Jae Y. Lim, M.D. is a principal surgeon at Atlantic Brain and Spine in Leesburg, Virginia. He also serves as an Assistant Clinical Professor of Neurosurgery at Virginia Commonwealth University School of Medicine. He has also practiced at Inland Neurosurgery and Spine in Spokane, Washington, and was head of Neurovascular Surgery at Sacred Heart Medical Center in Spokane.
He performs minimally invasive spine surgery, robotic spine surgery, and motion preservation spine surgery, a procedure that allows patients to avoid spinal fusions.
About 500,000 Americans have surgery for low-back problems each year. We asked Dr. Lim about the various types of back surgery and the likelihood of success.
PFL: What determines a person’s need to have back surgery?
Lim: Most spine surgeries in the United States are “elective,” meaning patients “elect” to have surgery to alleviate pain. Pain threshold and perception vary from person to person, so what one person might elect to address with surgery, another person might choose to address through other methods.
There are also several cases where surgery is considered medically necessary, including when patients have functional difficulty due to weakness, loss of control, and/or increased tone in the arms of legs. Also cases of difficulty with controlling the bowels or bladder are considered a medical need. In cases where these functional losses are rapid or severe, surgery may need to be performed on an emergency basis.
PFL: What is robotic spine surgery?
Lim: The term “robotic” in this case refers to a robotic arm that is attached to the patient during surgery after general anesthesia has been administered. This robotic arm sets the starting point, trajectory, and depth for spinal implants, allowing up to a 99 percent accuracy rate without the use of X-rays that expose patients to radiation during the procedure. Using the robotic system allows spine surgeons to preplan the placement of a spinal implant after considering the patient’s individual three-dimensional anatomy.
PFL: How do you decide whether a patient should have robotic spine surgery, minimally invasive spine surgery, or another procedure?
Lim: I believe every patient is a candidate to have robotic spine surgery in cases where spinal implants are being used. Similarly, every patient is a candidate for minimally invasive spine surgery (MIS).
MIS is not a reference to any one technology or equipment. Rather, it is a surgical philosophy that commits to minimizing the trauma a patient experiences during surgery. A surgeon utilizes special retractors, instruments, and guidance systems in order to complete the procedure through a much smaller opening compared to the traditional exposure.
A robotic spine system is one of these technologies that facilitates minimally invasive surgery, and a spine surgeon committed to truly minimally invasive techniques will employ it and other technologies in every spine surgery where it is appropriate.
PFL: How long is the recovery time from back surgery?
Lim: Recovery times vary based on a number of factors, including the section(s) of the spine that are treated as well as whether spinal implants were placed. For a typical lumbar decompression/fusion surgery, I advise patients that functional recovery is 3-6 months for open surgeries. This average drops to 1-3 months for minimally invasive spine surgeries.
PFL: How likely is it that a patient who has one of these procedures will be relieved of his or her pain?
Lim: The success of spine surgery in relieving a patient’s pain depends a great deal on the unique characteristics of each case. Understanding a specific patient’s individual needs, though an often overlooked part of spine surgery, is the single most important part of my job as a spine surgeon.
Matching the CT/MRI findings to the patient’s symptoms is often clear-cut in cases where functional loss (as I discussed above) is present. However, most patients considering spine surgeries have pain only. Determining the timing and appropriateness of surgeries for these patients is the art of spine surgery and is the biggest determining factor for a successful outcome.
PFL: For people who are interested in these procedures but live far from your location in Virginia, how can they find a surgeon who can perform the surgery they need?
Lim: They can search on the website of Mazor Robotics, the maker of robotic-based surgical tools.