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San Antonio Spine Surgeon, San Antonio Back Doctor, Mayo Clinic Trained Spine Surgeon, Bexar County Orthopedic Surgeon

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Become Pain Free | Pain Specialist in Texas

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February 17, 2013 at 9:25 pm

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Kyphoplasty Surgery, Kyphoplasty, Kypho, Vertebroplasty, Back Surgery, Spine Surgery

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What is Vertebroplasty & Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.

When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer.

In vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphohplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.

Performing Kyphoplasty Surgery

  1. During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
  2. Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.
  3. The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the pasty material hardens quickly, stabilizing the bone.

Kyphoplasty surgery to treat a fracture from osteoporosis is performed at a hospital under local or general anesthesia. Other logistics for a typical kyphoplasty procedure are:

  • The kyphoplasty procedure takes about one hour for each vertebra involved
  • Patients will be observed closely in the recovery room immediately following the kyphoplasty procedure
  • Patients may spend one day in the hospital after the kyphoplasty procedure

Patients should not drive until they are given approval by their doctor. If they are released the day of the kyphoplasty surgery, they will need to arrange for transportation home from the hospital.

Recovery from Kyphoplasty

Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.

Candidates for Kyphoplasty

Kyphoplasty cannot correct an established deformity of the spine, and certain patients with osteoporosis are not candidates for this treatment. Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are likely candidates for kyphoplasty. The procedure should be completed within 8 weeks of when the fracture occurs for the highest probability of restoring height.

It is not known whether kyphoplasty or vertebroplasty will increase the number of fractures at adjacent levels of the spine. Bench studies on treated bone have shown that inserting PMMA does not change the stiffness of the bone, but human studies have not been done. Osteoporosis is a chronic, progressive disease. As stated earlier, patients who have sustained fractures from osteoporosis are at an increased risk for additional fractures due to the loss of bone strength caused by osteoporosis.

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Confusion about Spinal Fusion, Spine Fusion, Spine Fusion Surgery, Back Fusion Surgery, Back Surgery

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Spinal Fusion is used to treat spinal instability and alleviate chronic mechanical back pain but many people are unsure of what spinal fusion actually does.  Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.


Spinal fusion involves many techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae all together, so they can heal into one solid unit.


Because spinal fusion surgery immobilizes parts of your spine, it changes the way your spine can move. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of your spine degenerate.

sharma-obesity-spinal-fusion1 can help

Become Pain Free | Pain Specialist in Texas

Minimally Invasive Surgery: Looking Ahead

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Filed under:  Surgery

The field of MIS owes its rate of expansion in part to growing consumer demands as news of these procedures spread through word of mouth and aggressive marketing campaigns conducted by developers.


LESS Is MoreIn a recent study conducted at the University of California San Diego School of Medicine, emerging laparoendoscopic single-site surgery, also known as the LESS technique, was shown to result in less pain for kidney cancer patients than conventional laparoscopic removal procedures.

While the procedures took approximately the same amount of time and resulted in similar amounts of blood loss, patients rated the LESS procedure as 40% less painful using the visual analog pain (VAP) comfort test.

Incidents of kidney cancer are on the rise in the United States, with more than 64,000 new cases diagnosed each year. With LESS, a single incision is used to remove tumors, compared to between four and six incisions needed for the procedure’s laparoscopic equivalent.

Endoscopic Vein Harvesting Given the OK

In a study of approximately 236,000 Medicare patients, the Duke University Medical Center found that endoscopic vein harvesting (EVH) of the saphenous vein for use as a bypass graft results in similar outcomes as traditional ankle-to-groin incisions.
Previous concerns linked EVH to narrowed grafts, however the five-year study with a three-year follow up showed no difference in mortality rates or incidents of revascularization and heart attacks.

Patients who underwent the EVH procedure experienced reduced on-site pain and swelling. They also had fewer complications and readmissions and were able to walk sooner after the procedure.

EVH requires between one and three 1-inch incisions and generally results in less tissue and muscle damage as well as reduced scarring compared to ankle to groin incisions. It is often recommended for patients with vascular issues who are at risk for leg wound complications.

In light of recent reform efforts, the health care industry is increasingly becoming an ideal environment for the continued growth and development of MIS. While procedural effectiveness is on par with many more open techniques, MIS typically results in shorter recovery periods. More efficient recovery means fewer resources are used while the patient regains his or her health, including less blood for transfusions and reduced manpower for physician follow-up sessions due to shorter hospital stays.

“The relationship of minimally invasive surgery to the health care industry is changing,” says Joe Flower, CEO of The Change Project, Inc., a health care futurist and policy specialist. “Surgery is becoming part of a larger arc of patient care designed to get and keep patients well.”

Outcomes-driven incentives may help give MIS the push it needs to expand more rapidly.

“Currently, many facilities incentivize in cost centers,” says William Taylor, M.D., co-founder of the Society for Minimally Invasive Spine Surgery and professor of neurosurgery at UCSD Medical Center in San Diego, CA. “Hospitals may incentivize less expensive open procedures because the instrumentation costs are reduced, saving money in a single cost center. However, when you consider the additional expense spent on longer recoveries, intensive care unit stays, physical therapy and blood transfusions, the slightly more expensive, yet more effective, minimally invasive procedure has the potential to reduce the overall cost for the hospital and benefit the patient.”

“We are seeing a growing population of young, active patients who want to stay active and aren’t interested in losing quality of life to conditions that can be treated through MIS,” Dr. Taylor says. “The same can be said for older groups of patients ages 65, 70 or 80 who are still active and aren’t willing to give that up.”

MIS techniques also continue to gain ground as more physicians who are trained to use them during residencies or fellowships join the workforce. For practitioners interested in developing these skills, additional training is often available remotely via teleconference.

Compared to open procedures, minimally invasive surgery (MIS) is linked to decreased risk of infection and other complications, as well as reduced blood loss in a wide variety of procedures from posterior approach total hip arthroplasty to minimally invasive aortic valve surgery.

“At this time, the 20% of spine surgery procedures being completed with MIS are more about minimal incisions, with the anatomy still in view. The next steps include introducing endoscopic or navigation systems to produce three-dimensional images on screens and revisiting the concept of even smaller incisions.” — William Taylor, M.D., co-founder of the Society for Minimally Invasive Spine Surgery and professor of neurosurgery at UCSD Medical Center in San DiegoMIS and Health Care Reform

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Minimally Invasive, Endoscopic, Endoscopic Spine Surgery and Laser Spine Surgery

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The trend in spine surgery has moved toward minimally invasive type procedures. Minimally invasive spine surgery (MIS) involves surgical treatment of the spine through small incisions with very minimal disruption of the surrounding muscle tissue.The benefits of minimally invasive spine surgery include decreased pain, shorter hospital stays, and quicker recovery. Come check out our large medical doctors and surgeons group at

Open Surgery and Minimally Invasive Surgery

Surgical procedures of the spine are often referred to as an “open back type” procedure or minimally invasive. An open procedure involves making a skin incision and retracting (moving aside) any tissues overlying the anatomy that is to be operated on so that the surgeon can directly view the desired anatomy. The surgeon will view the anatomy either with the naked eye, magnifying telescopic eyeglasses called loupes, or a magnifying microscope. Traditionally, open procedures have required larger incisions and more muscle tissue distraction than minimally invasive surgery.

Minimally invasive surgical techniques utilize specialized retractors which allow a surgical procedure to be done through smaller incisions with much less tissue disruption. One of these specialized retractors is called a tubular retractor, which is a series of gradually expanding tubes that gently and progressively dilate and separate muscles and soft tissues to expose the operative field. Using specialized instruments, surgery is performed through the tube.

Laser Spine Surgery

Laser is one of many specialized tools that can be used during minimally invasive spine surgery. There is a common misconception that if a laser is used during surgery, no incisions need to be made. Unfortunately, this is not the case. A laser is like any other surgical tool. In order for it to be used, it has to be placed into the appropriate area of the body through an incision.

A second misconception is that lasers can be used to remove arthritis. Spinal arthritis is a condition in which the facet joints degenerate and become inflamed.Unfortunately, there is no cure for arthritis and it cannot be “lasered away”.

Finally, many people think that laser surgery is always better than surgery without a laser. Although the laser is helpful for certain procedures, not all spinal conditions can be safely or appropriately treated with a laser, and using a laser does not always provide advantages over other techniques.

Transforaminal Endoscopic Discectomy

This is a technique that is being performed by some of the surgeons at to treat herniated discs in the lumbar spine. Transforaminal literally means “through the foramen”. The foramen is the “window” or “tunnel” through which the nerve exits from the spinal canal at each disc level. The foramen are located on the sides of the spinal canal, and provide a natural window through which the spinal canal can be accessed without having to remove any bone or ligament tissue.

The patient remains awake during the procedure. After a local anesthetic is administered, a small needle is inserted into the disc space. A 7mm (1/4 inch) “keyhole” skin incision is made and a tube is slipped over the needle into the abnormal disc. Muscle and tissue is dilated rater than being cut when accessing the disc and a laminotomy does not have to be performed. The endoscope is then inserted through the tube into the disc. Using x-ray guidance and endoscopic visualization, micro-instruments are used to remove the damaged disc. A laser may be used to further remove and shrink the disc (disc decompression) and to tighten the outer layers of the disc (annulus). On average, the procedure takes about 30 minutes to one hour per disc. Upon completion of the procedure, the probe is removed and a small bandage is applied over the incision.


Minimally invasive surgery is emerging as an alternative, reliable method of treatment for a variety of spinal disorders. Like “building a ship in a bottle”, there is a steep learning curve for surgeons learning to do these procedures. Although the recovery is often faster, the complication rate during surgery can be greater and the results may not be as predictable. Not every patient is a candidate for minimally invasive surgery.Each patient needs evaluation by a knowledgeable and experienced surgeon in this technique to determine their eligibility.

Our physicians specialize in numerous medical specialties, including, but not limited to: Orthopedics- spine and extremities, OB/GYN, Interventional Radiology, Oncology, Physical medicine and rehabilitation, Pain Management/Anesthesia, Surgical Anesthesia, Electro Diagnostic Testing, Autonomic Nervous System Testing, General Surgery/Bariatric Surgery, Hand/Plastic Surgery and Wound Care.

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Minimally Invasive Spine Surgery ,(MIS), Minimally Invasive Spine, Minimally Invasive Surgery

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This new way of helping and healing people in the spine surgery department of your doctors office  is now what people call Minimally invasive spine surgery. (MIS) was first performed in the 1980s or so, but has recently it seen rapid many advances. Technological advances have enabled spine and neuro surgeons to expand patient selection and treat an evolving array of spinal disorders, such as degenerative disc disease, herniated disc, fractures, tumors, infections, instability, and deformity. Our group here at would like to educate you on all of these types of procedures.

CT Scan of Burst Fracture | Donald Corenman, M...

CT Scan of Burst Fracture | Donald Corenman, MD | Spine Surgery Colorado (Photo credit: neckandback)

One of the potential downsides of traditional, open lumbar (back) surgeries is the damage that occurs from the major 5- to 6-inch incision. There are many potential sources for damage to the normal tissue: the muscle dissection and retraction required to uncover the spine (which contributes to the formation of scar and fibrotic tissue), the need for blood vessel cauterization, and the necessity of bone removal. Disrupting natural spinal anatomy is necessary to facilitate decompression of pinched nerves and the placement of screws and devices to stabilize the spine process. This may lead to lengthy hospital stays (up to five days or longer in many cases), prolonged pain and recovery periods, and the need for postoperative narcotic use, significant operative blood loss, and risk of tissue infection.

MIS was developed to treat disorders of the spine with less disruption to the muscles. This can result in quicker recovery, decrease operative blood loss, and speed patient return to normal function. In some MIS approaches, also called ” band aid holes, and keyhole type surgeries,” surgeons use a small endoscope with a camera on the end of it, which is inserted through a small incision in the skin. The camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine.

Not all of the critical mass of patients is appropriate ready candidates for MIS type procedures. We have a very educated team of some of the top doctors in the USA from Mayo Clinic Trained spine Surgeons to Jefferson Trained Spines surgeons feel free to do more research on our group at today. It is very important to keep in mind that their needs to be certainty that the same or better results can be achieved through MIS techniques as with the respective open procedures.

As with all non-emergency or elective spinal related surgeries, the patient should always undergo the appropriate period of conservative based treatments, such as physical therapy, pain medications, or bracing, without showing improvement, before surgery is considered. The time period of this varies depending on the specific condition and procedure, but is generally six weeks to six months. The benefits of surgery should always be weighed carefully against its possible risks.

Although a large percentage of patients say they report significant symptom and pain relief, there is no guarantee that surgery will help every individual patient.

Many MIS procedures can be performed on an outpatient basis. In some cases, the surgeon may require a hospital stay, typically less than 24 hours to 2 days in most cases, depending on the procedure selected.

The MIS Benefits

The potential many benefits of MIS include:

Surgery Risks

As with any spinal surgical procedure, there are many risks, including:

Make sure your informed of all of these details before you elect to have spine surgery. We have a large group of doctors that would love to help you with any pain or spine related problems feel free to call our group we are ready 24/7 to help you with your pain, spine, or orthopedic problems.

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