Minimally invasive spine surgery (MIS) was first performed in the 1980s, but has recently seen rapid advances. Technological advances have enabled spine surgeons to expand patient selection and treat an evolving array of spinal disorders, such as degenerative disc disease, herniated disc, fractures, tumors, infections, instability, and deformity.
One potential downside of traditional, open lumbar (back) surgeries is the damage that occurs from the 5- to 6-inch incision. There are many potential sources for damage to normal tissue: the muscle dissection and retraction required to uncover the spine (which contributes to the formation of scar and fibrotic tissue), the need for blood vessel cauterization, and the necessity of bone removal. Disrupting natural spinal anatomy is necessary to facilitate decompression of pinched nerves and the placement of screws and devices to stabilize the spine. This may lead to lengthy hospital stays (up to five days or longer), prolonged pain and recovery periods, the need for postoperative narcotic use, significant operative blood loss, and risk of tissue infection.
MIS was developed to treat disorders of the spine with less disruption to the muscles. This can result in quicker recovery, decrease operative blood loss, and speed patient return to normal function. In some MIS approaches, also called “keyhole surgeries,” surgeons use a tiny endoscope with a camera on the end, which is inserted through a small incision in the skin. The camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine.
Not all patients are appropriate candidates for MIS procedures. It is important to keep in mind that there needs to be certainty that the same or better results can be achieved through MIS techniques as with the respective open procedure.
Conditions Treated using MIS Procedures:
– Degenerative disc disease
– Herniated disc
– Lumbar spinal stenosis
– Spinal deformities such as scoliosis
– Spinal infections
– Spinal instability
– Vertebral compression fractures
As with all non-emergency spinal surgeries, the patient should undergo an appropriate period of conservative treatment, such as physical therapy, pain medication, or bracing, without showing improvement, before surgery is considered. The time period of this varies depending on the specific condition and procedure, but is generally six weeks to six months. The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of patients report significant symptom and pain relief, there is no guarantee that surgery will help every individual.
Many MIS procedures can be performed on an outpatient basis. In some cases, the surgeon may require a hospital stay, typically less than 24 hours to 2 days, depending on the procedure.
The potential benefits of MIS include:
– Smaller incisions
– Smaller scars/less scar tissue
– Reduced blood loss
– Less pain
– Less soft tissue damage
– Reduced muscle retraction
– Decreased postoperative narcotics
– Shorter hospital stay
– Possibility of performing on outpatient basis
– Faster recovery
– Quicker return to work and activities
As with any spinal surgical procedure, there are risks, including:
Blood vessel damage
Dissatisfactory instrumentation placement; may require re-operation
Need for further surgery
Pain or discomfort
Spinal fluid leakage