If a patient does not improve after non-surgical treatment and the vertebra continues to slip, Dr. Singh may suggest minimally surgery as a solution for the spondylolisthesis.
Minimally Invasive Laminectomy
In this procedure, Dr. Singh will make a small incision, the size of a nickel, in the back at the level of nerve compression and insert a device called a tubular retractor. This thin tube-shaped tool allows for the creation of a tunnel, gently moving aside muscle and soft tissue, in the affected area of the spine to provide access to the compressed nerves. He can then insert small tools through the tunnel and operate to decompress the affected nerves.
Ultra-Minimally Invasive Endoscopic Laminectomy
In this cutting-edge procedure, a 10 millimeter or smaller skin incision (pen tip sized incision) is made, and the endoscope, a thin flexible tube with a camera and light at the tip. Depending on the patient’s condition, the endoscopic technique may access the spine using one of two approaches: either an intralaminar (from the back of the spine between two laminae) or transforaminal (from the back/side of the spine into the neuroforamen; a nerve passageway) approach.
Throughout the procedure, the camera captures and projects real-time images of the operative site onto a monitor for Dr. Singh to see. The endoscopic camera assists and guides Dr. Singh during the surgical procedure. The images and videos of the disc bulge and nerve root are provided to the patient following surgery.
Most patients experience immediate and significant improvement in their pain because the compression of nerves has been corrected immediately following surgery.
Minimally Invasive Lumbar Fusion
If a patient has had repeated lumbar disc herniations or has significant instability and slippage, a minimally invasive lumbar fusion may be performed.
In a minimally invasive fusion, Dr. Singh uses special equipment that allows for a much smaller incisions (less than the size of a quarter) without cutting muscles that allows him to perform these procedures as outpatient surgery with patients going home 3-4 hours after the surgery.
A minimally invasive lumbar fusion can be performed from the front (anterior approach), from the back (posterior approach) or from the side (lateral approach). Dr. Singh chooses which approach is the least invasive based upon many factors, including the need for bone spur removal, the degree of instability, the medical condition, and build of the patient. The following are minimally invasive spinal fusion approaches that Dr. Singh performs in a minimally invasive outpatient fashion:
- Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation (from the front)
- Transforaminal Lumbar Interbody Fusion (TLIF) (from the back)
- Lateral Fusion Interbody Fusion (XLIF, DLIF, OLIF) (from the side)