Spine surgery is traditionally done as "open surgery," meaning the area being operated on is opened with a long incision to allow the surgeon to view and access the anatomy. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique.Because minimally invasive spine surgery (MISS), does not involve a long incision, it avoids significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a faster recovery.Spine surgery is typically recommended only when a period of nonsurgical treatment — such as medications and physical therapy — has not relieved the painful symptoms caused by your back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of your pain, such as a herniated disk or spinal stenosis.Minimally invasive techniques are beginning to be used for a wider range of spine procedures, and have been used for common procedures like decompression and spinal fusion since the 1990s. Decompression relieves pressure put on spinal nerves by removing portions of bone or a herniated disk. Spinal fusion corrects problems with the small bones of the spine (vertebrae). The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. This article focuses on decompression and fusion with a minimally invasive technique.
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 (sometimes less than 1 in.) 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, removes the damaged disk, and replaces it with bone graft material.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 called an MIS posterior cervical diskectomy.
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 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.Approaching the spine slightly from the side does not provide the surgeon with a full view and it is often a challenge to remove the disk completely. This may make fusion healing more difficult. Sometimes the surgeon will use additional bone graft besides the patient's own bone to improve the likelihood of healing.