Minimally Invasive Spine Surgery
Spine surgery is traditionally done as "open surgery," meaning the area being operated on is opened with a long incision to allow the surgeon to view and access the anatomy. In recent years, however, spine surgery has advanced dramatically with the technology surrounding minimally invasive surgical techniques. Surgical materials, nerve monitoring, and computer-aided navigation have improved significantly recently. With these techniques, the risks, recovery time, and surgical complications have decreased greatly.
X-rays, computer-aided navigation techniques, and specialized tubes or retractors with special cameras or microscopes have led to major advances in the capabilities of MIS surgery. In addition to a smaller incision, MIS surgery has been shown on average to cause decreases in blood loss, postoperative pain and narcotic use, soft tissue damage, and number of days spent in the hospital. On average, patients have a faster recovery, and return to normal activity and work faster.
Common MIS Surgery Treatment Options
Several specific techniques have been deployed for MIS surgery. Though the field continues to develop, the list below highlights some of the most common options:
: Spinal discs are essentially elastic rings with soft material inside that serve as cushions between the vertebral bones. If the elastic ring becomes incompetent or weakened, the soft tissue inside can extrude — or herniate — outside of the elastic ring. The herniated disc material can compress the nerves passing by, thus causing pain. If surgical treatment is recommended to trim or remove the herniated disc, it may be possible to perform this procedure with MIS surgery using tubular dilators and a microscope or endoscope.
: Spinal stenosis, which is a narrowing of the vertebral column, is a common condition that can result in compression of the nerves. This can produce a variety of symptoms, including pain, numbness and muscle weakness. If surgery is recommended, it may be possible to remove the bone and soft tissues causing the nerve compression through an MIS approach using tubular dilators and a microscope or endoscope. The more common decompressive procedures include laminectomy and foraminotomy.
MIS TLIF (Transforaminal lumbar interbody fusion)
: This is a MIS technique that is performed in patients with refractory mechanical low back and radicular pain associated with spondylolisthesis, degenerative disc disease and recurrent disc herniation. The TLIF approach may also have potential in patients with low back pain caused by postlaminectomy instability, spinal trauma or for treating pseudoarthrosis. The procedure is performed from the back (posterior) with the patient on his or her stomach.
When is spine surgery recommended?
It is important for patients to discuss minimally invasive options with their surgeon. Minimally invasive surgery, or “MIS,” is not the right option for all patients. It is important to understand why you may not be a candidate for MIS. Some surgeons have not been trained using these techniques, and do not offer them even though their patients may benefit. Before undergoing a spinal surgery, you should have a good understanding of the procedure itself and what to expect during the recovery process. Since pain and recovery are personal and individualized for each patient, no surgeon can guarantee a recovery course. However, for many patients, an MIS option may result in a smoother and more successful outcome.