A number of our readers have expressed concern about spinal surgery and
incisions. They have wanted to know if surgery requires a long incision
and how the incision will affect them in the healing process. With the
questions on spinal surgery in mind we requested an interview with Dr.
Richard S. Lee of the Newport Orthopedic Institute. Dr. Lee specializes
in surgical treatment of spinal conditions. His early experiences as an
undergraduate student and NASA researcher primed his interest in orthopedic
and spinal surgery as a medical student. We thank Dr. Lee for his generosity
in agreeing to an interview.
HOI: Does Spinal surgery mean you have to have a long incision?
Dr. Lee: Traditionally spinal surgery required fairly large incisions and
large surgical exposures in order to safely perform the operation. As
tools and techniques have evolved, the sizes of the operative incisions
required for safe surgery of the spine have decreased in length in many
types of cases.
HOI: Many people worry about the length of the incision they will have
with spinal surgery and the healing process from that incision as well
as the scar they will carry. What factors go into determining the length
of the incision?
Dr. Lee: The main factors are the type of surgery and the size of the patient.
For example, a procedure to correct a large scoliosis curvature affecting
many levels of the spine would require a larger surgical exposure than
an operation to treat a single level disc herniation. In general, a heavier
patient will require a larger incision to adequately expose the surgical site.
HOI: Is it possible for spinal surgery to require more than one incision?
Dr. Lee: Yes. Depending on what the goal of the surgery is, a spinal procedure
may require more than one incision. This is mainly due to the requirement
of achieving safe access to the spine. The spine is typically near the
center of a person's anatomy. Sometimes, it is necessary to approach
the pathology from multiple angles in order to accomplish the objectives
of the surgical procedure in a safe fashion.
HOI: Recently we have been reading that spinal surgery is becoming less
invasive. Can you tell us about
minimally invasive spinal surgery?
Dr. Lee: Minimally invasive spinal surgery is a set of operative techniques
that represents a continuum in the development of spinal surgery techniques.
The advent of newer tools for use in spinal surgery has allowed surgeons
to access the spine and perform procedures with lesser degrees of anatomy
dissection and tissue disruption. The intended goal with development of
minimally invasive spinal surgery techniques is to promote faster recovery
after surgery through less dissection of tissue.
HOI: How do incisions affect recovery?
Dr. Lee: In general the length of an incision has very little to do with
post operative recovery in spinal surgery. The length of the incision
often does not correlate with the amount of muscle and other tissue disruption
which are the aspects of spinal surgery that affect the recovery period
HOI: Is there any type of spinal surgery in which there is hardly any scarring
or evidence of an incision at all?
Dr. Lee: With certain minimally invasive spinal surgery techniques, the
length of the incisions can be quite small. However, this only affects
the cosmetic aspect of the procedure and not necessarily the functional
outcome of the patient. A general rule in spinal surgery is that an incision
will be made as small as possible but as large as necessary to achieve
a safe and adequate exposure of the intended operative site. Newer tools
have allowed for safe and adequate exposure through smaller length incisions.
Dr. Richard S. Lee is a specialist in surgical treatment of spinal conditions.
What he enjoys most about spinal surgery is the opportunity to combine
science and art to help patients rehab from physically debilitating conditions.
In college he studied neurobiology and was intrigued by the complexity
of the human nervous system. His laboratory research included work on
the effects of microgravity on gene expression in bone and muscle cells
in outer space. Dr. Lee attended medical school at the Albert Einstein
College of Medicine in New York. He completed his surgical internship
and orthopedic surgery residency at the
Yale School of Medicine, followed by a combined orthopedic and neurosurgical spinal surgery fellowship at
Harvard Medical School.