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October 30, 2023

Navigating the Spine with Precision: Advancements in Minimally Invasive Spine Surgery

Minimally invasive spine surgery involves using small incisions and specialised instruments to treat various spinal disorders. The surgery can be performed to treat a variety of spine conditions such as herniated discs, spinal stenosis, scoliosis, spondylolisthesis, spinal tumours, numbness, weakness, or disability in some cases. It aims to reduce damage to the surrounding muscles and tissues.

Minimally invasive spine surgery (MISS) offers an alternative to traditional open-spine surgery involving larger incisions and more tissue disruption. It can achieve similar or better results using smaller incisions and advanced technologies with less pain, blood loss, infection risk, hospital stay, and recovery time.

However, it is not suitable for everyone or every condition. It also requires skilled surgeons who are familiar with the techniques and technologies of MISS. Therefore, patients considering MISS should consult with their doctors about the benefits and risks of this procedure.

Conditions Treated by Minimally Invasive Spine Surgery

MISS can treat spinal conditions that cause back, neck, arm, or leg pain, a weakened feeling, or numbness in the legs.

Here are some of the common conditions that MISS can treat:

Herniated Disc: A condition where a tear in the outer layer allows the soft inside of a spinal disc to protrude, putting pressure on a nerve root or the spinal cord.
Spinal Stenosis: An ailment where the spinal canal becomes constrictive due to bone spurs, thickened ligaments, or disc degeneration, compressing the nerve roots or the spinal cord.
Spinal Deformities: Abnormal curvatures or misalignments of the spine, such as scoliosis, kyphosis, or spondylolisthesis, can affect posture, balance, and movement.
Spinal Instability: A condition where the vertebrae (spinal bones) move excessively or abnormally due to injury, infection, or degeneration, causing pain and nerve damage.
Spinal Fractures: Vertebral breaks or fissures due to trauma, osteoporosis, or tumours that can cause pain, deformity, and nerve damage.
Spinal Tumours: Abnormal growths of cells in or near the spine that can be benign (noncancerous) or malignant (cancerous), causing pain, weakness, and neurological problems.
Spinal Infections: Inflammation of the spine due to bacteria, fungi, or viruses that can cause pain, fever, and neurological problems.

How can Minimally Invasive Spine Surgery Help?

MISS uses small incisions and specialised instruments to treat some of these conditions without causing much damage to the surrounding tissues.

It can help improve your quality of life by reducing or eliminating your pain and other symptoms, improving your mobility and posture, and preventing further damage to your spine.

Types of Minimally Invasive Spine Surgery

Different techniques and approaches exist for performing MISS – depending on the location and severity of the spinal problem.

Some of the common types of MISS are:

Tubular Retractor

This technique involves inserting a small tube through a tiny incision in the skin and muscle, creating a tunnel to access the spine. The surgeon then uses small instruments and a microscope or an endoscope to perform the surgery through the tube. The tube also helps to keep the muscles and tissues away from the surgical area, reducing blood loss and inflammation. This technique is often used for decompression surgeries, such as discectomy or laminectomy.

Endoscopic Spine Surgery

This procedure entails making a tiny incision in the skin and inserting an endoscope, a narrow, bendable tube containing a little camera and light. The endoscope allows the surgeon to see the inside of the spine on a monitor and guide the surgical instruments. The endoscope also helps to remove any damaged tissue or bone fragments from the spine. This procedure is often used for herniated disc repair or spinal fusion.

Lateral Access Spine Surgery

This method requires a small incision in the side of the body, close to the waist or lower back, to access the spine from the side. The surgeon then uses special instruments and retractors to move the organs and blood vessels away from the spine, creating a clear path to perform the surgery. This method is often used for spinal fusion or correcting spinal deformities.

Minimally Invasive Spine Surgery vs. Traditional Surgery

Your quality of life is affected by the significant choice of whether or not to have spine surgery and what kind of spine surgery to have.

In general, there are two primary spine surgery procedures:

Minimally invasive spine surgery (MISS)
Traditional open surgery

Open surgery involves a long incision that allows the surgeon to see and access the spine more easily. By cutting through the skin and muscles, the surgeon can remove portions of bone or disc to decompress the nerves or spinal cord (decompression) or insert screws, rods, cages, or bone grafts to fuse two or more vertebrae (fusion). Open surgery can treat more complex spinal conditions that may not be amenable to MISS.

Both approaches have benefits and drawbacks, but the best option depends on several factors, such as your condition, medical history, personal preferences and most importantly, your doctor’s recommendation.

The choice between MISS and open surgery depends on several significant factors, such as:

The type and severity of your spinal condition
Your medical history and overall health
Your personal preferences and expectations
Your surgeon’s experience and expertise

Advantages and Disadvantages of MISS over Open Surgery

MISS can offer several advantages over open surgery, such as:

Less blood loss: MISS involves less cutting and exposure of the blood vessels than open surgery. It means there is less chance of bleeding during the surgery, which can lower the risk of needing a blood transfusion or developing an infection. Less blood loss can also help maintain the patient’s blood pressure and oxygen levels during and after the surgery.
Less muscle injury: MISS preserves more soft tissues, including the muscles surrounding the spine. Therefore, there is less disruption of the normal anatomy and function of the spine, which can prevent excessive pain, bleeding, swelling, and scarring after surgery. Additionally, it may maintain the stability and efficiency of the spine in the long term, which can prevent further degeneration or deterioration of the spinal structures.
Less pain: MISS causes less tissue damage and inflammation than open surgery. It may result in decreased post-operative discomfort and a reduction in the need for painkillers.
Shorter hospital stays: MISS requires less wound healing and recovery than open surgery. It can make a hospital stay shorter and lower the cost of care.
Faster recovery: MISS requires less time for the muscles and tissues to heal and regain strength than open surgery. It could result in a quicker recovery and a return to normal activities.
Lower risk of complications and infections: MISS involves a smaller wound area than open surgery. Thus, there is a lower possibility of infection and wound complications.

However, MISS is not free from limitations and challenges. Some of them are:

Difficulty in accessing and visualising the spine: In MISS the surgeon has to work in a narrow space with limited visibility and manoeuvrability. Some complex spinal conditions may not be amenable to MISS and require open surgery for better exposure and correction.
Higher cost of equipment: MISS requires more expensive instruments and devices than open surgery. The price of MISS may vary depending on the type of procedure, the hospital setting, and your insurance coverage.
Risk of radiation exposure: MISS may involve more use of X-rays or fluoroscopy than open surgery to guide the instruments and confirm the placement of implants. It may increase the risk of radiation exposure for the patient and the surgical team.

Advancements in Minimally Invasive Spine Surgery

MISS has been evolving rapidly in recent years, thanks to the development of new technologies and techniques that have improved the procedure’s safety, accuracy, and effectiveness. Some of the advancements in MISS are:

Robotic-Assisted Surgery

Robotic-assisted surgery is a method of performing spinal neurosurgery that uses a robotic device to assist the surgeon in guiding the surgical tools and implants through tiny openings in the skin. The robotic device, controlled by the surgeon through a console, has a robotic arm that can move with more accuracy, stability, and flexibility than the human hand. It can help the surgeon to perform delicate and complex procedures with less risk of damaging the surrounding tissues and nerves.

Robotic-assisted surgery can also lower the risk of radiation exposure for the patient, the surgeon, and the operating room staff by reducing the need for X-rays or fluoroscopy, which are imaging techniques that use radiation to show the body’s internal structures. Furthermore, robotic-assisted surgery can enhance the comfort and efficiency of the surgeon by improving the ergonomics of the surgical position and reducing the mental and physical fatigue that can result from prolonged and laborious operations.

Endoscopy

Endoscopy has advanced significantly in recent years thanks to the development of new instruments, technologies, and approaches. Some of the advancements include:

Complete endoscopic spine surgery: This technique uses a spinal endoscope that can provide an expanded and angled view of the spine, enabling the surgeon to treat various spinal conditions such as disc herniation, spinal stenosis, infection, and fusion.
Biportal endoscopy: This technique uses two portals, one for the endoscope and one for the surgical instruments, to perform spinal surgery. Biportal endoscopy is simple to adopt, requires less expensive equipment, has a shorter learning curve, and is suitable for interbody fusion.
Navigation, robotics, and augmented reality: These technologies can enhance the accuracy, safety, and efficiency of endoscopic spine surgery by providing real-time guidance, assistance, and visualisation of the surgical area.
- Navigation can reduce radiation exposure by using electromagnetic-based systems.
- Robotics can offer more precision, stability, and flexibility than the human hand.
- Augmented reality can overlay virtual images onto the actual surgical field.

Shaping the Future of Spine Surgery through Minimally Invasive Techniques

As an advancement in spine surgery, MISS offers several benefits over traditional open-spine surgery, which uses larger incisions and may cause more tissue disruption. It can achieve similar or better results using smaller incisions and advanced technologies with less pain, blood loss, infection risk, hospital stay, and recovery time. Some of the advanced technologies that MISS uses are:

Microscope or endoscope: These devices allow the surgeon to see the inside of the spine on a monitor and guide the surgical instruments. They also help to remove any damaged tissue or bone fragments from the spine.
Specialised instruments: These are tools designed to perform specific tasks on the spine, such as cutting, drilling, screwing, or grafting. They are also made to fit through the small incisions and tubes used in MISS.
Navigation system: This system helps the surgeon locate and align the surgical instruments with the spine using images from X-rays, CT scans, or MRI scans. It also helps avoid damaging vital structures such as nerves or blood vessels.

MISS is a promising option for patients with spine conditions seeking a less invasive and more effective treatment. By accurately navigating the spine, MISS can offer a better surgical experience and a faster recovery. MISS can also reduce open surgery’s potential complications and long-term effects on the spine.

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