Minimally invasive spine surgery

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What is Minimally Invasive Spine Surgery 

Spinal surgery is performed traditionally using a long incision, but advances in technology are allowing more neck and back disorders to be treated using minimally invasive spine surgery (MISS).

Since minimally invasive spine surgery avoids the need for an extensive incision, it does not involve injury to the tissues that surround the surgical site. In most instances, this means less post-surgical pain and patients are able to recover more quickly.

Typically, spinal surgery, either minimally invasive spine surgery or traditional open surgery, is only recommended when conservative treatments have failed. Surgery is also only an option if the physician is able to determine the exact cause of the pain.

Some of the conditions that can be treated with minimally invasive spine surgery include:

  • Spinal stenosis
  • Scoliosis
  • Herniated discs
  • Degenerative disc disease

Minimally invasive spine surgery lessens the risk of damage to the soft tissues surrounding the surgical site, such as the muscles. Compared to traditional surgery on the spine, minimally invasive spine surgery may be less of a risk because it is not as invasive. There are distinct advantages to MISS, but the goals of these procedures are the same as traditional surgical procedures.

The primary goals when minimally invasive spine surgery is performed are:

  • Decompression: Decompression takes pressure off the nerve roots or the spinal cord which reduces pain.
  • Stabilization: Stabilization usually involves fusion with instrumentation to help support the spine when abnormal movement is causing pain.

Surgeons use different methods to minimize trauma to the tissues during minimally invasive spine surgery. Some of these techniques include:

Mini-open surgery

These surgeries have fewer risks than open procedures including less blood loss and less chance of infection. This is because the incision in minimally invasive spine surgery is so much smaller. Better visualization techniques have made these procedures possible.

Other operation procedures include:

  • Operations using a tubular retractor,
  • Percutaneous placement of rods and screws,
  • Direct lateral access,
  • Thoracoscopic access.

Common Minimally Invasive Spine Surgeries

MISS Discectomy

A discectomy is a surgical procedure that removes a herniated disc that is pinching a nerve and causing severe pain, weakness or numbness. When the disc is removed, the symptoms are relieved in most cases. This operation can be performed using minimally invasive spine surgery.

During surgery, you will like on your abdomen and a very small incision will be made over the disc that is herniated. The incision may be less than an inch long. Using a retractor, the surgeon removes a small piece of the vertebra so the spinal nerve and affected nerve can be seen. The nerve is gently moved and the disc is removed and replaced with a graft.

MISS Lumbar Fusion

Lumbar fusion surgeries may be performed as open surgeries or they can be performed as minimally invasive spine surgery. They can be approached from the side, back or through the front of the abdomen.

  • Transforaminal lumbar interbody fusion (TLIF): In this minimally invasive spine surgery, the spine is approached from the side.
  • Anterior cervical discectomy:  This procedure is completed to remove a herniated disc from the cervical portion of the spine. In minimally invasive spine surgery a small cut is made in the front of your neck.
  • Anterior longitudinal ligament resection (ALL resection): This procedure is minimally invasive spine surgery to correct deformity and kyphosis.
  • Anterior lumbar interbody fusion (ALIF): This is minimally invasive spine surgery using a  small incision is made in the front of the abdomen and the affected disc is replaced with graft material.
  • Artificial cervical disc replacement or total disc replacement (TDR): This minimally invasive spine surgery is performed to remove all or most of a disc and then an artificial disc is placed in the disc space. A lateral approach is completed from the side of the body.
  • Endoscopic discectomy: This minimally invasive spine surgery is completed by the surgeon using a tiny camera called an endoscope inserted through a small incision.
  • Extreme lateral interbody fusion (XLIF): This minimally invasive spine surgery is done from the side. Muscles and nerves are less affected by this approach.
  • Lateral lumbar interbody fusion: This minimally invasive spine surgery allows for correction of many deformities including those that occur with kyphosis, scoliosis and traumatically. It can be performed using incisions which are many times less than 3 inches long.
  • Kyphoplasty: This procedure can be completed using minimally invasive spine surgery to treat spinal compression fractures due to osteoporosis. Surgical cement and a balloon are used to fill the fracture.
  • Laminectomy: This operation takes pressure off the spinal cord or the nerves by the removal of all almost all of the thin plate that lays over the spinal canal, known as the lamina. It can be done through minimally invasive spine surgery.
  • Laminotomy: This surgery is similar to a laminectomy, but it does not remove as much bone tissue. It too can be done with a minimally invasive spine surgery procedure.
  • Laser discectomy: This minimally invasive spine surgery uses laser technology to remove the gel-like center of a herniated vertebral disc which is pressing on a spinal nerve or on the spinal cord.
  • Percutaneous posterior pedicle screw fixation: In this procedure, metal rods are attached along the sides of the vertebrae which assist in supporting and stabilizing the spine.
  • Mini ALIF: This is minimally invasive spine surgery in which a small incision is made through the abdomen to remove a herniated disc.
  • Posterior cervical microforaminotomy (PCMF):  This procedure involves a small incision in the posterior neck to make the spinal canal larger, removing pressure on the nerves and spinal cord.
  • Video-assisted thoracoscopic surgery (VATS): This minimally invasive spine surgery is done in the mid or thoracic spine. With a small incision made in the chest area and a tiny camera is used to guide the surgeon.

Treatment and care for minimally invasive spine surgery

Minimally invasive spine surgery has been shown to result in shorter hospital stays following surgery. The length of stay varies with each procedure and depends on the individual patient, but typically, patients return home within 2 to 3 days.

Since minimally invasive spine surgery does not disrupt the soft tissues and muscles, patients experience less discomfort than is typical after traditional procedures. Following surgery, patients can expect some discomfort, but the pain is often less severe and easier to manage.

Many patients are provided with a brace following minimally invasive spine surgery for their comfort. The techniques used during MISS helps save the function of the muscles. Special instrumentation serves as the support and helps avoid the need for a brace. Many patients find the brace is only needed for one or two weeks after minimally invasive spine surgery.

Physical therapy is often recommended after spine operations. The goal of therapy is to help regain mobility, flexibility, and strength. You will be given specific instructions and exercises to help you heal and become stronger so you can return to your daily activities. How long it takes for full recovery depends on the type of minimally invasive spine surgery you had and on your individual condition. You will be evaluated by your surgeon several weeks after surgery to make sure you are progressing as expected.

Risks of minimally invasive spine surgery

There is a risk of complications with minimally invasive spine surgery, just as there are with any operation. Complications that arise due to MISS are very similar to those that occur with open spinal surgeries, but minimally invasive spine surgery has not been well researched. Studies are on-going. The studies so far have established that with minimally invasive spine surgery there is decreased pain after surgery, less risk of infection and less time spent in the hospital. Be sure to discuss these factors with your doctor before your operation:

  • Infection: In most procedures, whether open surgery or minimally invasive spine surgery, antibiotics are given before and during the operation to decrease the chance of infection.
  • Bleeding: Bleeding is not usually significant in minimally invasive spine surgeries, although some bleeding cannot be avoided in any type of surgery.
  • Recurring symptoms: Recurring symptoms develop in some patients, in both open surgeries, and in minimally invasive spine surgery.
  • Nerve damage: This is a rare complication but it is possible that blood vessel or nerve damage occurs during these procedures.
  • Blood clots: Blood clots are especially dangerous if, after forming in the legs, they migrate to the lungs. These may occur in open surgery as well as in minimally invasive spine surgery.

Other complications are possible when spinal fusion is performed including Pseudarthrosis and pain at the graft site.

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