ORLANDO - Each year, conference organizers reaffirmWCEC's position as the premier forum for research in workers'compensation and workplace safety/health issues with unsurpassededucational content and interactive learning opportunities.

In the passing years, attendees have also come to expect athrilling variation of hands-on learning in the form of a livesurgery demonstration, or two—as was the case in 2010 when doctorsfrom the Orlando Orthopaedic Center performed a carpal tunnelrelease and an arthroscopic meniscus repair.

The unique viewing experience returned in 2011 with aminimally invasive lumbar fusion procedure called transforaminallumbar interbody fusion (TLIF). As Dr. G. Grady McBride, aboard-certified spine surgeon, performed the surgery this morningat an offsite facility, Dr. Steven Weber acted as moderator ina conference ballroom filled with WCEC attendees.

Dr. Weber guided viewers in real-time through approximately 45minutes of progress, which represents the brunt of theprocedure (excluding the pre-implantation prep work and positioningof equipment). Using an animated slideshow to underscore keyconcepts, Dr. Weber fielded questions and helped the audiencediscern what exactly is transpiring in that relatively tinyincision.

“Spinal surgery is entering into the most amazing changes in thelast 25 years,” said Dr. McBride in a pre-surgery interview. “Therehave been so many phenomonal developments since I began mypractice.”

Although Dr. McBride acknowledged that other areas of medicinehave adopted alternatives to traditional surgery more rapidly overthe years, he pointed out that spinal surgery has been slow toevolve because of so many technology issues that had to be remediedover the years. Nevertheless, he said that TLIF holds tremendousappeal and is poised to become mainstream for two reasons:

• Minimally invasive surgery is minimally disruptive. Patientsundergoing the procedure typically heal about twice as quickly.This means they spend about 50 percent less time out of work andother activities.
• Far less muscle dissection. This means that woundcomplications and infection is much less likely than was the caseafter making a four- or five-inch incision and cutting awaymuscle.

Consequently, there is significantly less stress on the body,and the blood loss is often negligible. “Ninety percent of thosepatients today do not need a transfusion, whereas before most wouldrequire one,” Dr. McBride explained.

The minimally invasive procedure is appropriate for virtuallyanyone who has sustained a severe disc injury that would cause thespinal column to become unstable, although applicability andrecovery times are contingent upon the condition of the disc.Essentially instability at a disc causes a patient chronic pain.The objective of back fusion surgery is to stop the motion at apainful segment. Thus, the goal of TLIF is to provide “100-percentpain relief and restoration of work.”

“I've treated self-employed patients who recuperate more quicklythan the average worker, but these individuals generally have morelatitude with hours, schedule and restricted duty,” Dr. McBridereported. Even so, the hospital stay and recovery period aredecreased for all patients, regardless of occupation. This isbecause of the less-invasive placement of hardware.

Karen Ursulich, director of professional relations for theOrlando Orthopaedic Center, added that use of surgical narcoticscan be diminished with the minimally invasive method, therebyreducing costs.

Understanding some anatomy basics and the fundamentals of thisprocedure can assist adjusters and other professionals in assessinga realistic recovery period and overall claims costs.