Traditionally, spine surgery has been an open procedure–the surgeon makes a long incision and moves the back muscles to the side to access the spine. Moving or retracting the back muscles can cause additional back pain after surgery, and the recovery time can be rather lengthy.
Advances in surgical techniques have paved the way for minimally invasive spine surgery, which offers many benefits over open surgery and can be done for many common spine procedures.
Benefits of Minimally Invasive Spine Surgery
During a traditional, open procedure, the surgeon makes an incision that is approximately 5 to 6 inches long, and the muscles must be cut or retracted to gain access to the spine. This approach results in a higher risk of damage to the muscles and soft tissues in the back, and can lead to a longer hospital stay, prolonged pain, and a longer recovery time.
Minimally invasive spine surgery (MISS) is designed to allow spine procedures to be performed with less disruption to the structures in the spine. During a minimally invasive spine procedure, surgeons use special tools called tubular retractors. Tubular retractors are inserted into a small incision through the skin and soft tissues, all the way down to the spinal column, holding the muscles aside and creating a small tunnel to the problem area. All operating instruments and fixation devices, such as screws or rods, are inserted through the tubular retractor. Some procedures may require more than one retractor. In order to find the placement for the incision and retractor, the surgeon uses fluoroscopy, which displays real-time X-ray images of the patient’s spine on a screen in the operating room. Surgeons also operate microscopes to see a magnified view through the retractor.
Because minimally invasive procedures are performed through smaller incisions, they often results in less bleeding, less pain after surgery, and a shorter hospital stay when compared with open surgery. Many patients who undergo minimally invasive spine surgery are able to begin physical therapy within hours of the procedure and are often able to return to work and other daily activities sooner than those who undergo open surgery.
Common Minimally Invasive Spine Procedures
Minimally invasive techniques have become very common in spine surgery. Although it may not be the best approach for every spine procedure, it can be used for several common procedures, including discectomy, laminectomy, and spinal fusion.
Minimally Invasive Discectomy
During a discectomy, a herniated disc is removed to relieve the patient’s symptoms. A small incision is made over the location of the herniated disc. The retractor is inserted, and a small amount of bone is removed to access the herniated disc. The surgeon carefully moves the irritated nerve aside, then removes the herniated disc, replacing it with a bone graft.
Minimally Invasive Laminectomy
A laminectomy, also called a decompression, is often used to treat spinal stenosis. The surgeon makes an incision over the problem area and inserts a retractor. Any bone that puts pressure on the nerve roots is removed using small operating instruments.
Minimally Invasive Spinal Fusion
During a minimally invasive spinal fusion, the surgeon often approaches the spine slightly from the side to allow for less movement of the spinal nerve. Retractors are placed on either side of the spine so the midline ligaments and bones are not disrupted. The surgeon then removes the disc and lamina (the top portion of the vertebrae) through the retractor and inserts the bone graft, placing screws and rods for support.
More and more spinal procedures are being performed using minimally invasive techniques. With this approach, patients are able to return to their daily activities quickly and with less pain.