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LES Techniques are Revolutionizing Spine Surgery

Less Exposure Surgery

The years weren’t good to Bob Thomas’s back.

An old basketball injury, combined with years in the military and just plain life, left him in pain. He had back surgery previously, but even after years of recovery, he still had trouble. And it kept getting worse.

“It was to the point where I couldn’t stand straight,” says Thomas, a radio personality with 95.7 R&B FM in Norfolk, Va. “I’d walk 10 yards and have to sit down. I couldn’t stand at the bank. I couldn’t stand at church.”

Thomas, who lives in Hampton, didn’t want another surgery, but then he heard about a different kind of back surgery, one that was less invasive, would fix the problem and have him moving again normally in no time.

Although skeptical, Thomas agreed to the surgery, which involved the fusing of vertebrae in his back.

“I was blown away,” Thomas recalls of the surgery, which he had last year. “As soon as I got out of recovery, I was walking.” After a few weeks, he says he felt like a new man.

The surgery, performed by Dr. Jeffrey Carlson, a spine specialist at the Orthopaedic & Spine Center (OSC) in Newport News, Va., was Less Exposure Surgery (LES), a technique that’s less invasive than traditional surgery. LES uses smaller incisions through which a surgeon only exposes what needs to be treated for maximum effectiveness, sparing damage to nearby muscle and tissue. The result is a quicker surgery that results in less pain, less blood loss and has a speedier recovery. LES is most often done on an outpatient basis, meaning patients can recover at home, where they’re more comfortable and won’t run the risk of getting a hospital-based infection.

“Our patients aren’t sick,” says Carlson, who is considered an industry leader in LES along with his OSC colleague, Dr. Mark McFarland. “They have a back problem or nerve problem that doesn’t require hospitalization. They can get fixed and they can go home.”

Today, Thomas says his back doesn’t bother him at all. “Now, I have no problems,” he says. “I stand, I run, I walk. I average [walking] three miles a day.”

Carlson, the president and managing partner at OSC, has been doing LES for spine procedures for about five years. The types of surgeries are the same – treating cervical and lumbar spine issues as well as disc herniations, nerve compression, spinal stenosis, spinal cord compression and arthritis in the back around the joints – but require much smaller incisions.

Rather than exposing a large portion of the spine, LES techniques allow surgeons to “just open what we need to open, see what we need to see,” Carlson says. It uses the smallest incision possible, sometimes smaller than an inch, and does the same work through a midline approach just as effectively. Patients experience less pain because the technique employs a trajectory that lessens disruption to soft tissue and muscles.

LES reduces time in the operating room as well. Whereas conventional back surgery might take four to six hours, LES takes one to two hours. Recovery is also faster. Instead of taking months to return to normalcy, patients are back to walking immediately and usually resume all activity within weeks. After Thomas had his first conventional back surgery, he was out of commission for two to three months. After LES, he only missed a few weeks of work.

I was blown away,” Thomas says. “Dr. Carlson gave me back a life I hadn’t had in years.

LES is “really a shift-change in how we think about surgery,” says Carlson, who adopted the techniques through the Less Exposure Surgery Society, a group of physicians and researchers who collaborate on the growing practice. The LES Society also strives to show that the LES “less is more” philosophy and treatment options contribute to lowering the cost of healthcare, while also improving outcomes and patient satisfaction.

The LES philosophy hails back to spine surgeon Dr. Kingsley R. Chin, who founded SpineFrontier, a Massachusetts-based medical device company that makes spinal implants and instrumentation and works with surgeons to develop LES techniques around the world. The company has become known for its philanthropic outreach, donating its products and, through the LES Society, providing surgeon support in such places as Chin’s native Jamaica and most recently, in Ethiopia.

Williamsburg, Va., resident Susan Finkel is one of those helped by LES. The 60-year-old says she could hardly believe it when she walked out of the hospital after having back surgery several years ago. A failing artificial disc in her back had led her to Carlson. At the time, she couldn’t walk without “horrendous pain – it had gotten to the point where I couldn’t sleep at night,” she recalls.

Bon Secours Mary Immaculate Hospital in Newport News, where Finkel had her procedure and where Carlson operates, is among the top 10 percent of hospitals in the United States for spinal surgery and the top hospital in Virginia for spinal fusion.

Finkel’s surgery, a spine fusion, required less than a two-inch incision – small enough to be covered by a Band-Aid. She stopped taking pain meds after only five days and didn’t require any physical therapy. Best of all, the pain was gone, and she was back to work within a couple of weeks.

“A lot of people think your back goes bad because you’re getting old, and you have to suffer because of it,” says Finkel, who runs a real estate title company. “There’s just no reason for it. You can be 80 years old and they can still do something. To me, this surgery is the easiest possible way to fix the problem. It’s been miraculous.”

What is Less Exposure Surgery?

Less Exposure Surgery, or LES, is based on a philosophy of performing surgery that is less invasive than conventional measures.

The technique focuses on minimizing tissue disruption during spine surgery with the smallest incision necessary. Small incisions mean less blood loss, less pain and a quicker recovery time for the patient.

Historically, spine surgery involved a large incision to open the back, which exposes nerves and discs. Surgeons have worked over the years to make smaller incisions and perform back surgery through tubes, retractors and endoscopes. Even with this type of minimally invasive surgery, surgeons aren’t able to fully visualize what they need to and often compensate by using X-rays.

LES uses specific technologies and techniques to allow the surgeon to work using the smallest incision possible, sometimes only an inch long. Basically, surgeons go in at a different angle that causes the least disruption possible to surrounding tissues and muscles. The result is a quicker surgery that requires less time and gets the patient home sooner.

Less Exposure Surgery is done with less pain, less blood loss and has a speedier recovery.


About the author

Kim O'Brien Root

Kim O'Brien Root was a newspaper reporter — writing for papers in Virginia and Connecticut — for 15 years before she took a break to be a stay-at-home mom. When the lure of writing became too strong, she began freelancing and then took on the role of the Health Journal’s editor in Dec. 2017. She juggles work with being a chronic volunteer for two PTAs
and the Girl Scouts. She lives in Hampton, Virginia with her husband, a fellow journalist, their two children and a dog.

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