MINIMALLY INVASIVE SPINE SURGERY

With minimally invasive surgery, your doctor can employ methods that reduce the size and quantity of incisions. Generally speaking, it is seen as safer than open surgery. Generally, you’ll feel more comfortable as you heal and recover more rapidly. Additionally, you’ll waste less time in the hospital.

In conventional open surgery, your doctor makes a single, significant incision to view the area of your body they’re working on. In minimally invasive surgery, your doctor makes numerous tiny incisions in your skin and inserts tiny instruments, cameras, and lights. As a result, your surgeon can do surgery with less skin and muscle damage. Furthermore, robotic technology is used in some minimally invasive procedures to give the surgeon greater accuracy and precision control.

The Meaning of Minimally Invasive Spine Surgery

In recent years, the field of spine surgery has seen significant advancements in minimally invasive techniques. These innovative procedures offer a host of benefits over traditional open surgeries These include reduced trauma to surrounding tissues, smaller incisions, quicker recovery times, and improved patient outcomes. This article explores the concept of minimally invasive spine surgery and its numerous advantages in treating various spinal conditions, such as lumbar stenosis, sciatica, herniated discs, and cervical issues.

With minimally invasive surgery, your doctor can employ methods that reduce the size and quantity of incisions. Generally speaking, it is seen as safer than open surgery. Generally, you’ll feel more comfortable as you heal and recover more rapidly. Additionally, you’ll waste less time in the hospital. In conventional open surgery, your doctor makes a single, significant incision to view the area of your body they’re working on. In minimally invasive surgery, your doctor makes numerous tiny incisions in your skin and inserts tiny instruments, cameras, and lights. As a result, your surgeon can do surgery with less skin and muscle damage. Furthermore, robotic technology is used in some minimally invasive procedures to give the surgeon greater accuracy and precision control.

Key Devices and Technologies in Minimally Invasive Spine Surgery

• Endoscope: This is a slender, fiberoptic tube equipped with a light and lens. It allows surgeons to examine the interior of your body with minimal invasion, facilitating both diagnostic and surgical procedures.
• Fluoroscope: An imaging device that utilizes X-rays, the fluoroscope enables surgeons to view internal structures on a screen during surgery, providing real-time guidance.
• Laparoscope: By enabling visualization of specific body structures, the laparoscope requires only a small incision. Additional instruments can be introduced through the same incision or nearby, allowing complex procedures with minimal tissue disruption.
• Minimally Invasive Tubular Retractor (MITR): First introduced in 1995, MITR technology creates a tunnel to the spinal column. The tubular retractor, available in various sizes, uses a muscle-splitting approach, preserving surrounding muscle tissue and reducing blood loss compared to open procedures.
• Portals: These devices create a controlled passage for surgical instruments during endoscopic procedures. By maintaining tissue separation throughout the procedure, portals ensure minimal disruption, with sizes tailored to the surgical area—usually 11 to 12 mm in the thoracic spine.

These advanced tools and techniques underscore the precision and reduced trauma associated with minimally invasive spine surgery, enhancing patient recovery and outcomes.

Understanding Minimally Invasive Spine Surgery

Minimally invasive spine surgery, also known as MISS, is a specialized approach that utilizes state-of-the-art technology.  With advanced surgical techniques, our surgeons address various spinal disorders while minimizing disruption to adjacent structures. Overall, it involves smaller incisions compared to traditional open surgeries, leading to less pain, reduced scarring, and shorter hospital stays.

What Are Common Treatment Options for Minimally Invasive Spine Surgery?

Minimally invasive spine (MIS) surgery has revolutionized spinal treatment, offering less intrusive alternatives to traditional procedures. Several techniques are commonly used in MIS surgery, focusing on reducing recovery time and minimizing discomfort for patients.

Discectomy

A discectomy is often recommended when a spinal disc herniates. These discs act as cushions between your vertebrae, and when the outer ring weakens, the inner soft tissue can protrude and press on nearby nerves, causing pain. MIS discectomy involves trimming or entirely removing the herniated section through small incisions, utilizing advanced tools like tubular dilators and either microscopes or endoscopes for precision.

Spinal Decompression

For individuals with spinal stenosis, the vertebral canal may narrow, putting pressure on the nerves. This can lead to symptoms like pain, tingling, or muscle weakness. MIS spinal decompression removes bone and soft tissues pinching the nerves. Procedures like laminectomy and foraminotomy can be done using small incisions with the aid of tubular instruments and visualization technology.

Transforaminal Lumbar Interbody Fusion (TLIF)

TLIF is usually employed for conditions like spondylolisthesis, degenerative disc disease, or recurrent disc herniations causing persistent pain. This method involves stabilizing the spine by inserting a bone-filled cage into the disc space from an incision made in the back while securing the area with screws and rods. The approach minimizes muscle disruption, emphasizing small incision sites and the use of cameras for guidance.

Minimally invasive techniques like these continue to evolve, offering patients less pain and quicker recovery, making them a popular choice for those in need of spinal surgery.

• Tubular Dilators: These are used to create a small pathway to the spine, minimizing muscle disruption.
• Microscope or Endoscope: Surgeons utilize these tools for enhanced visualization of the affected area.
• Precision and Care: The damaged portion of the disc is carefully trimmed or removed to alleviate nerve pressure, all through a small incision.

This approach not only aims to relieve symptoms but also promotes a quicker recovery by reducing tissue damage compared to traditional surgery methods. These advanced techniques demonstrate the versatility and precision of minimally invasive approaches, offering patients effective treatment options with potentially reduced recovery times and lower risk of complications. Through the integration of cutting-edge technology and refined surgical methods, minimally invasive spine surgery continues to expand its role in both routine and complex medical procedures.

Success Rate of Minimally Invasive Spine Surgery:

• Success rates for MISS vary depending on the specific procedure, the patient’s condition, and the surgeon’s expertise.
• Generally, MISS has shown comparable or even superior outcomes in pain relief, functional improvement, and patient satisfaction compared to open surgery for many spinal conditions.

Who is a Good Candidate for Minimally Invasive Spine Surgery:

• Patients with specific spinal disorders or conditions that can be effectively treated using MISS.
• Individuals who are in overall good health and have realistic expectations about the outcomes of surgery.
• Patients who prefer smaller incisions, less tissue damage, and potentially faster recovery times.

Least Invasive Minimally Invasive Spine Surgery:

• Micro endoscopic Discectomy: This procedure uses a tubular retractor and an endoscope to remove herniated disc material through a small incision.

Types of Minimally Invasive Spine Surgery:

• Lumbar Decompression: Treats spinal stenosis or herniated discs in the lower back.
• Spinal Fusion: Joins two or more vertebrae to stabilize the spine.
• Vertebroplasty/Kyphoplasty: Treats compression fractures in the spine by injecting bone cement.
• Laminectomy: Removes part of the vertebra to relieve pressure on the spinal cord or nerves.

Techniques of Minimally Invasive Spine Surgery:

• Tubular Retractors: Allow access to the spine through small incisions while protecting surrounding tissues.
• Endoscopic Visualization: Uses a camera to visualize and guide the surgical instruments.
• Fluoroscopy: Real-time X-ray imaging to ensure accurate placement of instruments and implants.
• Direct lateral access: This is a technique employed in minimally invasive spine surgery, particularly beneficial in procedures involving the lumbar region. This approach allows surgeons to reach the spine by accessing it from the side of the body. By doing so, it minimizes the disturbance of surrounding muscle tissue, often leading to a reduction in postoperative discomfort for patients.

Duration of Minimally Invasive Spine Surgery:

• Operating times vary depending on the complexity of the procedure and the surgeon’s expertise.
• Many MISS procedures can be completed in 1-3 hours.

Minimally Invasive Spine Surgery vs. Open Surgery:

• Incision Size: MISS uses smaller incisions, while open surgery requires larger incisions.
• Tissue Disruption: MISS minimizes damage to surrounding muscles and tissues.
• Recovery Time: MISS often results in shorter hospital stays and quicker return to daily activities.
• Visibility: Open surgery provides better visualization but requires larger incisions.

Preparing for Minimally Invasive Spine Surgery

Before undergoing Minimally Invasive Spine Surgery, patients undergo a thorough evaluation, including:

• Medical history review: Discuss current and past medical conditions with the doctor.
• Physical examination: Assessing neurological function, strength, reflexes, and pain.
• Imaging studies: X-rays, CT scans, or MRIs to visualize the spine and pinpoint the problem area.

Depending on the specific procedure, additional preparation steps might involve:

• Stopping certain medications: Blood thinners or anti-inflammatory drugs might need to be stopped before surgery.
• Fasting: Patients might be instructed to refrain from food and drink for a certain period before surgery.

Arranging transportation home: Having someone to drive you home after surgery is crucial.

What Takes Place During Minimally Invasive Spine Surgery?

To “sleep” through a minimally invasive operation, the patient will get an anesthetic. Then the surgeon inserts the endoscope via a very small incision. Images from the endoscope are displayed on monitors to provide surgeons with a good view of the surgical region.  At that time, special surgical equipment or devices are placed through additional tiny incisions. Accordingly, the surgeon uses these to diagnose, address, or resolve the problem. Endoscopes come in a wide variety of styles. For instance, some have small surgical instruments attached to the end. While some are flexible, others are rigid.  Depending on the procedure, the endoscope has different names. As an illustration:

• Colonoscope: used for operations on the colon (such as a colonoscopy).
• Laparoscope: used for abdominal procedures (laparoscopic surgery).
• Thoracoscopy: used for chest operations (thoracoscopic surgery).

Understanding Thoracoscopic Access in Minimally Invasive Surgery

In certain medical conditions, accessing the thoracic spine may be necessary. This region, located in the chest and surrounded by critical organs like the heart and lungs, often requires a delicate approach.

Traditional surgical methods involve large incisions and may even necessitate the removal of ribs. However, thoracoscopic surgery offers a less invasive alternative. By using multiple small incisions, surgeons can insert working ports and cameras to perform procedures effectively while minimizing trauma to the body.

This method not only reduces recovery time but also lowers the risk of complications compared to conventional open surgeries. The precision and reduced recovery burden make thoracoscopic access a preferred choice in many spine-related procedures.”

Robotic Surgery

Robotic spine surgery, or robot-assisted spine surgery, describes using robotic technology to assist with guidance during spinal neurosurgery. This minimally invasive spine surgery technology employs small incisions, a camera, and tiny surgical equipment.  This makes it comparable to laparoscopic surgery and other less invasive procedures. However, robotic surgery is much more sophisticated and employs cameras that provide a 3D color image magnified 10 times. Robotic surgery in some cases gives greater control, flexibility, and precision.

Surgeons successfully use Robotic systems in the following spine procedures:

• Anesthetic block for nerve pain
• Correction of spinal deformities
• Anterior, lateral, and posterior fusion
• Decompression surgery
• Revision surgery after previous surgeries for conditions such as spondylolisthesis, stenosis, spondylolysis, vertebral fractures, and osteomyelitis
• Tumor resection
• Vertebroplasty for compression fractures in the spine
• Spinal fusion

What is Spinal Fusion and How is It Performed?

Spinal fusion is a surgical procedure aimed at creating a solid bond between two or more vertebrae, effectively stabilizing the spine. This technique is often chosen to combat severe or chronic back pain by reinforcing the spinal column’s strength and stability.

The Procedure

1. Bone Grafting: Central to spinal fusion is the use of bone grafts, which facilitate the fusion process. These grafts can be sourced from the patient’s own body, usually from the hip (known as an autograft), or they can come from a donor bone bank, referred to as an allograft. To reduce reliance on these traditional bone sources, surgeons might also use bone graft extenders or bone morphogenetic proteins. These synthetic options encourage new bone growth and can sometimes replace the need for natural bone graft material.
2. Supplemental Hardware: To support the fusion and maintain the spine’s stability during the healing process, surgeons often use tools like plates, screws, or cages. This hardware promises a more secure union of the vertebrae. Interestingly, once the bones have fused, this hardware becomes redundant, though many patients choose to retain it to avoid further surgery.
3. Minimally Invasive Techniques: Thanks to advancements in medical technology, spinal fusion can often be carried out through smaller incisions. This minimally invasive surgery (MIS) approach is aided by sophisticated imaging techniques like fluoroscopy and endoscopy, as well as navigation systems that enhance incision and hardware placement accuracy. These improvements significantly reduce tissue damage and promote a faster recovery.

In summary, spinal fusion is a meticulously planned procedure that relies on a combination of biological and technological components to restore stability to the spine. Whether through traditional or cutting-edge methods, the goal remains to alleviate pain and enhance patients’ quality of life.

Complications of Minimally Invasive Spine Surgery

As with any surgery, MISS carries some potential complications, although the risk is generally lower compared to traditional open spine surgery. These complications can include:

• Infection: Proper sterile technique minimizes this risk.
• Bleeding: Bleeding can occur at the surgical site.
• Nerve injury: Damage to nerves near the surgical area can lead to weakness, numbness, or pain.
• Dural tear: A tear in the membrane surrounding the spinal cord requires immediate repair.
• Failure to resolve symptoms: In some cases, the surgery might not fully alleviate the patient’s symptoms.

Recovery After Minimally Invasive Spine Surgery

Recovery from MISS is typically faster than with traditional open spine surgery. Here’s what to expect:

• Hospital stay: Patients may stay in the hospital for a day or overnight, depending on the procedure.
• Pain management: Pain medication is provided to manage post-operative discomfort.
• Physical therapy: Rehabilitation exercises are crucial to strengthen the back and core muscles and promote healing.
• Returning to work: The timeframe for returning to work depends on the type of surgery and the physical demands of the job. It typically ranges from a few days to several weeks.

Risks Associated with Minimally Invasive Spine Surgery

While minimally invasive, MISS still carries some inherent risks. Here’s a breakdown of some potential risks to consider:

• Anesthetic risks: As with any surgery requiring anesthesia, there are potential risks like allergic reactions or breathing problems.
• Limited visualization: The smaller surgical field in MISS might limit the surgeon’s visibility, potentially increasing the risk of unintended injury.
• Steeper learning curve: While MISS techniques are becoming more widespread, some surgeons might have less experience with these procedures compared to traditional open surgery.
• Not suitable for all cases: The complexity of the spinal condition or the patient’s anatomy might necessitate traditional open surgery for optimal outcomes.

Results of Minimally Invasive Spine Surgery

Studies have shown that MISS can be a highly successful approach for treating various spinal conditions. Benefits include:

• Reduced pain: MISS offers significant pain relief for patients suffering from chronic back pain, nerve compression, and other spinal issues.
• Improved function: By addressing the underlying spinal problem, MISS can help patients regain mobility, and strength, and return to daily activities.
• Faster recovery: Minimally invasive techniques lead to faster healing times and a quicker return to normal life.
• Improved quality of life: By alleviating pain and improving function, MISS can significantly enhance a patient’s overall quality of life.

Details About Minimally Invasive Spine Surgery

Although the practice of minimally invasive surgery (MIS) dates back to the early 1800s, it only really gained popularity as a diagnostic tool in the 1930s and 1940s. Due to advancements in camera and video technology, the surgical technique truly began to gain popularity in the middle of the 1980s. This gave surgeons the anatomical information they needed to carry out more difficult treatments.

Solid-state cameras and high-definition video made it possible for surgeons to view their work on a video screen rather than with their own eyes. This has been made possible by the laparoscope, a device necessary for MIS. Small surgical instruments make use of fiber optics, light, and high-definition cameras. The light enables the camera to capture a clean image of its surroundings, which it transmits to a video monitor for the medical staff to watch. Due to this, surgeons can operate in real-time and with a very high level of accuracy and precision.

Typically, Less Blood Loss Occurs

In contrast, to open surgery, MIS greatly lowers the risk of blood loss. This is mostly because it needs smaller incisions. Your risk of blood loss and the potential need for a blood transfusion increases with larger incisions. This increases the attraction of MIS for many patients and doctors who are concerned about complications. Blood loss is less likely, which benefits more than just your health. Additionally, it might ease your anxiety before the operation. It’s quite normal to feel anxious before having surgery, but knowing there’s a lesser chance of some consequences might make you feel less anxious.

Usually, There Is Less Pain

Although it’s normal for patients to be nervous leading up to surgery, recovering is challenging and patients will suffer from pain. However, the degree of pain patients experience from minimally invasive surgery will not last as long and is far less severe than with open surgery.  The small incisions made during the procedure will heal quickly and with less discomfort than a large incision from open surgery. Based on the skill and expertise of our doctors, when all is considered, minimally invasive surgery is far better for the patient’s health.

Benefits of Minimally Invasive Surgery

Obese individuals benefit from minimally invasive procedures because they are less likely to get infections or other problems that require extensive incisions on the patient’s body. These appear better for patients with pain problems and for whom a big incision might need the use of additional painkillers, which is often avoidable with lesser invasive procedures. Small incisions appear great for elderly patients because they allow them to heal more quickly and avoid problems like blood clots in the legs.

Benefits of Minimally Invasive Spine Procedures:

• Less trauma to muscles and soft tissue
• Quick recovery time
• Generally, patients may experience shorter hospital stays
• Less postoperative pain
• Quicker return to daily activities compared to open surgery
• Minimal pain or discomfort following the surgery
• Immediate leg pain relief in most cases
• Fewer problems and risks with minimally invasive spine surgery
• Small incision and minimal scar tissue
• High success rate
• No or very small blood loss
• Use of local anesthesia
• Visual control of the procedure
• No hardware placement or loss of mobility
• Non Invasive back procedure

When is a Minimally Invasive Surgical Procedure, Not an Option?

Every patient is different, and we treat each patient based on several things. In some cases, open surgery is the preferred method. For example, if the surgeon needs to make a large incision to expose tissue and structures then that procedure will take place.  In addition, small incisions just aren’t practical for some spine procedures. We will discuss the issues with you and present the facts.  We want to ensure that there is a clear understanding of the procedure and the reason for the procedure.  Please note that surgery is the last choice.  So, if physical therapy, a brace, observation, or medicine will reduce or stop the pain, that is our first choice. Other than that, we will use the smallest surgical procedure whenever possible.

Minimally invasive spine surgery has revolutionized the treatment of various spinal conditions, offering patients faster recovery and reduced pain. As technology and surgical techniques continue to advance, the future of spine surgery appears promising. The new techniques provide patients with the best possible care and optimal quality of life.

For individuals seeking the expertise of minimally invasive spine surgeons, centers specializing in this field, like the Southwest Scoliosis and Spine Institute, offer comprehensive care and state-of-the-art solutions to address a wide range of spinal issues. Consultation with a specialist in minimally invasive spine surgery can provide patients with personalized treatment plans.  These plans will achieve the best possible results for each patient’s unique condition.

The downside of Minimally Invasive Spine Surgery:

• Limited Visibility: The smaller incisions and specialized instruments used in MISS can limit the surgeon’s view, potentially making it challenging to fully visualize and address certain spinal structures.
• Learning Curve: MISS techniques require specialized training, and not all surgeons are proficient in them, which can affect outcomes if not performed by an experienced specialist.
• Cost: The specialized equipment and longer operating times associated with MISS can make it more expensive than traditional open surgery.

Who is Not a Candidate for Minimally Invasive Spine Surgery:

• Patients with complex spinal deformities or multi-level spinal disorders.
• Individuals with significant scar tissue from previous surgeries.
• Patients with certain medical conditions that increase surgical risks.

The Role of Minimally Invasive Spine Surgeons

Minimally invasive spine surgeons are highly skilled specialists who have undergone extensive training and possess advanced expertise in performing these intricate procedures. Their proficiency allows them to use specialized instruments and technologies, such as endoscopes and surgical robots, to navigate and treat targeted areas with precision.

Why Choose the Southwest Scoliosis and Spine Institute

The Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas specializes in the treatment of scoliosis and other spinal conditions, including neck and back pain. They offer a range of non-surgical and surgical treatments including physical therapy, medication, injections, and surgical interventions. In the past, we have sometimes been referred to as the Dallas Minimally Invasive Spine Institute.

The Institute’s team of spine specialists, orthopedic spine surgeons, and pain management specialists, work together to develop individualized treatment plans for each patient. They use the latest technology and techniques to provide effective, minimally invasive treatments that minimize pain and recovery time. Surgeons Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, treat patients with minimally invasive surgery whenever possible. The surgeons at the Southwest Scoliosis and Spine Institute use Minimally invasive spine surgery to treat conditions that affect the spinal column and the nerves that run through it.

Conclusion

Finally, the surgeons at the Southwest Scoliosis and Spine Institute treat the conditions mentioned earlier on this page with minimally invasive spine surgery techniques.  The benefits typically involve smaller incisions, less tissue disruption, and faster recovery times than open surgery. However, not all patients are candidates for this type of surgery.  In conclusion, patients should talk with their spine surgeon about the type of procedure that is best for their condition.  Additionally, we believe we are among the very best in the nation.  Lastly, we invite you to call the Southwest Scoliosis and Spine Institute and make an appointment. Note that we have appointments within 24 hours.

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National Cancer Institute: Minimally Invasive Surgery
Science Direct: Minimally Invasive Surgery