Option for Transverse Midline Incision and Other Factors That Determine Patient’s Decision to Have Cervical Spine Surgery

By Dr. Kingsley Chin

““I had my [cervical fusion and lumbar decompression] surgery ten days ago and I feel great, I’m wearing my heels and I’m ready to go!””

Introductory content by Fabio Pencle 

“[Dr. Chin] is a true professional… the whole team, the whole staff was great here at the LESS Institute.”

A newly published study has demonstrated that patients prefer a midline incision for cervical spine surgery.

The anterior approach to cervical spine surgery has become the standard for the treatment for degenerative disc, traumatic herniated disc and fracture dislocation. Cloward, Smith and Robinson have

devised operative techniques with modifications by several surgeons since 1958. There are varying types of skin incisions for cervical spine surgery; the incision is either on the right or left side of the trachea based on the surgical approach to the recurrent laryngeal nerve. Other factors determining the type of incision include a few pathological levels affected, if corpectomy is required and whetheraffected segments are contiguous.

Transverse midline incisions have been used by other surgical specialties such as ENT, vascular and general surgeons. This incision provides a more cosmetically acceptable result and allows for access to structures during surgery; however, few studies discuss the relevance of cosmesis. There are several named guidelines for determining surgical incision, most notably, Langer’s lines. A transverse midline incision would, however, follow the guideline by Kraissl, where the incision is made in a skin crease. The quality of surgery is judged immediately by the amount of relief of symptoms and the cosmetic.

Considering the patient-driven procedures offered to treat the same pathology, as well as recent trends in the increase in ambulatory surgery center (ASC) use, the authors felt it prudent to devise a questionnaire with the primary goal of determining the preferences of the patients. The secondary goal was to determine factors which lead to the decision to have anterior cervical spine surgery.

Scientific Paper

Fabio J.R. Pencle, Jason A. Seale, Amala Benny, Sephania Salomon, Ashley Simela, Kingsley R. Chin

To read the full paper & citations as published in the Journal of Orthopaedics, visit here.

Background

Authors aim to determine patients’ preference for surgical incision and factors affecting the decision for surgery to the anterior neck.

Methods

A questionnaire was presented prior to evaluation and if preceded to surgery followup given.

Results

243 patients completed questionnaire, with 60% female population and younger than 50 years. 151 patients preferred a transverse midline incision with a statistically significant increase in outcomes and cosmesis importance and a decrease in the importance of board certification.

Conclusion

Findings of questionnaire demonstrate that patients’ prefer a transverse midline anterior neck incision, with surgical outcomes being the overall factor affecting decision making.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, VisitingSpine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

Scientific Paper Author & Citation Details

Authors

Fabio J.R. Penclead, Jason A. Sealead, Amala Bennyd, Sephania Salomond, Ashley Simelade, Kingsley R. Chinabcf

Author information

a. Less Exposure Surgery Specialists Institute (LESS Institute), United States
b. Herbert Wertheim College of Medicine, Florida International University, United States
c. Charles E. Schmidt College of Medicine, Florida Atlantic University, United States
d. Less Exposure Surgery (LES) Society, United States
e. Bronx Lebanon Hospital Center, United States
f. University of Technology, Jamaica

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15-Year-Old Jamaican Girl Appreciates Life Changing Scoliosis Surgery in Jamaica by Dr. Kingsley R. Chin

By Caitlin Lubinski

On a late Saturday night in May, an unlikely group of people’s paths crossed in a small operating room in the University Hospital of the West Indies. It was hot, and beads of sweat formed on the doctors’ foreheads above their surgical masks. Outside the O.R., the windows in the hallways were open to catch the breeze that filtered through the open slats. The hallway was quiet, filled only with an empty gurney with a canvas stretcher and wood handles. A clock on the wall covered in a metal casing methodically tracked the passing moments.

Inside the O.R., Dr. Kingsley R. Chin, an orthopaedic surgeon and founder of Less Exposure Surgery Specialists (LESS) Institute in Florida, and Dr. Carl A. Bruce, a consultant neurosurgeon at the University of the West Indies at Mona Jamaica, operated on a fifteen year old young woman. Around them stood Kevin Chappuis, a medical technology engineer from SpineFrontier, Inc, Harisha Buggam, a medical device distributor in the West Indies, and the University’s Chief of Anesthesiology, Dr. Harding. The operation, a high level, scoliosis case, required that surgeons correct a deformity in the patient’s spine.

Shinel Binns, the patient lying on the operating table, was fit and healthy -a normal young woman in every way, except for the severe curve in her spine. Standing up, Shinel’s legs were perpendicular to the ground, but at her waist, her torso and head angled sharply to the left, as if she had to fight gravity from pulling her left shoulder and head to the ground. A lifetime of trying to hold her head and torso upright to counterbalance her lumbar spine’s deformity had begun to create a curve in her thoracic spine.

Shinel lived in Saint Elizabeth Parish –a two hour journey from the hospital she was now being treated at in Kingston, Jamaica. She and her family had waited a long time for this moment. She would never have been able to afford an operation, but the donated time from the doctors, and over $500,000 in donated technology and personnel from SpineFrontier, as well as her community’s donation of $5,000, was making her operation possible.

Dr. Kingsley R. Chin had flown in earlier that day from the United States. Born and raised in Jamaica, he often returned to perform surgeries for people in need. As a pioneer in the Less Exposure Surgery (LES®) approach, Chin has devoted his life to refining and training others in a revolutionary approach to back surgery. The LES Philosophy of surgery pinpoints the problem, fixes it without collateral damage to surrounding tissues, and lets patients go home the same day.

A patient examination and X-Rays had confirmed to the doctors that Shinel’s original spinal deformity was in the lumbar spine. Because the thoracic curve was compensatory to keep her upright, Dr. Chin and Dr. Bruce operated on the most pronounced section of the curve (L1-L4). Dr. Chin used a Less Exposure Surgery (LES) approach, addressing the most pronounced section of the spinal curve (L1-L4) by inserting SpineFrontier’s S-LIFT® Lateral Interbody through a single, three inch incision at those levels to straighten out the spine. The surgeons then placed unilateral MISquito® Percutaneous Pedicle Screws to hold the straightened position.

The LES approach through the small incision on the side of the abdomen was low impact and saved Shinel the trauma of an incision through her stabilizing back muscles that could disrupt her strength. It also minimized the surgical trauma and maximized its effectiveness for a rapid and less painful recovery. This approach was especially important because it would allow a teenage girl to resume her daily activities more quickly. The surgeons expected that the thoracic curve would straighten itself over time. After the operation, Shinel already felt straighter and only had minimal superficial pain.

Harisha Buggum, the medical device distributor, had observed several other scoliosis corrections before through the Scotiabank Scoliosis Programme that provided implants at a greatly reduced cost to teenagers with scoliosis. But she had a renewed sense of excitement when talking about Shinel’s operation.

“In this surgery, you could see the technology changing the deformity and you could see the spine literally straightening up through the fluoro imaging. It’s good to know technology has turned in the direction so that someone with scoliosis can actually get a correction from Less Exposure Surgery.””

“I’ve never seen that kind of procedure done,” Harisha said, leaning forward and talking energetically, “This was different for us than our day-to-day [procedures]. In this surgery, you could see the technology changing the deformity and you could see the spine literally straightening up through the fluoro imaging. It’s good to know technology has turned in the direction so that someone with scoliosis can actually get a correction from Less Exposure Surgery.”     

Harisha’s excitement over what she observed in the O.R. was just a small window into the many cases that Dr. Chin and his colleagues at the LESS Institute perform on a daily basis in the United States.

“This case is a perfect example of how Less Exposure Surgery can transform a patient’s life,” Chin commented.

Learn More About Less Exposure Surgery and connect with Dr. Kingsley R. Chin.