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Minimally Invasive Surgery
Minimally invasive surgical techniques have dramatically improved the way surgeons operate today. While some techniques may be new and evolving, many others are now well established as safe and highly effective surgical options. Computer-assisted technology (such as image guidance, computer navigation and nerve monitoring) is just one example of how technological advancements have led the progress in this contemporary field of medicine.
Using smaller incisions, modern technology and specialized instruments together with their unique skills, our surgeons may access and repair the injured area of the spine without the damaging effects of large muscle dissection or retraction, thereby leaving the body as naturally intact as it was prior to surgery. Although the advantages of many new minimally invasive and endoscopic procedures are yet to be proven, some of the demonstrated benefits of minimally invasive surgery include:
- Smaller incisions
- Reduced blood loss
- Decreased damage to tissues and muscles
- Less post-operative pain
- Shorter recovery time
- Minimized scarring
Quicker return to activity
The goal of minimally invasive surgery remains the same as a formal, open surgical procedure, which is to address the abnormality of the spinal column. While the incision and tissue dissection to the spine may be less, it is important to discuss with your spine surgeon if your particular condition is amenable to a minimally invasive approach. The outcome of the surgery should not be compromised for a smaller incision.
Minimally invasive spine surgery may be used to treat a variety of spinal disorders and conditions, including:
Scoliosis or kyphosis
Degenerative disc disease
Tubular retractors are used with small incisions to gently dilate and separate muscles and soft tissues, thereby creating an opening to the spinal area that requires operation. These tubes reach between the dilated muscles so that with microscopic visualization and modified instruments surgery is able to be performed through the small opening of the tube.
Lasers are one of many specialized tools used during minimally invasive spine surgery. During endoscopic spinal surgery, a laser may be used with additional tools to remove hard disc herniations and bone spurs. Lasers are not used during minimally invasive fusion surgery to treat disorders such as spondylolisthesis or degenerative scoliosis, since larger areas of diseased disc and bone must be treated.
Computer-Assisted Navigation (Image-Guided Surgery)
During surgery, computer-assisted navigation systems display the position of the instruments inside the body onto a monitor, similar to the GPS system in your car. As the surgeon moves the instrument within the patient, a camera calculates its position and transfers that data to a computer in the operating room. Computer-assisted surgery provides visual confirmation and verification for the surgeon, and enables him or her to perform a more precise implantation. Due to its ability to increase accuracy during a surgical procedure, image-guided surgery systems have the potential to lead to excellent outcomes. Many leading orthopedic surgeons believe that computer-assisted navigation systems will replace fluoroscopy and other traditional surgeries within five years.
The endoscope allows the surgeon to have an illuminated and magnified view of the operating field without having to make a large incision. With the assistance of the endoscope, surgeons can use several small incisions to perform the same procedure they would otherwise perform using a single large incision.
- Endoscopy is the visual inspection of any cavity or space by means of an endoscope.
- Thoracoscopy is the visualization of the thoracic cavity or the chest.
- Laparoscopy is the visualization of the abdominal cavity and is used to assist in procedures on the lumbar spine.
Mini Open Procedures
Even today, only a small percentage of spinal conditions are suitable for endoscopic surgery. However, there are ways to decrease the muscle dissection by performing mini open procedures. These mini open procedures allow fusion and instrumentation, procedures that classically involve much larger incisions and muscle dissection.
Minimally Invasive Procedures
Types of minimally invasive (MIS) procedures include:
- X-STOP IPD
- MIS Lumbar Laminectomy
- Trans-sacral Fusion (TranS1)
- Vertebroplasty and Kyphoplasty
- Muscle-Sparing Cervical Disc Replacement
- (Percutaneous) Pedicle Screw Instrumentation
- Lumbar Tubular Microdiscectomy (MIS Tubular Microdiscectomy)
- Laser (lumbar) Endoscopic Discectomy (Endoscopic Discectomy)
- Cervical Posterior MIS Tubular Microdiscectomy (Cervical or Lumbar Posterior MIS Tubular Hemilaminotomy or Cervical Laminoforaminotomy)
- Anterior Cervical Discectomy and Uncovertebrectomy
- Muscle-sparing Anterior Cervical Discectomy and Fusion (ACDF)
- Anterior Lumbar Interbody Fusion (ALIF)
- Direct Lateral Interbody Fusion (DLIF/XLIF)
MIS Transforaminal Lumbar Interbody Fusion (TLIF)
The possible risks and complications are similar in minimally invasive/less-invasive surgery as compared with open surgery. However, minimally invasive surgery is a relatively new field and should be performed by board-certified surgeons who are extensively trained and experienced in these highly specialized techniques.
Generally, patients have required less pain medication, experienced less blood loss and shorter hospital stays. Rehabilitation exercises generally can begin sooner. Studies are underway to better determine the long-term benefits and outcome of minimally invasive surgery.