- There are two main forms of minimally invasive spine surgery, microendoscopic decompression and transforaminal lumbar interbody fusion.
- Benefits of minimally invasive spine surgery are faster recovery and reduced risk of infection, when compared to open spine surgery.
- In certain cases, MIS surgery may not be as safe or effective as traditional open surgery.
Spinal surgery usually requires that the surgeon makes a relatively huge incision on the patient’s back in order to have complete access to the spinal vertebrae. This is the usual procedure in dealing with defects of the spine, and it has been so because of the delicate nature of the spine.
However, now with improved technology, you don’t need to cut open a patient’s back to access the spine, instead, making only a small precise incision provides direct access to the specific vertebra with a problem. This is a minimally invasive spine surgery, and it can be done in various ways.
Your doctor will be able to tell you which MIS surgeries, if any, might be an option for treating your spinal condition. If so, your doctor will be able to inform you about the relative risks and benefits.
Forms of minimally invasive spine surgery
Minimally invasive spine surgeries are not very varied since the objective is the same, but the instruments and methods used differ slightly.
The 2 main forms of minimally invasive spinal surgeries are:
If the patient is experiencing pain due to one or more spinal vertebrae pressing upon a spinal nerve, then this situation is usually treated using decompression surgery. Most forms of spinal decompression surgeries are ‘open’ because they require a large incision, but the microendoscopic decompression surgery does not require this level of the incision.A small incision of about 1 or 1 and a half inches is made on the back of the patient, and then, the back muscles are moved to the side to reveal the spine. They run vertically, so they don’t have to be cut. Using an endoscope or an operating microscope, the surgeon is able to see the spinal nerves, move them aside too and remove the part of the intervertebral disc that was causing the problem.Since no muscles or ligaments are cut during this procedure, the structure of the patient’s back remains intact. This allows for a very quick recovery, and the patient can be discharged soon afterward. Furthermore, the 1-inch incision does not require a lot of attention, and a simple bandage can prevent any infections.
This is simply a minimally invasive surgery (MIS) on the transforaminal lumbar interbody fusion (TLIF). It is similar to the previous surgery, except that the incision is made on the side rather than the back, and it can also be done through the abdomen.An instrument known as a retractor is inserted through a small incision of about 1 inch, and it is hollow. Its purpose is to move aside the muscles and ligaments surrounding the spine and leave the spinal nerves and vertebra exposed.Once the retractor is in position, the surgeon then uses another narrower instrument which is passed through the hollow core of the retractor, and this is responsible for removing the problematic part of the intervertebral disk. The surgeon can also use 2 retractors inserted on either side of the spine if there is a need to add some screws or rods into the spine for extra support.Compared to the previous procedure, the MIS TLIF does not provide a full view of the spine, which makes it more difficult to remove part of the disc. In addition, it causes more loss of bone to the vertebrae, and the surgeon might have to use an additional bone graft to help the spine heal faster.However, an approach from the side does not have a lot of spinal nerves in the way, and fewer nerves have to be moved, reducing chances of nerve damage.
Recovery after a minimally invasive surgery
The pain felt after MIS is significantly less than the pain experienced after an open surgery, and because less tissue is damaged, the patient feels fine with just some pain relievers.
However, the patient still needs to stay in the hospital for at least 2 days as the doctors observe the changes and analyze how the body is responding. In the end, though, these kinds of surgeries are a lot less complicated and recovery time is significantly reduced.
Your doctor may also suggest physical therapy to help you get stronger and recover faster. This will depend on the procedure you have had and your general physical condition. Specific exercises will help you become strong enough to return to work and daily activities.
Why minimally invasive surgery is becoming more common?
The idea that a patient has to be operated under general anesthesia and in an operating room with a team of doctors is slowly being done away with. More patients are being treated for spinal stenosis and other spinal conditions through minimally invasive procedures rather than the typical surgery.
Some of the reasons for this shift may be:
- Improved imaging technologyX-ray technology has been around for decades, and the core principle around it hasn’t changed since it was invented. In fact, the only change made to the X-ray technology has been to make it more accessible by creating more portable X-ray machines.X-rays are very important to doctors and surgeons because they help then to observe the state of bones inside the body by identifying fractures and other problems. This revolutionary technology has not been very effective for examining all bones in the body, though, such as the spine. An X-ray image can inform the doctor on a possible fracture, but it is not effective in determining the extent of damage to the spinal vertebrae or how it is affecting the spinal nerves.Newer technology has enabled doctors to do this now, using Computerized Tomography (CT) Scans, Magnetic Resonance Imaging (MRI) and other technologies. With this advanced imaging technologies, surgeons can perform operations using the information provided without having to physically access the spine.
Obviously, the more intense the surgical operation, the longer it will take for the patient to heal and resume regular activities. Invasive surgical operations involve making larger incisions through the body, which take the body more time to heal and the patient to recover. In today’s world, quick recovery is essential because the world has become extremely competitive and any delays in recovery can cost the individual their jobs. Therefore, less invasive procedures are being preferred which allows the patient to get back on their feet within days.
Reduced risk of infection
The larger the incision made, the more care is needed to prevent any infection from taking a hold and worsening the situation. Minimally invasive procedures require only a small incision which can be more easily cared for even with minimal attention, preventing infection.
Minimally invasive spine surgery has some disadvantages as well. This type of surgery is not appropriate for everyone and there is always the risk of converting it into an open spine surgery, if necessary. In addition, there are some conditions that are not truly accessible with MIS surgery.
Minimally invasive spine surgery also requires a well–trained and competent surgeon to perform it. There is always an increased exposure to radiation or a potential for a prolonged time of the surgical procedure.
If you are considering minimally invasive spine surgery as an option for your problem, it is good to know that any case is individual. Talk to your doctor and he/she will give you all the necessary information.