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

In the passing years, attendees have also come to expect a thrilling variation of hands-on learning in the form of a live surgery demonstration, or two—as was the case in 2010 when doctors from the Orlando Orthopaedic Center performed a carpal tunnel release and an arthroscopic meniscus repair.

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

Dr. Weber guided viewers in real-time through approximately 45 minutes of progress, which represents the  brunt of the procedure (excluding the pre-implantation prep work and positioning of equipment). Using an animated slideshow to underscore key concepts, Dr. Weber fielded questions and helped the audience discern what exactly is transpiring in that relatively tiny incision.

“Spinal surgery is entering into the most amazing changes in the last 25 years,” said Dr. McBride in a pre-surgery interview. “There have been so many phenomonal developments since I began my practice.”

Although Dr. McBride acknowledged that other areas of medicine have adopted alternatives to traditional surgery more rapidly over the years, he pointed out that spinal surgery has been slow to evolve because of so many technology issues that had to be remedied over the years. Nevertheless, he said that TLIF holds tremendous appeal and is poised to become mainstream for two reasons:

• Minimally invasive surgery is minimally disruptive. Patients undergoing the procedure typically heal about twice as quickly. This means they spend about 50 percent less time out of work and other activities.
• Far less muscle dissection. This means that wound complications and infection is much less likely than was the case after making a four- or five-inch incision and cutting away muscle.     

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

The minimally invasive procedure is appropriate for virtually anyone who has sustained a severe disc injury that would cause the spinal column to become unstable, although applicability and recovery 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 a painful segment. Thus, the goal of TLIF is to provide “100-percent pain relief and restoration of work.”

“I've treated self-employed patients who recuperate more quickly than the average worker, but these individuals generally have more latitude with hours, schedule and restricted duty,” Dr. McBride reported. Even so, the hospital stay and recovery period are decreased for all patients, regardless of occupation. This is because of the less-invasive placement of hardware.

Karen Ursulich, director of professional relations for the Orlando Orthopaedic Center, added that use of surgical narcotics can be diminished with the minimally invasive method, thereby reducing costs.

Understanding some anatomy basics and the fundamentals of this procedure can assist adjusters and other professionals in assessing a realistic recovery period and overall claims costs.