Complex spine surgery in Florida

Vertebral tumors and deformities can cause significant morbidity and pain. Surgery to treat patients with these conditions is inherently complex, posing risks to critical neurovascular structures. Mayo Clinic in Jacksonville, Fla., has a large team of neurosurgeons with experience in complex spine surgeries for tumors, deformities and other conditions.

"We treat a full range of spine problems including trauma, complex deformities, disk problems, and tumors of the spinal cord and spine, both primary and metastatic," says H. Gordon Deen Jr., M.D., a neurosurgeon at Mayo in Florida.

Among the spinal deformities treated is scoliosis — both idiopathic scoliosis in older adolescents and adult degenerative scoliosis. The latter may be seen in older adults who had minor scoliosis in adolescence and were treated with a brace.

"With the degenerative changes of aging on top of previous adolescent scoliosis, these older adults may again experience progression of spinal deformity and benefit from surgery," notes Mark A. Pichelmann, M.D., a neurosurgeon at Mayo in Florida.

Team approach

Mayo's commitment to team medicine is apparent in its approach to complex spine surgery. Two attending neurosurgeons often work together on highly complex cases. "There are a lot of decisions that must be made during the surgery. With two of us in the operating room, we can bounce ideas off each other," says Stephen Pirris, M.D., a neurosurgeon at Mayo in Florida.

The treatment team also includes anesthesiologists and nurses with experience in complex spine surgery. After surgery, patients work with an inpatient pain management service as well as physical, occupational and speech therapists to help with rehabilitation.

Another key component of Mayo's approach is intensive patient monitoring during surgery. Sensory and motor functioning of the spinal cord is monitored in real time, to minimize the patient's chances of developing new complications or neurological deficits.

Neurosurgeons at Mayo in Florida have also pioneered the use of 3-D image-guidance techniques, which allow spinal implants to be placed more safely. Enhanced image guidance facilitates placement of more-robust implants with novel trajectories to better stabilize complex spinal deformities. These technologies, along with improvements in instrumentation and surgical techniques, enable Mayo neurosurgeons to treat more-complex cases than was previously possible.

"We are doing more osteotomies for complicated three-dimensional curvature," Dr. Pichelmann says. "We can essentially take the spine apart and put it back together with minimal risk to the spinal cord." Minimally invasive surgery and anterior-posterior surgery also are offered when appropriate.

Dr. Pirris notes that patients who undergo complex spine surgery must be able to tolerate a long and complicated procedure. Candidates for surgery are therefore selected according to their medical history and bone quality. The patients who tend to benefit most from spine surgery are those with sagittal imbalance, the most common determinant of back pain. "Chronic back pain that persists after surgery is frequently due to sagittal imbalance, and that is a potentially correctable problem," he says.

For more information

Nottmeier EW, et al. Placement of thoracic transvertebral pedicle screws using 3-D image guidance. Journal of Neurosurgery: Spine. 2013;18:479.