Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From OHSU Health Hillsboro Medical Center Neurosurgery
David A. Yam, M.D.
Dr. David Yam is a neurosurgeon at OHSU Health Hillsboro Medical Center (formerly Tuality Healthcare) with clinical interests in complex spinal surgery and cervical and lumbar disc replacement surgery. Dr. Yam strives to provide minimally invasive spinal surgery for every patient no matter the complexity, including discectomy, scoliosis, degenerative disc disease, fracture, tumor and revision surgery.
If a 75-year-old patient with failed spine surgery comes to your clinic complaining of back pain, her options may appear very limited. She may have been turned down for revision surgery due to her age and risk factors. She may require pain management therapies but not get much relief. But here in Oregon, OHSU is a resource for minimally invasive spine surgery. We are one of the few centers in the world expanding the indications for spine surgery with tubular retractors.
Since tubular retractors transformed spine surgery in the early 2000s, OHSU neurosurgeons have been at the forefront of exploring the boundaries of possibility with this technique.
We can now perform complicated surgeries through small tubes. These procedures used to only be possible through open surgery. For example, 99% of surgery for adjacent segment disease in the U.S. is performed open, but at OHSU, we can accomplish it percutaneously through tiny incisions.
Dramatic advantages of percutaneous options
The advantages of the minimally invasive approach include:
- Reduced blood loss
- Shorter operative time
- Reduced postoperative pain
- Low complication rate
- Earlier discharge
- More rapid return to normal activities
For example, an open pedicle subtraction osteotomy to correct kyphosis is associated with around 2 liters of blood loss; now we can perform similar corrections with almost no blood loss.
With these and other minimally invasive surgeries, patients spend a short time or no time at all in the ICU. A large volume of literature supports the reduction in risk to the patient, while the outcomes evidence compares favorably to open surgeries.
Helping more people with less risk
With the diversity of minimally invasive options now available, we can help many more patients who would not previously have been candidates for spine surgery due to age, health complications and previous surgeries.
OHSU will be publishing a large volume of literature in the coming years to move the bar for the indications of tubular spine surgery, sharing the latest innovations and treatments for better spine surgical options for the people of Oregon and beyond.
Spine surgeries performed via tubular retractors at OHSU Health Hillsboro Medical Center
- Cervical discectomy for selected disc protrusion
- Cervical foraminotomy for stenosis
- Cervical laminectomy for selected benign and malignant tumors
- Lumbar discectomy
- Lumbar far lateral discectomy
- Lumbar laminectomy for stenosis
- Lumbar laminectomy for selected benign and malignant tumors
- Lumbar laminotomy for synovial cyst
- Lumbar fusion for degenerative disc disease
- Lumbar fusion for spondylolisthesis
- Lumbar fusion for scoliosis or kyphosis
- Lumbar fusion for spinal fractures
- Lumbar fusion for tumors of the spine
- Lumbar revision surgery for failed fusion
- Thoracic laminectomy for stenosis
- Thoracic laminectomy for selected benign and malignant tumors
- Thoracic laminotomy/facetectomy for selected thoracic disc protrusion
- Thoracic fusion for spinal fractures
- Thoracic fusion for tumors of the spine
When to refer or consult
The following patients may be candidates at OHSU Health Hillsboro Medical Center Neurosurgery for minimally invasive spine surgery:
- Patients with scoliosis or deformity
- Patients with failed fusions or back surgeries
- Patients declined for spine surgery due to high risk factors
- Patients interested in a second opinion that would benefit from a less invasive operation
For the evaluation, we recommend that you include the results of an MRI that assesses the degree of nerve compression or a CT myelogram if MRI is not available or if the patient has not had one in the last year.
At the evaluation at OHSU Health Hillsboro Medical Center Neurosurgery, technicians will provide more detailed imaging and tests for diagnosis and surgical planning.
To refer a patient to OHSU Health Hillsboro Medical Center Neurosurgery, fax to 503-844-8321. For physician advice, call 503-844-8220.