new approach to perform spinal decompression and fusion on the patient, who went home after just one night in the hospital.

"When this type of surgery is done via traditional approaches, patients spend an average of three to five days in the hospital and require significantly more post-operative pain medications" Dr. Dial says. "We're one of the first centers in our region to offer this prone approach, and we've been excited to see the positive outcomes that are as good as or better than traditional open surgery."

The First Step: Expert Physiatry Care

Imaging revealed that the patient had lumbar stenosis at L2-3 and lumbar instability at L3-4 and L4-5. She wanted to avoid surgery if at all possible. This made her a good match for our program — we have expert physiatrists and a commitment to exploring conservative options.

"At least 90% of our patients are evaluated for non-surgical options," Dr. Dial says. "Having such a robust physiatry group enables us to work together, trade ideas from different perspectives and select the treatment approach that best matches the patient's condition and lifestyle goals."

This patient tried physical therapy for six months and received multiple spinal injections. When her pain didn't resolve, she elected to pursue minimally invasive surgery.

The Benefits of Prone Surgery

Our team has been teaching lateral surgery and other minimally invasive techniques to surgeons across the country and will soon start teaching this prone approach. This reflects our overall commitment to embracing and advancing techniques that improve outcomes and advance the field.

For this patient, Dr. Dial created a roughly four-centimeter incision in the patient's side and used it to access her spine. He performed a decompression and prone lateral interbody fusion at L3-4 and L4-5, and a decompression at L2-3.

"The main advantages of the prone position are that it enables better deformity correction, that we can perform the entire surgery in a single position, and that we're able to do multiple procedures at once," Dr. Dial says. "That means we can avoid intraoperative repositioning, which means the surgery is shorter and has fewer risks."

Fast Recovery and Comprehensive Follow-Up Care

The patient went home the day after her surgery. At her two-week follow-up appointment, she was walking on her own and only needed Tylenol to control her intermittent pain. After six weeks she is advancing her activity and is already back to hiking and living her life!

"This patient highlights how the EvergreenHealth Neuroscience Institute's care for degenerative spine conditions on par with any center in the nation," Dr. Dial says. "We're thrilled with her outcome and we're excited to bring this approach to many more patients."