Minimally Invasive Spine Surgery
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What is minimally invasive spine surgery?
Minimally invasive spine surgery is a method of performing surgery. In a “traditional” open surgery approach, your surgeon makes a single long incision (cut) through your skin. To help your surgeon clearly see the surgical site, a relatively large amount of muscle and surrounding soft tissue are spread or pulled out of the way or removed from bone. This can result in more muscle damage and pain after surgery.
In minimally invasive surgery, your surgeon makes one or more small incisions (about ½ inch each) through your skin. A small metal tube or endoscope is placed through the incision to allow the surgeon to work through a smaller operative field. Working through smaller incisions causes much less damage to muscles and soft tissues than a single long incision.
What types of spine surgeries can be performed using a minimally invasive approach?
Many types of spine surgeries can be performed using a minimally invasive approach. These include:
- Spinal fusion, which is often performed on degenerative or “slipped” disks.
- Deformity corrections, such as for scoliosis and kyphosis.
- Decompression of spinal tumors.
- Repair and stabilization of vertebral compression fractures.
- Lumbar spinal stenosis.
- Infection in the spine.
If I need spine surgery, am I a candidate for minimally invasive surgery?
Not every patient is a candidate for a minimally invasive approach. There are specific indications for minimally invasive surgery – when it works well and when it shouldn’t be done from a safety stand point. Each surgery must be customized for the patient and the technique. However, before surgery is even considered, your spine care team may decide, during your evaluation, that there are other treatment options that should be tried first before surgery is considered.
How do I prepare for spine surgery?
To prepare for spine surgery:
- Quit smoking if you smoke. Ask your provider for help. There are medications and programs that can help you quit.
- Exercise on a regular basis to keep your body and muscles in shape to shorten your recovery time.
- Make sure you and your surgical team review all the products you take a few weeks before the date of your surgery. You may need to stop taking non-essential medications and herbal remedies. These may react with anesthetics or other medications you may be given.
You surgeon will order X-rays or magnetic resonance imaging (MRI) tests of your spine. You may be given antibiotics to take before and after your surgery. Antibiotics help prevent infection. Your healthcare provider will tell you what you can eat or drink the night before your surgery.
What happens during minimally invasive spine surgery?
You will be given anesthesia. Anesthesia may be regional (to numb an area of your spine) or general (you will sleep through your surgery).
There are several minimally invasive techniques. What they share in common is that your surgeon makes one or more small incisions through your skin – made through your back, chest or abdomen – instead of one long incision.
To determine where to make incisions, your surgeon may use a fluoroscope or an endoscope. A fluoroscope is a portable X-ray machine that provides real-time images of your spine during the operation. An endoscope is a thin, telescope-like instrument that is attached to a tiny video camera – smaller than a dime – which projects an internal view of your spine onto television screens in the operating room. Small surgical instruments are passed through the endoscope or through the other half-inch incisions through which tubular retractors have been placed.
Tubular retractors are thin, hollow tubes. Retractors create small tunnels of work space from the opening in your skin to the targeted area on your spine. Instruments are inserted through one or more retractors. Spinal bone and tissue removed during surgery are also withdrawn through these same retractors. The tubular retractors hold your muscles away from the surgery site during the surgery. When the retractors are removed, your muscles return to their original position.
After surgery, your incisions are closed with sutures (stitches) glue or staples and covered with surgical tape or small bandages.
Risks / Benefits
What are the risks of spine surgery?
All surgeries have risks, even minimally invasive procedures.
Common general risks of spine surgery include:
- Bad reaction to the anesthesia.
- Pneumonia after surgery.
- Blood clots in your legs (deep vein thrombosis) that may travel to the lungs (pulmonary embolus).
- Infection at the site of surgery.
- Blood loss during surgery requiring a transfusion.
Specific risks of spine surgery include:
- Injury to the nerves or spinal cord resulting in pain or even paralysis. (Risk of paralysis for major spinal reconstructions is about 1 in 10,000.)
- Damage to surrounding tissues.
- Pain from the surgery itself.
- Spinal fluid leak
On rare occasions, minimally invasive surgery may not be able to be completed as planned. A second surgery may be required and/or the approach may need to be changed from minimally invasive to an open technique.
What are the benefits of minimally invasive spine surgery?
Minimally invasive spine surgery offers several advantages over open surgery, including:
- Less anesthesia.
- Less blood loss during surgery.
- Less muscle and soft tissue damage.
- Reduced risk of infection.
- Less pain after surgery.
- Less pain medication use.
- Better cosmetic result (a few tiny scars vs one large scar).
- Shorter hospital stay (a few days vs about a week).
- Shorter recovery time (a few months vs up to a year).
- Quicker return to daily activities, including work.
Recovery and Outlook
What should I expect during my recovery from a minimally invasive spine surgery?
Compared with open surgery, minimally invasive spine surgery results in less pain, less damage to muscles, shorter hospital stay, and a faster recovery and return to work and daily activities.
Typically, the hospital stay of patients who have undergone a minimally invasive spine surgery procedures is three to five days. The total time to fully recovery varies from individual to individual and depends on your spinal problem, degree of difficulty of your procedure, expertise of your surgical team, your age, your general health and other factors. Your complete recovery may take months. Ask your surgeon about the full recovery time expected for your procedure.
Your doctor may recommend physical therapy to help regain strength and speed your recovery.
Make sure you keep all follow-up appointments with your spine center team. They will check your progress and answer any questions or concerns you may have.
When to Call the Doctor
What signs should I look for that indicate I need to call my healthcare provider?
Call your provider right away if:
- The amount of fluid leaking from your incision increases (a small amount is normal).
- You have a fever (over 100.4° F or 38 oC)
- Your pain is getting worse.
Call 911 or go to the emergency room if you:
- Are having trouble breathing.
- Have a severe headache.
What factors do I need to consider when looking for medical help for my spine problem?
To achieve the best outcome for your spine or back pain problem, it’s important to do some research and find a spine treatment center that offer a team approach. Surgeons need to be highly knowledgeable, skilled and have a lot of experience in using minimally invasive techniques. Surgeons shouldn’t be the only team members however. A good spine health team will include physical medicine and rehabilitation physicians, interventionalists (addresses both the mental and physical aspects of your spine problem), general neurologists, pain psychologists as well as a diverse surgical team. Never hesitate to ask many questions about a step-wise plan for your spinal health and, if surgery is needed, don’t hesitate to ask about the number of surgeries the team has performed and their outcomes.
What are some of the latest exciting advances in minimally invasive spine surgery?
Some of the biggest advances in minimally invasive spine surgery include:
- Endoscopic spine surgery: Surgeons now have better visibility, light and 3D depth perception due to the improvements made in endoscopes (thin tube with camera lens and light source). Also, a larger variety of tools can be inserted through the endoscope, allowing the minimally invasive approach to be an option for more types of surgeries and patients. Spinal fusions as well as decompressions can be performed with an endoscopic approach.
- Robotic-assisted spinal surgery: Surgeons can plan access to the spine through using a computer-guided surgical robot. Gaining access to the spine using robotic technology helps make the surgery safer and the placement of spinal hardware more accurate.
- Artificial intelligence: Surgeons can use of the power of computers to review the wealth of available patient data to predict what type of surgery might be most successful in a specific patient.
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