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August 10, 2017

Penn neurosurgeon becomes first in Pennsylvania to perform back-saving procedure

Lower back and leg pain related to a spinal disc injury is the second most common reason American patients make visits to their physicians, trailing only respiratory infections. Worldwide, it's the leading cause of disability and a regular complaint made by those who lead both active and sedentary lifestyles. 

In many cases, the reason for the pain is compression of the spinal nerves, a diagnosis that can be treated and reversed with an increasingly successful surgical procedure. 

For the first time in Pennsylvania, a neurosurgeon at the University of Pennsylvania performed endoscopic minimally invasive spinal surgery, relieving a 50-year-old bridge inspector of a debilitating pain that had been dogging him for several years. 

Dr. Neil Malhotra completed the surgery on Quakertown resident Kevin Clark back in May, making a single incision in his side that enabled Clark to walk on his own power within hours.

It had been a long and inconsistent road to the operation room. Three years earlier, Clark underwent open spinal laminectomy surgery. The procedure required removing a small portion of bone over the nerve root to create more space, and while Clark saw a complete reversal of his symptoms, the pain resulting from the incision in that procedure lasted three months. 

Over the past year, Clark started to feel back pain and numbness returning to his right leg upper leg and thigh. When he learned of the opportunity offered at Penn, he decided to give it a try. 

Malhotra said Clark's symptoms — numbness, stabbing pains and cramps in the leg — were caused by a spinal disc herniation. It's a sensation some patients compare to a toothache in the leg. Malhotra said the single-incision endoscopic procedure reduces surgical symptoms such as muscle dissection pain. 

“It’s exciting to be able to offer the least invasive surgery for the greatest immediate benefit to the patient,” Malhotra said. “The reason why I was excited to adopt and help develop the procedure is because I can provide the same benefits to patients as a more invasive procedure does with the least incision and risk.”

Doctors in the U.S. perform about 500,000 spinal decompression surgeries every year, some of which Malhotra said could be done using this less invasive method. While the success rate is 70-90 percent compared to 90-100 percent for more invasive procedures, the benefits are likely worth the added risk because a more invasive option can be pursued in the event the endoscopic option falls short. 

Malhotra hopes to develop the procedure in the future to treat cancer patients with spinal column and spinal cord tumors. 

“I am enthusiastic to develop this remarkable tool to serve my cancer patients in the coming years, and I am ecstatic that it is ready today for patients with spinal nerve pain."

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