New Jersey Spine Institute

1 Robertson Dr, Suite 11
Bedminster, NJ 07921
Ph: 908-234-9200

New Jersey’s only medical facility specializing in both surgical
and non-surgical diagnosis and treatment of spinal conditions.

Patient Education

Minimally Invasive Spinal Surgery Technologies

Lumbar pain or lower back pain is a very common cause of acute and chronic pain in the adult population.  It is the second most common reason for visits to a doctor’s office and is the most common cause of disability in adults under the age of 40-years-old.  It provides for significant loss of time from work and limitation of leisure activities.  The most common structures causing structural low back pain is the intervertebral disc as well as the spinal nerve.  The intervertebral disc is a soft tissue spacer between the bony vertebrae or bones of the spinal column.  The spinal column is the bony structure that protects the spinal cord and spinal nerves.  It is separated by intervertebral discs that allow flexibility, but also stabilize the spine.  The intervertebral discs are soft tissue structures commonly made of collagen that has an inner portion called a nucleus and an outer portion called the annulus.  The nucleus is a non-compressible gelatin-like material.  The annulus is a highly fibrous, rigid, tough, soft tissue material much like the outer ply of a tire.  The outer layers of the posterior annulus are very highly innervated and injury to the disc, itself, can result in significant pain.

Age and injury can damage the disc, resulting in leakage, (or herniation) of nuclear material/disc material onto the spinal nerves.  Other injuries can cause instability both resulting in painful conditions.  Spinal nerve pain resulting from compression of the spinal nerve, by a fragment of disc material, or bone spur is called radiculopathy.  Spinal instability pain resulting from weakening or loss of water content of the intervertebral disc is called discogenic pain.

Many painful spine conditions are treated successfully without surgery.  Treatment often consists of the judicious use of anti-inflammatory medications, physical therapy, and sometimes spinal injections.  Physical therapy includes lumbar stabilization exercises, other exercises called McKenzie exercises, postural training, and physical therapy modalities.  When spinal conditions, such as disc herniations or discogenic pain are refractory to improvement with physical therapy and medications, we will often implement  the use of spinal injections, such as epidural steroid injections.  These are x-ray guided injections with application of a small, yet powerful amounts of steroids adjacent to the injured spinal nerve and disc that often result in significant and major improvement in a patient’s spinal condition

Approximately 90% of individuals with painful disc conditions will improve without surgery.  Unfortunately 10% of patients presenting with spinal conditions either end up living with chronic pain or come to surgical treatment.  Fortunately surgical treatment today has become much less invasive and much more efficacious than in the past.  Surgical treatment involves either partial or complete removal of the painful and injured disc material.

Spinal nerve pain and radiculopathy is relieved by a procedure called microdiscectomy. Through an incision less than one-inch long, a series of tubes is used to spread the spinal muscles away from the spinal column.  This creates a window through which the surgeon is able to visualize the spinal nerve.  Once the spinal nerve is identified, it is protected.  Once the spinal nerve is protected the fragment of disc material is identified, visualized, and subsequently removed using very specialized surgical instruments.  The decompressed injured nerve is then allowed to heal naturally.  Surgical time for this procedure is

approximately one hour and this procedure is performed on most patients as an outpatient procedure in our ambulatory surgical center.  Our center in Bridgewater, New Jersey is called Ambulatory Surgical Center of Somerset.

Discogenic pain syndromes require a more extensive surgery that removes the majority of the injured or damaged intervertebral disc.  This procedure is called a spinal fusion.  Spinal fusion requires almost complete removal of the nuclear material and subtotal removal of the entire disc.  Once the disc cavity is evacuated, it is stabilized using rigid, strong, structural bone and then locked in position with a rod and screw implant.  Special technology has made this surgery much less invasive than in the past.  Historically spinal fusions have been very invasive surgeries that required long incisions, caused significant amounts of blood loss, often required four to seven day hospitalizations with postoperative rehab and recovery that lasted almost six months.  Now at the Ambulatory Surgical Center of Somerset, we are employing new technology that allows fusion surgery using an incision that is less than one-and-a-half inches long, exposes the patient to minimal blood loss, with the patient having minimal postoperative pain.  Most patients are discharged home in less than 24 hours.  This procedure is called a minimally invasive TLIF.

Utilizing a special retractor system, the spinal muscles are gently spread aside from the spine without cutting.  Using both x-ray and electronic spinal monitoring, the spinal disc is identified, as is the spinal nerve.  Electronic spinal monitoring allows effective and safe identification of the spinal nerves adjacent to the disc spaces, which are then protected.  The disc space is identified and opened.  Using special instruments the nuclear material of the intervertebral disc is almost completely evacuated.  Once the disc space is evacuated, large, rigid implants of structural bone are placed into the disc space and augmented with a powerful biologic protein called BMP.  After placement of the structural bone and BMP, vertebral screws and rods are attached to the spine locking the implants in position and rigidly stabilizing the spine.

During 2010 and 2011 all patients undergoing this minimally invasive TLIF procedure at Ambulatory Surgical Center of Somerset have all been discharged home in less than 24 hours with no history of complications, no hospitalization required, and minimal postoperative pain.  All patients have considered their results successful.

Spinal rehabilitation and return to activity occurs rapidly secondary to the small incision size and increased functionality of these patients.

Appropriate application of this new technology allows for more successful, less painful spinal surgery; allowing more patients to return to function with less morbidity, providing longstanding, dramatic relief from painful spinal conditions.


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