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Minimally Invasive Spine Surgery
In general, the goal of minimally invasive spine (MIS) surgery is to stabilize the vertebral bones and spinal joints and/or relieve pressure being applied to the spinal nerves — often a result of conditions such as spinal instability, bone spurs, herniated discs, scoliosis or spinal tumors.
As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. Because of the reduced trauma to the muscles and soft tissues (compared to open procedures), the potential benefits are:
Better cosmetic results from smaller skin incisions (sometimes as small as several millimeters)
Less blood loss from surgery
Reduced risk of muscle damage, since less or no cutting of the muscle is required
Reduced risk of infection and postoperative pain
Faster recovery from surgery and less rehabilitation required
Diminished reliance on pain medications after 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.
As with any surgical procedure, no matter how minimal, there are certain risks associated that include, but are not limited to:
Possible adverse reaction to the anesthetic
Unexpected blood loss during the procedure
Localized infections, no matter how small the incision area
And, though uncommon, there is always a small chance that the initial MIS surgery cannot be completed, requiring either a second procedure or full open surgery.
Conditions Treated Using MIS Procedures
Degenerative disc disease
Lumbar spinal stenosis
Spinal deformities such as scoliosis
Spinal instability including spondylolisthesis
Vertebral compression fractures
Common Minimally Invasive Spine Surgeries
MIS Lumbar Diskectomy
A herniated disk in the lower back that pinches a nerve may cause severe leg pain, numbness, or weakness. To surgically relieve these symptoms the disk is removed. This procedure is called a diskectomy.
For the surgery, the patient is positioned face-down and a small incision is made over the location of the herniated disk. The surgeon inserts the retractor and removes a small amount of the lamina bone. This provides the surgeon with a view of the spinal nerve and the disk. The surgeon carefully retracts the nerve and removes only the damaged disk.
This minimally invasive technique can also be used for herniated disks in the neck. The procedure is done through the back of the neck and is called an MIS posterior cervical foraminotomy/diskectomy.
MIS Lumbar Fusion
A standard open lumbar fusion may be performed from the back, through the abdomen, or from the side. Minimally invasive lumbar fusions can be done the same way.
A common MISS fusion is the transforaminal lumbar interbody fusion (TLIF) Using this technique, the surgeon approaches the spine a little bit from the side, which reduces how much of the spinal nerve must be moved.
In an MIS TLIF, the patient is positioned face-down and the surgeon places one retractor on either side of the spine. This approach prevents disruption of the midline ligaments and bone. Using the two retractors, the surgeon can remove the lamina and the disk, place the bone graft into the disk space, and place screws or rods to provide additional support.
Sometimes the surgeon will use additional bone graft besides the patient’s own bone to improve the likelihood of healing.
Recovering from Spine Surgery
Minimally invasive procedures can shorten hospital stays. The exact length of time needed in the hospital will vary with from patient to patient and with the individual procedure but, in general, MISS patients go home on the same day or in 1 to 2 days. Most patients having traditional surgery stay in the hospital for 3 to 5 days.
Because minimally invasive techniques do not disrupt muscles and soft tissues, it is believed that postoperative pain is less than pain after traditional open procedures. Although you should still expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve your pain.
To help you regain strength and speed your recovery, your doctor may recommend physical therapy. This will depend on the procedure and your general physical condition. Specific exercises will help you become strong enough to return to work and daily activities.
If you have had a fusion procedure, it may be several months before the bone is solid. Your comfort level, however, will often improve much faster. During this healing time, the fused spine must be kept in proper alignment. You will be taught how to move properly, reposition, sit, stand, and walk.
The time it takes to return to your daily activities after MISS depends upon your individual procedure and condition. Your doctor will evaluate you after your surgery to make sure that your recovery is progressing as expected.