Skip the Traditional Surgery and Spinal Fusion

February 17, 2011

Spine expert Dr. Lui on a better way to treat that pain in your neck.
Edison, NJ, January 2011 – A serious car accident left Michelle Petigny, 40-something from Manhattan, in pain most of the time from the spring of 2004 through the autumn of 2009. Severe cervical disc herniations—a protrusion of the gel-like material of the discs in her neck and lower back—had left her incapacitated, with near-constant pain in her head, neck, shoulders, upper and lower back. “In 5 years I had 10 procedures. There was a lot of suffering,” she says. “The pain was near constant.” Physical therapy and an assortment of pain medications had done little to help her.

Now, according to Dr. Kaixuan Liu, MD, PhD, chief surgeon at Atlantic Spinal Care in Edison, N.J, we can treat patients like Michelle Petigny with cervical disc herniation with a new and less invasive procedure known as endoscopic cervical discectomy (ECD) and help patients avoid open spinal fusion.

Herniated discs can occur in the cervical region of the spine—the seven vertebrae connecting your skull to the upper and middle (or lumbar) region of your spine—as a result of injury or plain old aging, says Dr. Liu. In most cases, people in their 30s or 40s are at the greatest risk for disc herniation, but older people—especially those who are very active or engage in physically strenuous work—are also susceptible. Most herniated discs appear in the lower back, but roughly 8 percent of them occur in the cervical spine.

The cervical vertebrae support the weight of your head (about 10 pounds) and allow it to move and rotate. They are separated by discs, which are round, flat pads that act as shock absorbers and keep the vertebrae from rubbing together. Each disc is located next to a pair of nerves, which branch out from the spinal cord to carry messages to and from your brain and the various parts of your body. A herniation in one or more of the discs in the cervical spine can mean pain, numbness, and weakness originating in the neck and radiating out to the surrounding areas, including the shoulders, arms, chest, and head.

Michelle’s story is not unusual among people with cervical disc problems, says Dr. Liu. “In our practice, we see lots of patients who have been dealing with cervical spine problems—and who haven’t found relief anywhere else.” Moreover, he says, recent research show that many of these people also experience severe daily or recurrent headaches, and patients with cervical disc herniation complicated by headaches report significantly more pain and limitations in their daily activities than those who don’t get headaches, he says.

The traditional approach to treating herniated cervical discs is simple R & R, says Dr. Liu, along with physical therapy and pain-relieving drugs. But in cases that don’t respond to these treatments after eight to 12 weeks, most doctors will recommend surgery.  “At lots of places, that means an invasive procedure known as a discectomy or foraminotomy, in which a surgeon makes an incision in your neck to get to the spine and remove the disc material,” he explains. This is known as “open” spinal surgery, as the surgeon must open up the skin, muscles and other tissue in the area to get to the problematic disc. In many cases, the surgeon may also perform a fusion, which involves the insertion of a bone graft into the now-empty disc space. This prevents the disc from collapsing and encourages the two vertebrae to grow (or “fuse”) into a single unit.

A Better Approach

While traditional spinal surgery and fusion can be an effective course of treatment, in many cases they are not, says Dr. Liu. “Open back surgery and spinal fusion are traumatic procedures, which, unfortunately, have a high rate of failure. And if the operation fails, the patient can be left with significant pain for the rest of his or her life.”

Instead, Dr. Liu performs a much less invasive procedure known as endoscopic cervical discectomy (ECD), in which he inserts a small metal tube, about 4 millimeters in diameter, into the spine through a tiny incision. Using a camera inserted through the tube, he can see the damaged disc and determine the best course of action: A large piece can be pulled out with a grasper, while a small bulge can be vaporized with a laser. In most cases, the patient can go home the same day and be back to normal, pre-herniated-disc life, in a few weeks.

“We can treat disc herniation and many other conditions and help patients avoid open spinal fusion,” he says.

The procedure certainly worked for Michelle Petigny “When I woke up after the surgery, I could already feel the difference,” she says. “I didn’t have the constant pressure in my head, and the muscles in my neck and across my shoulders felt so much better.” Michelle’s only regret is that she didn’t seek out endoscopic surgery sooner. She believes it would have saved her years of pain and suffering.”

About: Kaixuan Liu, M.D., Ph.D., Dr. Liu is a nationally recognized leader in endoscopic spinal surgery. He has substantial experience in this rapidly developing field, and he treats disc herniations, spinal stenosis, failed neck or back surgeries, spondylolisthesis, and many other diseases and conditions in the cervical, thoracic, and lumbar spine. Dr. Liu is certified by American Board of Pain Medicine and American Board of Anesthesiology. After fellowship training in Minimally Invasive Spine Surgery at the Advanced Orthopedic of South Florida, Dr. Liu founded Atlantic Spinal Care, LLC, in Edison, New Jersey.

Dr. Liu graduated from Hubei Medical College in China in 1985. He completed resident training in Beijing Medical University and was awarded a Master of Surgery in 1989. He subsequently received an additional year of postgraduate training in thoracic surgery at the China-Japan Friendship hospital in Beijing.  In 1990, Dr. Liu immigrated to the United States as a physician scientist to develop innovative therapies for human lung cancer at the University of Medicine and Dentistry of New Jersey (UMDNJ). He completed his master's and doctoral study focusing on breast cancer research and gene therapy in Auburn University, Alabama where he also earned a PhD degree in Molecular Medicine. Subsequently, Dr. Liu developed a strong interest in pain medicine and received one year clinical training in surgery and three years of training in Anesthesia at Columbia University College of Physicians and Surgeons.

As a renowned physician scientist, Dr. Liu is frequently invited to speak at national and international conferences. Dr. Liu is currently a member of International Society for Advancement of Spine Surgery, American Society of Interventional Pain Physicians (ASIPP), American Academy of Pain Medicine (AAPM), International Intradiscal Therapy Society (IITS), and American Society of Anesthesiologists (ASA). He also serves as an international surgeon for the Spinal Foundations in England.