Minimally invasive spine surgery is a term that generally is defined as the performance of spine surgery in such a way as to minimize tissue damage and maximize recovery potential. While most physicians would agree with that definition it’s the interpretation that has become very loose.
On a surgeon by surgeon basis minimally invasive surgery becomes very subjective. Often it’s interpreted as “what’s the least invasive means I know of to perform what I deem to be effective spine surgery.” As a result, surgeon A may define minimally invasive as a 20mm skin incision and shaving off of portions of bone to perform a discectomy as an outpatient procedure. Down the street surgeon B may define minimally invasive as the complete removal of the disc, removal of most of a spinal joint, placement of a graft and prosthesis and placement of screws and rods through 2-20mm incisions performed as a procedure requiring an overnight hospital stay. What makes this all so subjective is that both surgeons may be offering this widely varied treatment to the same patient.
With such variations in the practice of minimally invasive spine surgery it’s more important than ever for patients to know what their options for effective treatment might be. Patients can rest assured that their surgeon is recommending the least invasive means of treating their problem that that surgeon feels competent with. However, that doesn’t mean that patients are being offered the least minimally invasive alternative. Therefore, it’s important to ask about damage to collateral tissues and the effects of that damage on recovery and rehabilitation. Also, ask if important ligaments and joints are going to be partially removed. Feel free to make comparisons by seeking a second opinion. Be leery though of surgeons that criticize each other’s approach. A good surgeon will know that there is more than one way to do minimally invasive surgery.
At the Los Angeles minimally Invasive Spine Institute we perform a very specialized form of minimally invasive spine surgery called endoscopic surgery. While endoscopic surgery used to be effective only for the treatment of small disc herniations, that has changed with evolving techniques and technology. Today, skilled endoscopic surgeons can fix stenosis, large extruded herniations and can perform fusion procedures. Endoscopic surgery is achieved via a 7mm-8mm skin opening and through a 6mm-7mm tube, about 1/3 the size of what is commonly used in most minimally invasive spine surgeries. A small tube means non-existent or minimal disruption to muscles, ligaments and joints. Remember though that minimally invasive means the least invasive means to do the job. Some patients may need to be referred for larger procedures. The Institute will not perform a minimally invasive endoscopic operation if we don’t think you stand as high a likelihood of a good result as with a larger operation.