At the USC Spine Center, minimally invasive spine surgery enables patients to return to their lives more quickly.

Karen Sartoris believes in keeping her muscles moving, which is why she has been athletic her hole life, including cycling, running and playing fast-pitch softball. “I love the wind in my hair,” she says.

In volleyball, her main sport, she typically was the setter, taking charge of the team’s offensive strategy in the moment. So, when she needed to find someone to help her with unrelenting back pain, she took charge and made things happen.

Her back problems started gradually with a twinge here and there, but quickly escalated. Karen couldn’t get on the elliptical at the gym for five minutes without a searing electric shock running down her back and legs, and her feet going numb. “It just kept getting worse and worse,” she recalls.

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All of her beloved sports fell by the wayside. Nothing helped — not over-the-counter medication, pain specialists, acupuncture, cupping (an ancient Chinese procedure said to draw toxins from the body) or even surgery to address two herniated discs.

Finally, a friend told her to go see neurosurgeon Patrick C. Hsieh, MD, professor of clinical neurological surgery at the Keck School of Medicine of USC, and co-director of the neurosurgical spine program at the USC Spine Center at Keck Medicine of USC. “He can fix anything,” she said.

The friend had known a woman who fell from a second-story balcony and crushed her spine, but recovered. Dr. Hsieh, who also was appointed recently to the Todd-Wells Professorship in Neurological Surgery at the Keck School, was her physician. “I wanted the best doctor,” Karen says. “I found him.”

Dr. Hsieh is a specialist in minimally invasive spine surgery at the USC Spine Center, which has one of the highest volumes of cases in the region, giving its surgeons invaluable experience.

Keck Medicine surgeons use minimally invasive surgical techniques for a comprehensive range of conditions — from degenerative disc disease such as Karen experienced (the most common procedure), to herniated discs and spinal stenosis (narrowing) to spinal trauma, infection, complex tumors and multi-level spinal deformities.

While many of these conditions are only tackled elsewhere with traditional open spinal fusion surgery, the doctors of Keck Medicine are expanding what minimally invasive surgery can do. “We are developing

cutting-edge techniques and technologies, which are enabling us to approach cases once thought too complicated,” Dr. Hsieh says.

Less Pain, Shorter Recovery

The advantages of minimally invasive surgery are numerous. Open procedures call for larger incisions and muscle stripping as surgeons push aside the muscles of the spinal column in order to operate.

Minimally invasive procedures use small incisions, perhaps an inch in length, through which the surgeon can insert specialized instruments to obtain a magnified and illuminated view of the surgical area. The approach typically results in less blood loss during surgery, lowered risk of wound infection and post-surgical complications, less pain, and shorter recovery time.

Karen describes herself as “pretty desperate” at her first meeting with Dr. Hsieh in fall 2013. When the staff asked about her quality of life, she burst into tears. By then, she was unable to walk to her mother-in-law’s home five houses away.

The solution: a transforaminal lumbar interbody fusion (TLIF). To repair her degenerated discs, Dr. Hsieh began with two small incisions in her back, into which he inserted tiny tubes, then an endoscope. He stabilized the back portion of her lumbar spine with metal rods and screws, as well as a bone graft alongside the spine bones. He replaced the damaged vertebrae with a bone graft spacer. As the grafts healed, the newly mended spine would fuse.

Prescription: Second Opinion

Dr. Hsieh encourages patients to do their research and get a second opinion when facing spinal surgery. “We frequently see people who have been told somewhere else that they are not candidates for minimally invasive surgery,” he says. “That’s not necessarily true — it depends on the institution’s capabilities.”

At Keck Medicine, those capabilities are backed by a research program aimed at miniaturizing endoscopic technology even more to allow additional surgeries on an outpatient basis. Clinical trials using similar minimally invasive surgical techniques are underway with the hope that recovery can be improved and the number of serious complications, such as spinal fluid leaks, meningitis and headaches, can be reduced.

Karen went home from Keck Hospital after a few days and began her rehabilitation. The first day, she walked to the front door, then the porch, then the sidewalk.

These days, she has her athletic life back. To protect her new spine, she decided to forgo volleyball, running and softball. Instead, she upped her cycling time and took up swimming and a new sport — pickleball — a paddle sport that combines elements of tennis, badminton and pingpong. “I feel very fortunate,” Karen says. “There’s nothing bad about being a success story.”

All of the physicians in the USC Spine Center are spine fellowship-trained in spinal surgery and interventions. Each of the faculty holds appointments and academic titles in both the department of neurological surgery and in the department of orthopaedic surgery. The USC Spine Center team approach ensures that each patient receives the very best clinical and surgical evaluation of their individual spine problem, which allows for the optimal multidisciplinary treatment for their condition.

The USC Spine Center maintains a robust training program for residents and fellows in orthopaedics and neurosurgery, which has a global impact: 10 to 15 international fellows come to the USC Spine Center each year to train in minimally invasive spinal surgery.

Better to See You With

At Keck Medicine of USC, Intraoperative Navigation and Imaging Improve Outcomes

One key element to a successful outcome in any surgery is the ability of the surgeon to clearly see what is happening at the surgery site. In the past, physicians relied upon their eyesight alone, but modern minimally invasive surgery methods that don’t use an open incision technique need something more than the naked eye.

Luckily, new, cutting-edge technologies have been developed that can help surgeons see beyond what is on the surface.

Spine surgeons at Keck Medicine of USC and USC Verdugo Hills Hospital are not only experts in minimally invasive surgery, they also have access to the latest technologies in intraoperative imaging and navigation equipment. These cutting-edge, specialized machines provide quick and detailed visual aids for complex surgeries. The majority of surgeries in the United States are performed without this navigational assistance.

The imaging system delivers a fast and precise 3-D representation of a patient’s anatomy during surgery, and the guidance system then uses this 3-D image to ensure that implants, such as screws, are placed in the spine with millimeter precision.

Compared to traditional surgical methods, this navigational technique improves accuracy, requires a smaller incision and reduces postoperative pain. It also produces less radiation than a CT scan, improving outcomes by making complex cases more effective, safe and accurate.

By Candace Pearson