Significant advancements have been made in the field of spinal surgery. Today, patients of all ages are benefiting from new technology that allows surgeons to perform complex operations on the spine.
What is minimally invasive surgery?
Minimally invasive surgery is a type of surgery performed through several small incisions (less than 1 inch in diameter), or puncture sites. An endoscope - a thin, lighted tube with an attached camera - and surgical instruments are passed through these incisions. The endoscope enables the surgeon to view the problem area on a monitor without having to make a large incision.
By performing the operation through small incisions, the surgeon can safely work on the spine (while disturbing minimal tissue.) As a result, patients are less likely to develop complications. They also recover more quickly and can return to normal activities sooner. Many of these procedures can be performed as outpatient surgery. Controlled studies have proven that these procedures are safe, very successful, and cost effective.
Currently, minimally invasive spinal surgery is used to treat herniated disks, spinal stenosis, and spinal deformity. A minimally invasive technique also can be used for spinal fusion surgery.
Herniated disk
Patients who have herniated disks typically complain of severe pain that runs down the leg or arm. A pinched nerve causes this pain. Nerve damage may cause numbness, weakness, or partial paralysis. Candidates for surgery usually have pain that has failed to improve after at least six weeks of non-surgical care. Often, they are unable to work or care for their families because of severe pain that requires the use of strong pain medicine.
A ruptured disk in the spine is most often responsible for this pinched nerve. Minimally invasive spinal surgery allows the surgeon to remove the ruptured disk material using an endoscope along with special small instruments, including a laser. The surgery can even be performed under local anesthesia, and most patients leave the hospital within 23 hours. Ninety-five percent of the patients leave the hospital with little to no nerve pain after surgery.
Spinal stenosis
Spinal stenosis is a condition that results from degeneration and arthritis of the spine. Thickening of the bone and ligaments of the vertebrae narrow the spinal canal, which contains nerves. Nerve damage can produce severe pain, numbness, weakness, bowel and bladder problems, and -- in severe cases - partial paralysis. Patients typically feel better if they sit or lean forward. They have difficulty walking any distances without their legs going "dead," and many patients cannot shop for groceries without "hanging onto the cart."
As with herniated disk surgery, minimally invasive spinal surgery allows the surgeon to remove the offending bone or tissue microscopically, thereby removing the pressure on the spinal nerves and improving the patient's condition. Most patients leave the hospital within 23 hours and start physical therapy shortly after.
Spinal deformity
Spinal deformities such as scoliosis (curvature of the spine), kyphosis (hump back), fractures, and tumors require major surgical procedures from two approaches: the front and the back. Today, surgeons can use minimally invasive surgery techniques to work on the front and back simultaneously, in many cases eliminating the need for two separate surgeries. This approach has proven to be safer, to have fewer complications, to allow quicker recovery, and to be more cost effective than traditional surgical approaches.
Spinal fusion
Spinal fusion is a process in which a number of vertebrae are made to grow, or "fuse" together. The surgery is performed for spinal instability, certain deformities (such as scoliosis), and for painful spine degeneration. A fusion consists of placing bone between two or more vertebrae to promote the growth of bone between the vertebrae. Over time, the vertebrae fuse together and can no longer move.
The surgery eliminates painful, abnormal motion, reducing nerve irritation and increasing function in most patients. To fuse the spine, a laparoscope (a type of endoscope), special surgical instruments, and spinal cages (hollow, metal cylinders) are placed between the vertebrae through puncture incisions in the abdomen. Most patients having this surgery can leave the hospital in two to three days.
How is a person evaluated for minimally invasive spine surgery?
First, a spine surgery specialist evaluates the patient. This evaluation includes a detailed history and physical exam. At the initial visit, patients are asked to bring with them all previous information, test results, letters from physicians and surgeons, and any previous X-rays or imaging studies. Patients also may be asked to complete a spine information form. Additional testing may include:
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X-rays
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MRI scans
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CAT scans
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Bone scan
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Discography
Consulting with the patient, a spine surgery specialist will review this information and discuss options for surgical treatments, including minimally invasive spine surgery.
Other minimally invasive treatments for chronic, low-back pain include:
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Epiduroscopy
- Epiduroscopy is a technique used to evaluate the epidural space, an area surrounding the spinal cord. The epidural space contains a network of nerves that travel from the spinal cord to different parts of the body. The epidural space also contains blood vessels, fat, and sometimes fibrous tissue. A small, fiberoptic scope is used to evaluate the presence of scar tissue on or near the nerves, which might be causing pain. Epiduroscopy also can be used to move scar tissue away from the irritated nerve roots. In some patients, epiduroscopy provides better pain relief than other back pain treatments.
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Intradiscal electrothermal therapy (IDET)
- IDET is a minimally invasive treatment in which controlled levels of heat are applied to a broad section of the affected disc wall. The heat will cause the collagen in the disc wall to contract and thicken. The temperature of the nerve endings is also raised. The goal of the therapy is to desensitize pain sensors within the disk, reduce the bulge of inner disk material, and close disk wall fissures (cracks). This treatment affects only disk material and won't relieve pain from other structural problems such as nerve root or joint damage.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/13/2004
