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Spring 2017
After 20 Years, Neck Surgery Created At Our Practice Has Helped Thousands Of Patients
Practice Neurosurgeon Who Developed Cervical Microendoscopic Discectomy Recounts Origin Of This Minimally Invasive Spine Surgery




In 1997, neurosurgeon Tim Adamson, MD, of Carolina Neurosurgery & Spine Associates developed cervical microendoscopic discectomy (MED), an outpatient procedure to relieve pressure on the spinal nerve caused by a herniated cervical disc. We mark the 20th anniversary of cervical MED by recounting the origin of this procedure that has made a dramatic difference in the quality of life for thousands of patients.

The diagram above shows how cervical MED only requires a half-inch incision. Instead of cutting through muscle, a tubular retractor system is used to separate muscles in order to access the damaged cervical spine. An endoscope is then inserted into the tube to visualize the anatomy, allowing the surgeon to safely remove damaged material and decompress the spine.
Dr. Adamson's first exposure to the concept of minimally invasive surgery, or microsurgery, was during his neurosurgery fellowship with Dr. Gazi Yasargil in Switzerland.

"It was an incredible opportunity to learn from the Michael Jordan of neurosurgery," said Dr. Adamson. "He is a true innovator and was even named Neurosurgeon of the Century in 2000."

Dr. Yasargil wanted to improve outcomes and reduce the trauma that patients had to endure during and after neurosurgical procedures. His primary area of focus was related to brain procedures, but Dr. Adamson realized these same principles could be applied to spine surgery as well.

"Today, the term 'minimally invasive' is a buzzword among patients and within the medical community. The idea of surgery with a small incision and short recovery time is very common now, but in the 1990s, it was just becoming a hot topic," said Dr. Adamson.

In 1997, Drs. Kevin Foley and Maurice Smith in Memphis developed the lumbar microendoscopic discectomy (MED) procedure. The neurosurgeons of Carolina Neurosurgery & Spine Associates saw the benefits of lumbar MED and began using the technique. After learning the lumbar procedure, Dr. Adamson thought it was a natural fit to develop a similar type of technique for the cervical spine. Traditionally, cervical spine disease was treated using techniques that originated in the 1950s and required cutting muscles in the neck. As a result of significant muscle disturbance, procedure recovery took several weeks and patients experienced significant post-operative pain. A new minimally invasive option could make a real difference for these patients in terms of both recovery time and pain reduction.

"I consulted with the two surgeons who created the original lumbar procedure and explained my idea. They wished me well but did not think the lumbar technique could be adapted for cervical spine disorders," said Dr. Adamson.

After about three months of intense focus and exploring options, Dr. Adamson was successful in getting positive results for patients using cervical MED. This meant that neurosurgeons could now treat a very painful and potentially dangerous condition in the neck much more easily and quickly with an outpatient procedure.

Unlike traditional surgery, the cervical MED procedure only requires a half-inch incision. Instead of cutting through muscle, a tubular retractor system is used to separate muscles and access the damaged cervical spine. An endoscope is then inserted into the tube to visualize the anatomy, allowing the surgeon to safely remove damaged material and decompress the spine.

Over the past two decades, cervical MED has proven to be a highly effective treatment for cervical radiculopathy, especially for physically active patients. It is routinely performed on an outpatient basis. Patients are usually discharged the same day as surgery, and can return to a light normal routine after three to five days of limited activity.

Tim Adamson, MD
The procedure has been successful enough to gain attention around the world. Surgeons from other states and countries routinely come and train at Carolina Neurosurgery & Spine Associates to learn the cervical MED technique.

Minimally invasive surgery will continue to play a larger role in spine surgery over the next decade. At Carolina Neurosurgery & Spine Associates, Dr. Adamson and Dom Coric, MD, are working on a new minimally invasive technique for cervical fusion that will hopefully be in clinical trials in April. Our practice and other doctors around the world will continue to push the boundaries of neurosurgery to provide better outcomes for patients.

"Twenty years have gone by very quickly," said Dr. Adamson. "But as I look back to the time when we pioneered cervical MED right here in Charlotte, I was just doing then what all of us in the medical field hope to do every day; build upon the advancements that came before us, add our own insight, and hopefully serve as a catalyst to create new innovations to help patients in the future."The diagram above shows how cervical MED only requires a half-inch incision. Instead of cutting through muscle, a tubular retractor system is used to separate muscles in order to access the damaged cervical spine. An endoscope is then inserted into the tube to visualize the anatomy, allowing the surgeon to safely remove damaged material and decompress the spine.
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