JGH is first in Quebec to offer new type of minimally invasive spinal surgery

Composite photo of Dr. Jeff Golan performing a spinal endoscopy. Above, he manipulates an ultra-thin surgical tool that has been inserted through a very narrow metal tube into the patient’s spine. Below, Dr. Golan watches a pair of screens that show two x ray views of the spine (at left and centre) and real-time video of the impact of his tiny tool on spinal tissue
Composite photo of Dr. Jeff Golan performing a spinal endoscopy. Above, he manipulates an ultra-thin surgical tool that has been inserted through a very narrow metal tube into the patient’s spine. Below, Dr. Golan watches a pair of screens that show two x ray views of the spine (at left and centre) and real-time video of the impact of his tiny tool on spinal tissue

The moment Jennifer Orr felt her right leg buckle, she knew she was in serious trouble.

She’d been lifting some heavy equipment and was experiencing twinges of pain in her back. But, she figured, that was probably just a flare-up of an old condition that irritated her tendons and ligaments.

And then, suddenly, her right leg went numb.

As Ms. Orr later learned, the cause of her distress was a herniated disc in her spine. The fibrous outer portion of one of her vertebral discs had torn, allowing the inner portion to poke out (herniate) through the fibres. This put pressure on the nerves near the injured disc and sent pain radiating through her back and leg.

Normally, her surgical treatment would have required a sizeable incision in her back. Then surgeons would have had to cut through or possibly even remove normal, healthy tissue to gain access to the spinal canal.

But when Dr. Jeff Golan, JGH Chief of Neurosurgery, operated on Ms. Orr in June, she became one of the first patients in Canada to undergo a new type of minimally invasive surgery known as spinal endoscopy.

As a result, she was able to stand up an hour after the operation, return home the same day and resume near-normal activity two weeks later, including non-strenuous tasks at work.

“I’m excited and thrilled by this surgery,” says Dr. Golan, who trained extensively on the surgical tools, which are more commonly used in Europe and in only a handful of medical centres in the United States.

Instrument for performing spinal endoscopy. Above, at the top right, a thin surgical tool has been inserted into a narrow metal tube, exiting at the bottom left. Below, in a magnified view of the tip of the tube, the widest opening is the one through which the surgical tool emerges. Two other channels irrigate and the surgical area and drain the water. The tube also contains a micro-miniaturized camera and light source to show the surgeon what is happening in the surgical area.
Instrument for performing spinal endoscopy. Above, at the top right, a thin surgical tool has been inserted into a narrow metal tube, exiting at the bottom left. Below, in a magnified view of the tip of the tube, the widest opening is the one through which the surgical tool emerges. Two other channels irrigate and the surgical area and drain the water. The tube also contains a micro-miniaturized camera and light source to show the surgeon what is happening in the surgical area.

“At last, we have technology that I feel has been lacking in Canada for a long time,” he says, adding that that the JGH is the first hospital in Quebec to offer this type of surgery.

Dr. Golan says the procedure is also ideal for treating spinal stenosis (pinched spinal nerves that cause debilitating numbness and weakness in the legs), sciatica and certain types of back pain.

For Ms. Orr’s operation, Dr. Golan made a small incision in her side, and then—assisted by digital x-ray images that were projected onto a large screen—slowly pushed a long, thin needle through the opening, until it reached the area of her herniated disc. The needle acted as a guide for the careful insertion of a metal tube about 8 millimetres (¼ inch) in diameter, which followed the needle’s path to the area of the injury.

The tube contained four passageways: one through which tiny, thin surgical instruments were able to reach the surgical area, another to irrigate the area with water, a third to drain the water, and a fourth containing a light source and a fibre-optic camera to show Dr. Golan and the surgical team what was happening at the site of the surgery.

Real-time video of the surgical site appeared on a large screen in the operating room, alongside two smaller screens that displayed the instantly available x-ray images.

The surgical tool that Dr. Golan used—part of a new generation of equipment for minimally invasive surgery—is of key importance, since only a single passageway into the body needs to be created.

Dr. Golan says the number of patients who are treated with spinal endoscopy will depend on the demand, but he estimates the JGH can handle anywhere from 100 to 200 patients per year.

“Years down the road, patients will continue feel the difference,” he says, “because it’s likely there will be less deterioration. Since the original, healthy tissue is left pretty much intact, we believe the surgery will keep patients pain-free for a very long time.”

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