I've heard it's possible to do spinal fusion with tiny incisions now. Can they do this anywhere in the spine (like the neck)?

Minimally invasive surgery (MIS) is a fairly new development in spinal surgery. Openings called portals are made just big enough to pass the needed instruments including wires, rods, and screws. It's called percutaneous placement.

The surgeon uses special X-ray imaging called fluoroscopy to guide each step of the operation. Standard CT scans are also used to make sure everything is in its proper place.

Scientists are just beginning to explore the use of percutaneous placement with MIS to fuse the cervical spine. Studies are done first on cadavers and then on animals before attempting the operation on live humans. A special C-arm 3-D fluoroscopy unit has made this possible.

The fluoroscopy unit moves around the patient in a 190-degree arc giving the surgeon a clear view of the anatomy. This is important in the cervical spine because the spinal nerves and the spinal cord are very close and easily damaged. Likewise, the vertebral artery to the brain runs alongside the cervical spine and can be cut by mistake.

Don't look for this type of surgery at every orthopedist's office. The machinery is expensive and it takes time for surgeons to learn the technique. Most likely it will be offered first through large university or teaching hospitals where research is a vital part of the ongoing services.