Minimally Invasive Spine Surgery
Generally speaking, minimally invasive spine surgery (MISS) refers to highly advanced surgical procedures that offer a less intrusive surgery option for a variety of conditions that cause pain and reduced functionality in the spine. The goal of such surgery is typically to stabilize and reduce any pressure resulting from conditions such as facet joint syndrome, spinal stenosis, or a herniated disc. In contrast to open or microscopic spinal surgery, these procedures require only very small incisions and do not usually require substantial disruption of surrounding tissue. Minimally invasive procedures require less hospitalization and recovery time. Consequently, such procedures are considered by many to be a strong treatment option for those patients whose symptoms have not been effectively alleviated using non-surgical methods.
Remember: The information on these web sites cannot replace a consultation with a doctor. Therefore, always refer to your doctor for a personal diagnosis and treatment.
What are the advantages of minimally invasive spine surgery?
For the patient, minimally invasive spine surgery can offer a number of benefits as compared to other surgical procedures. The smaller incisions used in MISS often result in less collateral damage to nearby tissues. Further, smaller incisions generally result in smaller scars and minimally invasive surgery is thus associated with less cosmetic damage than traditional surgery.
Additionally, through the use of advanced equipment, MISS can often be performed without the removal of tissue between the targeted area of surgery and the incision. Muscle and other surrounding tissue can be gently moved aside along natural muscle planes, resulting in less overall tissue trauma. This means that physicians have a greater chance of preserving the integrity of all or most of the supportive tissue in the spinal column.
Due to the relatively gentle nature of MISS, general anesthetic is not often necessary and thus complications arising from general anesthesia are also less likely.
Minimally invasive surgical techniques are further associated with reduced blood loss, reduced risk of infection or other post-surgical complications, and can require a substantially reduced amount of time spent both in the hospital or clinic and in recovery. These factors, as well as the overall reduction in tissue trauma, means that patients often experience less post-operative pain and a reduction in need for post-operative pain medication.
MISS procedures are usually performed as outpatient procedures and patients are quickly able to return to their daily lifes. As a result, minimally invasive surgeries generally have a lower overall economic cost to the patient.
It is important to note that the aforementioned advantages of minimally invasive surgical techniques are dependent on the expertise of the surgeon as well as the appropriateness of the procedure for a given patient. It is imperative that a patient thoroughly discuss all treatment options with their clinical provider and ensure that they fully understand all the risks and potential outcomes associated with any procedure that they may be considering before moving forward.
Who may benefit from minimally invasive spine surgery?
For patients with chronic back or neck pain resulting from certain spinal conditions who have exhausted all non-surgical treatment options, minimally invasive spine surgery can help to reduce pain and increase mobility and quality of life. Surgery is generally considered to be a last option, and in most cases pain management and physical strengthening therapies should be tried first. If an individual continues to experience chronic pain and inhibited mobility after these initial treatments, a physician may recommend a surgical procedure such as an endoscopic minimally invasive spine surgery.
Minimally invasive surgery techniques and technologies are continually growing and can be used to treat a wide variety of back and neck issues. Conditions for which MISS may be a viable treatment include but are not limited to fractured vertebra, a herniated disc, facet joint syndrome, spondylolysis, spinal stenosis, certain infections, mild scoliosis, or spinal instability. There are some cases in which traditional open surgery is necessary such as tumors, certain infections, or severe scoliosis.
Ultimately, it is up to the individual and their healthcare providers to determine whether or not a surgery is the right choice in their particular case. A thorough differential diagnosis must be performed before surgery is considered.
Questions to consider when deciding whether MISS is right for you:
- Have you already exhausted non-surgical options such as pain management therapy, physical strengthening, massage therapy, and acupuncture?
- Does your back or neck pain seriously affect your ability to perform daily tasks?
- Is your overall quality of life affected by chronic back or neck pain?
- Has your healthcare provider suggested MISS as a possible treatment?
- Have you already had back or neck surgery but are still experiencing pain?
If you answered “yes” to three or more of these questions, minimally invasive spine surgery may provide some relief.
What to expect before and during the procedure?
Once a patient and their physician have decided that MISS in the right course of action through differential diagnosis and thorough evaluation of available treatments, it is relatively simple to move forward with the operation. In preparation for surgery, discuss all prescription and over-the-counter medications you take with your doctor as it may be necessary to temporarily stop some of these medications before the procedure. If you smoke, your surgeon may also ask that you stop before your surgery as smoking reduces the speed with which the body heals. Some surgeons may ask that you restrict what you eat and drink in the hours before the operation. If you have noticed any changes in your health or have any other concerns, be sure to discuss these with your healthcare provider prior to surgery as well.
The primary procedural difference between MISS and traditional open spinal surgery is the pathway by which the affected area (for example, the herniated disc) is accessed. In open surgery, a long vertical incision is made and soft tissues are removed and moved as necessary so that the surgeon can directly access the injury being treated. In minimally invasive spine surgery, a very small incision is made using a scalpel or in less frequent cases a laser and soft tissues are moved aside along their natural planes. The intention behind performing surgery in this way as opposed to how it is done in open surgery is to reduce operation-related destruction and overall trauma.
Your surgeon may want to do an X-ray, MRI, and/or other imaging test to get a good visualization of the affected spinal structures prior to surgery.
The endoscopic spinal surgery is a full endoscopic technique. That means, just a single small incision is necessary due to the special construction of the endoscope. It provides the surgeon with a view of the target area. Tools for the treatment of the pathology are inserted directly through the working channel of the endoscope.
From this point in the operation forward, minimally invasive spinal surgeries generally involve the same procedures as would be performed in a corresponding open surgery. The specific actions performed depend on the type of condition that is being treated.
For example, in a transforaminal or interlaminar endoscopic minimally invasive surgery, the next steps would be to remove only the tissue that is causing pain by compression of the nerve and then to make sure that the nerve has indeed been freed.
How long does it take to recover from minimally invasive spine surgery?
Minimally invasive spine surgeries are usually performed on an outpatient basis, meaning that the patient is in and out of the surgical clinic in the same day. Procedures can often be completed in 1-2 hours.
The amount of time that it takes to fully recover after MISS varies by individual and is affected by the specific type of surgery being performed, the severity of the injury being treated, the overall
health of the patient, and the completion of post-operative physical therapy.
In many cases, an individual can be up and walking around within a few hours after surgery. Post-operative pain is typically minimal but can be treated with medication if necessary. Additionally, a back brace may be provided as an option to help alleviate pain for the first couple of weeks. In many cases, patients will be pain-free immediately upon the completion of the procedure.
Often, patients will enter physical therapy within several weeks after MISS to help facilitate a full and speedy recovery.
For some, returning to work can happen as quickly as 1-2 weeks after the operation if their MISS procedure was relatively simple for example, and their work not very physically taxing. For others – those who require a more complex procedure, for example, or those with highly physical professions – it can take 6 weeks or longer to return to full activity.
Your surgeon will discuss your individual case with you and advise you as to when you can return to work and resume other daily activities. They will help you determine whether pain medication or a back brace is appropriate. Additionally, they will provide you with information about when to begin a physical therapy regimen and how to go about doing so.
Because nerves and tissues grow back and some illnesses can be recurring, there are some cases in which follow-up surgery is required down the road after minimally invasive spine surgery has already been performed. Inform your healthcare provider if your pain returns months or years after your MISS operation.
Are there any risks associated with minimally invasive spine surgery?
There are risks associated with any surgical procedure, which is one of the reasons it is usually best to exhaust non-surgical treatment options before moving forward with surgery. As a relatively new surgical method – though supported by recent research – researchers have not yet produced as many studies about the long-term results of these procedures as compared to more traditional ones.
One of the most important factors in managing the risks of MISS is the expertise of the surgeon performing the procedure. MISS requires advanced technologies and usually involves thorough training. Further, it is important to note that because these operations require sophisticated medical apparatuses, not all facilities are properly equipped to perform MISS. Inadequate training or clinic facilities can increase the chances of complications.
Because these operations are highly technical and often complex, minimally invasive spine surgery can sometimes take longer than expected to complete. Intraoperative radiation exposure is also a potential risk of MISS.
In some cases, an adverse reaction to the analgesic or anesthetic can occur. Bleeding or pain at the incision sites or the area that has been operated upon are also possible complications. Additional risks include blood clots, nerve injury, incidental durotomy, leaking of spinal fluid, and infection. Inadequate relief of pre-operative pain and/or other symptoms due to insufficient decompression or other causes can also occur in some situations.
Again, there are risks associated with any surgical procedure, and many of the potential complications of minimally invasive spin surgery are also possible risks of conventional open spine surgery.
Patient factors that can contribute to surgical complications include age, a suppressed immune system, pre-operative infection, hyperglycemia, tobacco use, inadequate nutrition, obesity, post-operative incision site contamination, other health issues, and the type of surgery you require.
It is important to discuss which risk factors most apply to you based on your individual situation with your surgeon as well as with your general practitioner.
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Minimally invasive endoscopic procedure to treat a herniated disc, spinal stenosis, facet joint and SIJ syndrome.
Treatment options
Endoscopic minimally invasive surgery solutions
Endoscopic minimally invasive spine surgery has proven to be an alternative and reliable method for a multitude of pathologies. Today, spine surgery can be achieved through various methods utilizing small access channels to the spine. A whole variety of methods had been established in everydays surgery within the last couple of years. Additionally, new implants can now be introduced using minimally invasive techniques with significant tissue trauma reduction, like e.g. percutaneous screw systems. Experienced doctors view endoscopic surgical methods as a gentle alternative to microsurgical techniques. Scientific studies also confirm that endoscopic surgery offers advantages over microsurgery.
Remember: The information on these web sites cannot replace a consultation with a doctor. Therefore, always refer to your doctor for a personal diagnosis and treatment.
