Minimally invasive spine surgery (MISS) uses small incisions and specialized techniques to reduce damage to muscles, ligaments, and overall trauma during the procedure. This leads to faster recovery, reduced pain, and fewer potential complications compared to open surgery.
Many types of spinal surgery can be performed using MISS techniques. Understanding what to expect can ease anxiety regarding the procedure. At LAMIS Institute, our neuro-interventional surgeons can help you determine if MISS is right for you. Get in touch with us if you are looking for a Florida minimally invasive spine surgery expert
What Is Minimally Invasive Spine Surgery?
Minimally invasive spine surgery (MISS) is a contemporary innovation in spine surgery. It uses smaller incisions than traditional open spine surgery. It is a more localized procedure that relies on image guidance technology to plan the surgical approach.
Your surgeon makes small incisions directly over the pathological area and uses special retractors to move muscles out of the way instead of dissecting them. As a result, there is less blood loss and collateral damage to surrounding tissues. Studies at the University of Virginia have shown that minimally invasive spine surgery can lead to faster healing times, less postoperative pain, and a shorter hospital stay.
Minimally Invasive Spine Surgery (MISS) Vs. Open Spine Surgery
Comparatively, MISS uses smaller incisions than traditional open surgery, typically 2 inches or less, which leads to less tissue damage and blood loss. Due to less tissue disruption, patients usually experience a shorter hospital stay and a quicker return to normal activities.
Smaller incisions and less muscle disruption result in less postoperative pain. Also, smaller incisions are associated with a lower infection risk than open surgery. They may result in less noticeable scars.
Open surgery may be necessary for complex spinal conditions or those that require extensive visualization or manipulation of the spine. This surgery has a long history of successful outcomes, and its effectiveness for specific conditions is well-established.
The Types of Minimally Invasive Spine Surgery Procedures
Several specific techniques are used in MISS surgery. This field is constantly evolving, but the sections below outline some currently popular approaches as explained by the American Association of Neurological Surgeons (AANS).
Corpectomy
A corpectomy is a surgical procedure involving removing part or all of a vertebral body. Your surgeon performs this procedure to relieve spinal cord and nerve pressure. The pressure is usually caused by conditions such as:
- stenosis.
- bone spurs.
- fractures.
- spinal tumors.
- infections in the cervical (neck) spine.
- infections in the thoracic (mid-back) spine.
- infections in the lumbar (lower back) spine.
During a corpectomy, the discs above and below the affected vertebra and the middle portion of the bone are also removed.
A bone graft or metal prosthesis is sometimes implanted to maintain spinal stability after removing the damaged structures. Minimally invasive techniques can sometimes be used to perform a corpectomy. MISS results in faster recovery times and less postoperative pain than traditional open surgery.
Cyberknife® Radiosurgery
CyberKnife radiosurgery is a painless, non-invasive form of radiation treatment for tumors. The procedure uses technological advancements like image-guided cameras, computers, and robotic technology to deliver high-powered radiation beams directly at the tumor. As a result, radiosurgery minimizes damage to surrounding healthy tissues. The non-invasive procedure limits radiation exposure to neighboring healthy tissues.
CyberKnife radiosurgery may be an alternative to traditional surgery for some patients with spinal tumors.
Discectomy
A discectomy involves the surgical removal of disc material pressing on a nerve root or the spinal cord due to a herniated or bulging disc. Discectomy can treat the following:
- Sciatica.
- Radiating pain through the limbs also called radiculopathy.
- Bone spur.
- A pinched nerve (nerve root compression).
Minimally invasive discectomy techniques use special retractors and a microscope or endoscope to visualize and remove the herniated disc material. Your surgeon can make smaller incisions, leading to faster recovery and less postoperative pain than traditional open surgery.
Cervical Discectomy And Fusion
This surgical procedure, anterior cervical discectomy and fusion (ACDF), combines two techniques, including:
- Discectomy - As mentioned above, discectomy involves removing the disc material pressing on a nerve root or the spinal cord.
- Fusion - This procedure aims to stabilize the spine by fusing the vertebrae using bone grafts or implants.
ACDF is typically performed through the front of the neck (anterior approach) to relieve pressure on the spine (decompression) and alleviate pain.
The procedure commonly treats herniated disc and degenerative disc disease in the cervical spine.
Foraminotomy
A foraminotomy procedure widens the opening where nerve roots exit the spinal canal - the neural foramina. The AANS suggests that this procedure relieves pressure on nerves caused by spinal stenosis, herniated discs, or bone spurs.
Minimally invasive techniques can be used for this procedure, involving smaller incisions and less disruption to surrounding muscles and tissues.
Laminectomy
In a laminectomy, the expert removes the lamina that shields the spinal canal. They perform this surgery to take pressure off the spinal cord or a spinal nerve in cases such as lumbar stenosis, a herniated disc, or a bone spur.
Laminectomy can be performed at any level of the spine using minimally invasive techniques. You can undergo a laminectomy within a day and go back home if you have a single-level or two-level stenosis of the lumbar spine.
Kyphoplasty
Kyphoplasty is a minimally invasive procedure used to treat spinal compression fractures in the vertebrae caused by osteoporosis or trauma. The procedure involves inserting a balloon into the collapsed vertebra to restore height and shape. It could also include injecting bone cement into the vertebral body to stabilize the fracture.
Why Might I Need Minimally Invasive Spine Surgery?
Minimally invasive spine surgery may not be suitable for everyone. You must first undergo an assessment at your doctor’s office to determine eligibility for this type of surgery based on your condition. According to the AANS, a doctor can tell which MIS surgeries, if any, might be an option for treating a spinal condition.
Sometimes, MIS surgery may not be as effective as traditional open surgery. This is true if the conditions are not treatable with MIS surgery.
According to the University of Pittsburgh School of Health Sciences, conditions that can necessitate you to undergo minimally invasive spine surgery are:
- Herniated disc.
- Pinched nerve.
- Spinal stenosis.
- Degenerative disc disease.
- Spondylolisthesis.
- Scoliosis.
- Fracture.
- Infection.
- Tumor.
- Failed back surgery syndrome.
- Chronic pain.
- Compression fractures.
- Kyphosis.
Advantages Of Minimally Invasive Spine Surgery
Here are some of the advantages of MISS:
- MISS uses smaller incisions, often less than an inch, compared to traditional open spine surgery. Smaller incisions reduce tissue damage, blood loss, and postoperative scarring.
- MISS techniques often involve working around the muscles instead of cutting through them. This technique minimizes muscle damage, leading to less postoperative pain.
- With smaller incisions, reduced muscle disruption, and less pain, patients often experience shorter hospital stays and can return to normal activities more quickly after MISS.
- The smaller incisions and reduced tissue trauma in MISS can translate to a lower infection risk than open surgery.
- Due to smaller incisions and less muscle damage, patients usually experience less pain after MISS procedures. This can decrease the need for pain medication and its associated side effects.
- Smaller incisions result in smaller, less noticeable scars, improving cosmetic outcomes.
What Are the Risks of a Florida Minimally Invasive Spine Surgery?
Like any surgical procedure, MISS carries risks, including potential complications like infection. Common risks include general risks and those specific to MISS.
General Surgical Risks
Examples are:
- Infection can still occur at the surgical site, even though the risk is lower with smaller incisions.
- Some blood loss can occur during the procedure.
- You might experience adverse reactions to the anesthesia used during surgery.
- There is a risk of blood clots forming in the legs, which could travel to the lungs (pulmonary embolism), presenting a dangerous risk.
Risks Specific to MISS
These include:
- Potential for injury to nerve roots or the spinal cord, depending on the procedure. Nerve damage causes weakness, numbness, or paralysis.
- The protective covering of the spinal cord (dura) can be accidentally torn, potentially causing headaches or other neurological issues.
- If spinal implants, such as screws or rods, are used, there is a small risk of them malfunctioning or shifting.
- In some cases, MISS might not fully alleviate the pain or symptoms the patient was experiencing before surgery.
Preparing for a Florida Minimally Invasive Spine Surgery
Consult your surgeon in advance to learn how to prepare for your MISS. Under this section, you will learn tips that will be useful during MISS preparation.
Before Surgery
Discuss with your surgeon the risks and benefits of the procedure, ensuring you are a good candidate for a Florida minimally invasive spine surgery. Your surgeon might recommend you undergo imaging tests, like X-rays, MRIs, or CT scans. You may also need blood tests, an EKG, or other tests to ensure you are fit for surgery.
Inform your surgeon of your medical history, allergies, and any medications you're taking. This includes over-the-counter drugs, vitamins, and supplements, as some may need to be stopped before surgery. If you smoke, quitting before surgery is essential. Smoking can interfere with healing and increase the risk of complications.
Arrange for someone to drive you home after surgery and provide assistance for a few days during your initial recovery.
Day of Surgery
Follow your surgeon's instructions carefully when fasting before surgery. Usually, you should not eat food or drink any beverage after midnight. If you need medicine, do so with a small sip of water. Also, wear loose, comfortable clothing. Leave valuables at home. Shower with antibacterial soap the night before or on the morning of your surgery to prevent possible infection.
At the Hospital
When checking in, go through the hospital admissions process. Nurses will conduct preoperative preparations such as checking your vitals, starting an IV for fluids and medication, and providing any necessary pre-surgery care. You will also meet the anesthesiologist to discuss the type of anesthesia used, whether general anesthesia or sedation.
What Happens During Minimally Invasive Spine Surgery?
A team of skilled medical professionals, including an orthopedic surgeon or neurosurgeon, will perform your Florida minimally invasive spine surgery procedure. The specifics of the surgery will be customized based on the area of your spine being treated and other factors. Consult your healthcare provider for a detailed explanation of what you can expect.
The general steps for minimally invasive spine surgery, are as follows:
- You will either receive general anesthesia, putting you to sleep for the duration, or a combination of sedation and local anesthesia to numb the surgical area.
- Depending on the procedure, you will be carefully positioned on the operating table, typically lying face down.
- Surgeons often use a fluoroscope (real-time X-ray) or other imaging technology to guide the procedure and ensure the precise placement of instruments.
- One or several small incisions are made at the surgical site.
- Special retractors that resemble tubes are inserted through the incisions. These retractors gently dilate (expand) the soft tissue without cutting the muscles, creating a narrow pathway to access the spine.
- Using specialized instruments and a microscope or endoscope for visualization, the surgeon performs the necessary procedure, such as:
- Decompression — Removing bone or disc material pressing on nerves, for example, discectomy or laminectomy.
- Stabilization — Fusing spinal segments with bone grafts and implants, such as spinal fusion.
- Tumor removal — Resecting a tumor.
- After the procedure, the retractors are removed, and the incisions are closed with stitches or surgical staples.
What Happens After Minimally Invasive Spine Surgery?
After surgery, you will be taken to a recovery room, where nurses will monitor your vitals, such as blood pressure, heart rate, or breathing. You may feel pain and discomfort, but it's usually less than open surgery. Nurses will administer pain medication as needed.
Depending on the type of procedure, you may be encouraged to get out of bed within a few hours of surgery to promote blood flow and help with the healing process.
Some Florida minimally invasive spine surgery procedures can be performed outpatient, meaning you can go home within 24 hours or less. For others, you might require a short hospital stay - a day or two. You want to fully understand instructions on wound care, pain management, and activity restrictions before being discharged.
When you arrive at home, you will need to rest in the initial days after surgery. However, walking and light activity are encouraged to promote healing and prevent complications. Initially, your doctor may prescribe pain medication. Over-the-counter pain relief might suffice as healing progresses.
Lifting, bending, and twisting should be restricted based on your surgeon's instructions to avoid straining the surgical area. Depending on the procedure, physical therapy may be recommended to help with pain, gain strength, and return to regular activity.
Follow instructions for cleaning and dressing your incision site. Watch out for signs of infection, such as redness, swelling, or drainage.
You will have a follow-up with your surgeon a week or two after surgery to check on your recovery and the incision site.
Find a Certified Neuro-Interventional Surgeon Near Me
If traditional treatments like medication, injections, activity changes, and physical therapy have not eased your neck or back pain, your surgeon may recommend MISS. Minimally invasive spine surgery is a less disruptive approach focused on treating the root cause of your pain while promoting a faster recovery with less discomfort. If you need a Florida minimally invasive spine surgery, contact LAMIS Institute at 310-734-6088 to schedule your appointment.
