MINIMALLY INVASIVE SPINE SURGERY

MISS is the latest advanced technology available to perform spinal surgeries through small, less than one inch long, incisions. It involves the use of special surgical instruments, devices and advanced imaging techniques to visualize and perform the surgery through such small incisions. MISS is aimed at minimizing damage to the muscles and surrounding structures. MISS possesses numerous benefits over the traditional spine surgery that includes:

• Small surgery scars
• Reduced risk of infections
• Less blood loss during the surgery
• Less post-operative pain
• Quicker recovery
• Shorter hospital stay
• Quicker return to work and normal activities

With advances in technology, several spine surgeries can be performed through a minimally invasive approach including anterior cervical discectomy and fusion (ACDF), kyphoplasty, intradiscal electrothermal annuloplasty (IDET), posterior cervical laminectomy and fusion, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion(PLIF), transforaminal lumbar interbody fusion(TLIF), axial lumbar interbody fusion(AxialLIF) and direct lateral lumbar interbody fusion (DLIF).

Selection of patients for minimally invasive surgery

Minimally invasive surgery is suitable only for selected patients. Thus, before the surgery, the patient’s medical history and various diagnostic tests, such as X-rays or other imaging tests, are used to ascertain the underlying spinal conditions causing pain and other associated symptoms. The current health status of the patient is also evaluated through blood tests and other specialized tests, for diseases such as diabetes, heart disease and osteoporosis. The decision of performing the surgery through a minimally invasive approach is decided by the surgeon based on their experience and the benefits to the patient as compared to the traditional open spine surgery.
The surgeon explains the surgery and its benefits along with the possible risks to the patient.

Risk and Complications

The risks and complications of the surgery may include infection, bleeding, nerve injury, or spinal cord injury. Complications due to general anaesthesia may also occur.

Procedure

Minimally invasive spine surgery is done through small incisions. Segmental tubular retractors and dilators are then inserted through these small incisions to retract muscles and provide access to the spine by creating a working channel for the surgery. This minimizes the damage to the muscles and soft tissues and decreases the blood loss during the surgery. An endoscope is inserted through one of the incisions to provide images of the operation field, on the monitor in the operation room. The surgery is done with special surgical instruments passed through the working channel. Sometimes surgical microscopes may also be used to magnify the visual field. The tissues fall back in place, as the various instruments are withdrawn. The incision is then closed and dressed.