Minimally Invasive Spine Surgery
Last updated date: 13-Mar-2023
Originally Written in English
Minimally Invasive Spine Surgery
Minimally invasive spine surgery (MISS) is a form of spine surgery that involves just the bones of your spine (backbone). Smaller incisions are used in this sort of surgery than in normal surgery. This frequently results in reduced damage to surrounding muscles and other tissues. It may result in reduced discomfort and a quicker recovery following surgery.
Open spine surgery is the most common type of spine surgery. A large incision along the back is used for this. The muscles and soft tissue around the spine would have to be moved. Tissue would have to be removed in some circumstances.
The healthcare professional creates a smaller incision during MISS. He or she will next insert a device known as a tubular retractor. This instrument is rigid and tube-shaped. It makes a tunnel to the affected portion of the spine. It softly moves the muscle and soft tissue surrounding the region aside. The surgeon can then use tiny instruments to work on the spine via the tunnel. In addition, the surgeon employs a special operating microscope and examines real-time X-ray pictures of the spine.
Every operation has risks. The hazards of minimally invasive spine surgery include infection, excessive bleeding, pain at the graft site, nerve damage, blood clots, anesthetic complications, and spinal fluid leakage. This may result in headaches or other issues, as well as insufficient alleviation of your back pain.
Your risks may differ depending on your age, general health, and the sort of operation you undergo. Having the surgery performed at a clinic that is familiar with the procedure can help reduce your risks.
What is Minimally Invasive Spine Surgery?
Minimally invasive spine surgery is a surgical technique. Your surgeon makes a single large incision (cut) into your skin in a "conventional" open surgical procedure. A considerable quantity of muscle and surrounding soft tissue is distributed or pushed out of the way or removed from bone to let your surgeon see the surgery site properly. This might lead to further muscle injury and discomfort following surgery.
Your surgeon will create one or more tiny incisions (approximately 0.5 inch each) into your skin during minimally invasive surgery. A thin metal tube, known as an endoscope, is inserted into the incision, allowing the surgeon to operate in a narrower operating field. Working via fewer incisions harms muscles and soft tissues far less than a single long incision.
Benefits of Minimally Invasive Spine Surgery
Minimally invasive spine surgery offers several advantages over open surgery, including:
- Less anesthesia.
- Less blood loss during surgery.
- Less muscle and soft tissue damage.
- Reduced risk of infection.
- Less pain after surgery.
- Less pain medication use.
- Better cosmetic result (a few tiny scars vs one large scar).
- Shorter hospital stay (a few days vs about a week).
- Shorter recovery time (a few months vs up to a year).
- Quicker return to daily activities, including work.
Latest Advances in Minimally Invasive Spine Surgery
Some of the biggest advances in minimally invasive spine surgery include:
- Endoscopic spine surgery: Endoscope advances have provided surgeons with improved sight, light, and 3D depth awareness (thin tube with camera lens and light source). Furthermore, a wider range of instruments may be put through the endoscope, making the minimally invasive technique suitable for a wider range of procedures and patients. An endoscopic technique can be used to conduct spinal fusions and decompressions.
- Robotic-assisted spinal surgery: Surgeons can design spine access utilizing a computer-guided surgical robot. Using robotic technology to get access to the spine makes the surgery safer and the placement of spinal hardware more accurate.
- Artificial intelligence: Surgeons can use of the power of computers to review the wealth of available patient data to predict what type of surgery might be most successful in a specific patient.
Factors to Consider When Looking For Medical Help for My Spine Problem
To get the greatest results for your spine or back pain condition, do some research and choose a spine treatment clinic that uses a team approach. Surgeons must be extremely informed, talented, and have extensive expertise with minimally invasive methods.
However, surgeons should not be the sole team members. Physical medicine and rehabilitation physicians, interventionists (who address both the emotional and physical components of your spinal condition), general neurologists, pain psychologists, and a diversified surgical team are all part of a competent spine health team.
Never be afraid to ask several questions regarding a step-by-step strategy for your spinal health, and if surgery is required, never be afraid to inquire about the number of procedures the team has conducted and their results.
What are Minimally Invasive Spine Surgery Goals?
Whether spine surgery is performed open or minimally invasively, two main goals remain the same.
- Decompression: Spinal decompression involves removing tissue that is compressing nerve structures, such as a spinal nerve root and/or the spinal cord. Bone spurs and/or fragments from a herniated disc are examples of tissues that can cause neural compression.
- Stabilization: Abnormal movement of one or more levels or segments of the spine can cause back or neck pain. Surgical procedures that stabilize and stop movement of the spine involve spinal instrumentation and fusion.
Spinal Disorders Treated Using MISS
1. Degenerative disc disease:
Degenerative disc disease (DDD) affects the intervertebral discs of the spine and often develops progressively in older persons. Normal cellular aging can lead discs to stiffen, lose flexibility, strength, height and form, and the capacity to absorb and distribute pressures associated with movement. These structural alterations may increase the likelihood of disc herniation.
2. Herniated discs:
A herniated disc, also known as a slipped disc or ruptured disc, happens when the gel-like inner core of an intervertebral disc ruptures through the disc's protective outer shell. In addition to the injured disc, the inner gel can irritate and inflame surrounding spinal nerves, resulting in back discomfort.
Scoliosis is an abnormal sideward curve of the spine that may cause progressive spinal deformity. A scoliotic curve may resemble an “S” or “C.” Most cases of scoliosis have no known cause—and while the condition is mostly associated with children, adults can develop scoliosis, too.
4. Spinal stenosis:
When the spinal nerve roots and/or the spinal cord get compressed, this is referred to as spinal stenosis. The nerve roots emerge from the spinal cord and exit the spinal canal via tunnels known as neuroforamen. Symptoms of nerve and/or spinal cord compression include pain, weakness, tingling sensations, and numbness. Pain and discomfort might sometimes spread to the arms or legs.
The majority of spinal cancers are caused by metastasis. Cancer patients are living longer lifetimes as chemotherapy and targeted therapies develop, and more individuals are being diagnosed with spinal metastases. Patients with metastatic malignancies to the spine were formerly restricted to palliative radiation. Cancer patients now have a new therapy option thanks to advancements in surgical technique and radiosurgery.
The MIS method allows for aggressive tumor excision. Even in patients with advanced metastatic cancer, surgeons can safely remove the tumor from vital neurological structures, allowing radiation oncologists to give high-dose targeted radiation to inhibit tumor development.
Various minimally invasive techniques such as mini open decompression, corpectomy and percutaneous fixation allow spine surgeons to remove the tumor with small incisions and effectively separate the tumor from nerves and spinal cord. A short recovery period and expedited wound healing allow the radiation oncologists to start radiation without delay.
In selected patients, the spine fracture can be stabilized and fixed with rods and screws using MIS technique. Special device can be used to correct the spinal deformity associated with spinal fracture and restore spinal alignment. Percutaneous pedicle screws are often used to maintain spine alignment after correction and provide rigid support for bone healing.
7. Extreme lateral lumbar interbody fusion (XLIF):
A unique minimally invasive treatment that provides a surgical corridor to the anterior thoracic or lumbar spine for fusion is extreme lateral lumbar interbody fusion. The patient is positioned lateral decubitus. With the help of neuromonitoring and x-rays, a tiny incision and cautious dissection allow the implantation of a series of dilators and retractor to safely reach the latera portion of the spine. Once in the disc space, discectomy and interbody fusion can be done, as well as distraction of the disc space, allowing successful pinched nerve decompression without direct bone removal.
Are You a Candidate for Minimally Invasive Spine Surgery?
Minimally invasive spine surgery has several advantages, including smaller incisions, less discomfort, less hazards, and faster recovery periods. MISS, on the other hand, is still a surgical treatment. Remember that less than 5% of patients with back or neck pain require spine surgery, and that surgery should only be done as a last option to alleviate pain caused by a spinal condition.
If non-surgical therapies such as medicines, physical therapy, and/or spinal injections do not adequately relieve your symptoms after 3 to 6 months, you may be a candidate for spine surgery. Certain sorts of spinal diseases, of course, necessitate urgent or immediate surgical intervention. Discuss your pain and symptoms, as well as the outcomes of various therapy, with your doctor or spine expert. There are several factors you and your doctor should address before deciding on surgery to alleviate back or neck pain—and if minimally invasive spine surgery is a possibility for you.
How Do I Prepare for MISS?
To prepare for spine surgery:
- Quit smoking if you smoke. Ask your provider for help. There are medications and programs that can help you quit.
- Exercise on a regular basis to keep your body and muscles in shape to shorten your recovery time.
- Make sure you and your surgical team review all the products you take a few weeks before the date of your surgery. You may need to stop taking non-essential medications and herbal remedies. These may react with anesthetics or other medications you may be given.
X-rays or magnetic resonance imaging (MRI) of your spine will be ordered by your surgeon. Antibiotics may be prescribed before and after your procedure. Antibiotics aid in infection prevention. Your doctor will inform you what you may and cannot eat or drink the night before surgery.
What Happens During Minimally Invasive Spine Surgery?
Anesthesia will be administered to you. Regional anesthesia (to numb a specific portion of your spine) or general anesthesia (you will sleep through your surgery).
There are various less invasive procedures available. They all have one thing in common: your surgeon makes one or more tiny incisions through your skin — through your back, chest, or abdomen – rather than one long incision.
Your surgeon may use a fluoroscope or an endoscope to identify where incisions should be made. A fluoroscope is a portable X-ray equipment that offers real-time views of your spine during surgery. An endoscope is a slender, telescope-like equipment that is coupled to a tiny video camera - about the size of a dime - that shows an interior picture of your spine onto television screens in the operating room.
Small surgical instruments are inserted through the endoscope or the other half-inch incisions where tubular retractors have been implanted.
Tubular retractors are hollow, thin tubes. Retractors create little work tunnels from the opening in your skin to the targeted spot on your spine. One or more retractors are used to insert instruments. These retractors are also used to extract spinal bone and tissue removed during surgery. During surgery, tubular retractors keep your muscles away from the surgical site. When you remove the retractors, your muscles return to their previous place.
Your wounds are closed with sutures (stitches), glue, or staples and covered with surgical tape or thin bandages after surgery.
Recovery From a Minimally Invasive Spine Surgery
Minimally invasive spine surgery leads in less pain, less muscle damage, a shorter hospital stay, and a faster recovery and return to work and everyday activities as compared to open surgery.
Patients who have had minimally invasive spine surgical treatments often stay in the hospital for three to five days. The overall time to full recovery varies from person to person and is determined by your spinal condition, the severity of your operation, the experience of your surgical team, your age, general health, and other considerations. Your full recovery might take months. Inquire with your surgeon about the total recuperation time for your treatment.
Your doctor may recommend physical therapy to help regain strength and speed your recovery.
Make sure you keep all follow-up appointments with your spine center team. They will check your progress and answer any questions or concerns you may have.
MISS, like any other procedure, has possible dangers. MISS problems are similar to those of open spinal fusion operations; however, some studies show that MISS has a lower infection rate. Before your operation, your doctor will go through all of the risks with you and take special precautions to avoid any issues.
The potential complications of MISS include:
- Infection. Antibiotics are given to the patient before, during, and often after surgery to lessen the risk of infections.
- Bleeding. A certain amount of bleeding is expected, but this is not typically significant.
- Pain at graft site. A small percentage of patients will experience persistent pain at the bone graft site.
- Recurring symptoms. Some patients may experience a recurrence of their original symptoms.
- Pseudarthrosis. This is a condition in which there is not enough bone formation, and a spinal fusion does not completely heal. If this occurs, a second surgery may be needed to obtain a solid fusion. Patients who smoke are more likely to develop a pseudarthrosis.
- Nerve damage. It is possible that the nerves or blood vessels may be injured during these operations. These complications are very rare.
- Blood clots. Formation of blood clots in the legs (deep vein thrombosis) is another uncommon complication after surgery. They pose a significant danger if they break off and travel to the lungs.
The goal of minimally invasive spine (MIS) surgery is to stabilize the vertebral bones and spinal joints and/or relieve pressure on the spinal nerves, which is typically caused by problems such as spinal instability, bone spurs, ruptured discs, scoliosis, or spinal malignancies.
In comparison to open spine surgery, minimally invasive surgical procedures can be faster, safer, and require less recovery time. Because there is less stress to the muscles and soft tissues (as compared to open treatments), the possible benefits include better aesthetic outcomes from smaller skin incisions (sometimes as small as several millimeters), less blood loss after operation, lower chance of muscle injury since less or no muscle cutting is necessary, reduced risk of infection and postoperative pain, faster recovery from surgery and less rehabilitation required, less reliance on pain drugs following surgery.
In addition, some MIS surgeries are performed as outpatient procedures and utilize only local anesthesia — so there is less risk for an adverse reaction to general anesthesia.