An innovative, two-staged approach to treat patients requiring lumbar fusion where traditional approaches have failed is now available to patients at Mediclinic Paarl.

This approach allows for a spinal fusion and decompression to be done simultaneously with much less tissue damage and blood loss than traditional open surgery techniques. 

Since the beginning of 2024, this combination of surgical techniques has been performed by spinal surgeon Dr Reggie King and endoscopic surgeon Dr Shawn Venter of the Spine Centre in Paarl, one of the few centres internationally that offers this fairly new technique to treat patients with neurological problems.

Within the same operation, Dr King performs a spinal fusion, while Dr Venter performs a spinal decompression to relieve the neurological symptoms.

Spinal fusion and decompression

Dr King’s expertise is in anterior lumbar surgery to treat disc problems in the lower back. Anterior lumbar surgery is done through an incision in the front of the patient’s belly, whereby the problematic disc is removed, and two or more bones are fused together to eliminate painful motion and correct alignment.

His partner Dr Venter is skilled in endoscopic surgery, and particularly biportal endoscopic spine surgery, a very new spinal surgery technique using endoscopes. In this way, Dr Venter can perform minimally invasive spinal decompressions.

Dr King notes that, in the past 15-20 years, the vast majority of spinal surgery was done from the back, not the front.

“In the last few years, it has become more popular for spinal surgeons to access the spine by operating from the front with some elegant surgical approaches,” he says.

Releasing the pain

“This allows for surgical techniques to restore lumbar anatomy a lot better than we used to be able to. The reason for this is that the surgeon is not working past nerves, as is the case when the operation is performed from the back, which limits what the surgeon can do.”

Dr King approaches the interbody disc space from either an anterior, oblique, or lateral retroperitoneal approach to remove the intervertebral disc from the front side of the body. He then implants a spacer filled with bone graft between the vertebral bodies to restore the lumbar anatomy and allow the two vertebrae to grow together in an interbody fusion.

The patient is then turned on their stomach during the same anaesthetic for Dr Venter to perform the spinal decompression. For this, screws are placed under the skin through small incisions to stabilise the vertebral bodies fused from the front. This allows for additional stability to achieve a successful union of the stabilised vertebrae. He then uses a unique biportal endoscopic technique to release the compressed nerves causing the leg pain or neurological problem. 

Faster recovery

“This combined technique allows for a spinal fusion and decompression to be done with much less tissue damage and blood loss than the traditional open techniques. This also means that the patient recovers quicker with less post-operative pain,” says Dr King.

He notes that the reason this surgery is not offered more widely is that it is a highly specialised type of surgery, which involves both the fusion and the decompression being done from front and back, respectively, with minimal invasion.

“We have had very good results from the seven patients we operated on in the first two months of 2024. Going forward, both Dr Venter and I would like to conduct more research on our patients to see what their outcomes are, but, so far, the operations have gone very well,” Dr King says.

For more information on spinal surgery, visit Mediclinic Paarl or contact Mediclinic Paarl at 086 122 7778 or 021 807 8000.