you put bigger and bigger tubes on top so it separates the muscle
without cutting it. And, if you don’t cut muscle, then the muscle
survives and there’s minimal blood loss.”
Beginning in 2002, Dr. Rouben and his peers began doing a variety
of operations through tubes including fusions and the removal of
bones, discs and ligaments. In his opinion, the arguments in favor of
the procedures (minimal blood loss, shorter hospitalization, earlier
return to work, and the ability to rehabilitate muscles in the back)
far outweigh the arguments against.
“Even in the best of hands, it does take more time to operate
through a tube than it does to just cut down the middle. It’s really
a muscle and tissue sparing technique that accomplishes the same
goal in a more traditional way,” said Dr. Rouben. He added that
even though the procedure has been successfully performed for
over 12 years now, only 1/3 of spinal surgeons in the U.S routinely
perform the technique and use it on a regular basis.
“It takes time to learn it well. You have to do it repetitively and
you can’t be in a rush,” he said, acknowledging that physicians who
have long been in practice might not want to change their usual
way of doing things so dramatically. After all, the procedure is more
demanding for the surgeon to master.
A one level fusion, involving just one spinal disc between two
bones, will typically take two hours to complete. Cumulatively, each
additional disc segment