Minimally invasive spine surgery (MIS) aims to bring stability to vertebral bones and the joints of the spine and/or relieve the spinal nerves of applied pressure. This often happens due to instability of the spine, bone spurs, herniated discs, scoliosis, or spinal tumors. When comparing minimally invasive spine surgery to an open spine surgery, it is typically a faster surgery and recovery time and less risky. Minimally invasive spine surgery also reduces trauma to soft tissues and muscle versus an open surgery.
Some potential benefits of minimally invasive spine procedures:
- Smaller incision marks (sometimes only millimeters in size)
- Decrease blood loss from surgery
- Less risk of damage to muscles
- Less risk of infection
- Decrease in pain post operation
- Faster postoperative recovery
- Less reliance for pain medications post surgery
Some minimally invasive spine surgeries use local anesthesia which has less risk for adverse reactions compared to general anesthesia.
There are still risk to a minimally invasive procedure which include:
- Reaction to anesthesia
- Unforeseen blood loss during procedure
- infection , even with a small incision
It is possible, but very uncommon, that the planned minimally invasive spine surgery cannot be completed and a second produce or open surgery may be required.
CONDITIONS TREATED WITH MINIMALLY INVASIVE SPINE SURGERY
- Degenerative disc disease
- Herniated discs
- Lumbar spinal stenosis
- Spinal deformities
- Scoliosis
- Spinal infections
- Spinal instability, for example spondylolisthesis
- Vertebral compression fractures
- Spinal tumors
HOW MINIMALLY INVASIVE SURGERY WORKS
Spinal nerves, vertebrae, and discs are positions deep inside of the body. To gain access to these areas of the spine, the muscle tissue must be moved aside. Often, this is done with a small incision, guiding instruments, and microscopic video cameras. Lasers are extremely uncommon in minimally invasive spine surgeries. There are many methods to decrease trauma during a MIS surgery.
COMMON MINIMALLY INVASIVE SPINAL SURGERY TREATMENTS
Discectomy: Spinal discs are basically elastic rings. These rings are filled with a soft tissue and work as pillows between the bones of the spine. When the elastic ring weakens, the material inside can herniate and leak outside the ring. This material can put pressure on the surrounding nerve and lead to pain. MIS surgery can be used using tubular dilators and a microscope or endoscope to repair a herniated disc.
Spinal decompression: Spinal stenosis is when the spinal canal is narrowing. This narrowing of the spinal canal can put pressure on the nerves leading to pain, weakness in the muscles, or numbness. Through a MIS surgery, with tubular dilators and a microscope or endoscope, a surgeon can remove the pressure on the nerves by removing the bone or tissue. Laminectomy and foraminotomy are also common surgeries for decompression.
Transforaminal Lumbar Interbody Fusion (TLIF): For a refractory mechanical low back and radicular pain related to spondylolisthesis, degenerative disc disease, and recurrent disc herniation, a TLIF is a common minimally invasive spinal surgery that is used. During this surgery, the patient will be lying on his or her stomach as the surgery is performed through the back. There will be two small incisions made and screws and rods put between multiple vertebral levels. The intervertebral disc is taken out being replaced with a cage of bone to stabilize the affected levels.
CANDIDATES FOR MINIMALLY INVASIVE SPINE SURGERY
It will vary for each patient whether or not they are the right fit for a MIS surgery. Sometimes an open surgery is the better route. Some conditions may not be fixed with MIS surgery. A doctor will inform the patient of the pros and cons of their options.
SPINAL FUSION
During a spinal fusion operation, two or more vertebrae will be fused together. This procedure can be done to help stabilize and strengthen the spine which can decrease debilitating and ongoing back pain. When fusing the vertebrae together, a bone graft will be placed between the vertebrae. There are multiple places where a bone graft may be taken from including the hip, an autograft, or an allograft. Bone graft extenders and bone morphogenetic proteins can be used instead of a bone graft. A bone morphogenetic protein is a hormone that can make bone grow in the body. Some spinal fusions may use plates, screws, or cages but not all will. Placing a bone graft between the vertebrae will make a permanent fusion of the bones. Once the fusion occurs, the hardware (plates, screws, or cages) may be removed but that may require another surgery. Some patients opt to leave the hardware in their body. With MIS surgery technique, a fusion can be performed with smaller incisions. Advanced fluoroscopy, endoscopy, and navigation has benefited the accuracy and precision of incisions and the placement of screws, plates, and cages. A MIS surgery can reduce the amount of trauma to the tissue.
MIS FUSION PROCEDURES
- Minimally Invasive Lateral Interbody Fusion
- Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)
- Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
- Minimally Invasive Posterior Thoracic Fusion
