Minimally Invasive Spine Surgery (MISS) is an upcoming aspect of modern-day Spine surgery practice.
Endoscopic and Laparoscopic surgery are well-established entities for various surgical problems. Minimally invasive Spine surgery offers similar advantages for the management of spine problems.
As compared to open surgery, MISS approaches involve multiple small or keyhole access to the spine. This makes surgery faster, less painful, and enables quick recovery. Advantages of MISS are:
- Better cosmetic results from smaller skin incisions (sometimes as small as several millimetres)
- Less blood loss from surgery
- Reduced risk of muscle damage, since less or no cutting of the muscle, is required
- Reduced risk of infection and postoperative pain
- Faster recovery from surgery and less rehabilitation required
- Diminished reliance on pain medications after surgery
Some MISS surgeries can also be performed under local anaesthesia and as daycare procedures, which makes the hospital stay very short.
Conditions treated using MISS procedures:
- Degenerative disc disease
- Herniated disc
- Lumbar spinal stenosis
- Spinal infections
- Spinal instability including spondylolisthesis
- Vertebral compression fractures
- Spinal tumors
Common MISS procedures which are routinely performed today:
- Discectomy or Decompression by Tubular retractors: It involves serial dilatation of muscles and reaching to the affected area of the spine using Tubes. A normal open approach involves cutting and stripping muscles from bone to reach that part. Discectomy and Decompression procedures can be done through tubes. The incision is 2-3 cms only and ensures quick recovery and short hospital stay.
- Endoscopic Spine Surgery: Endoscopic spine surgery involves approaching the spine through a very lateral approach through an endoscope. The incision is hardly equal to a fingertip and the entire procedure is performed under local anaesthesia. The patient is awake during the procedure so the risk of neurological injury in such a case is very less. The patient can be made to walk immediately after the surgery and can be discharged in a few hours or very next day.
- MISS TLIF: Open fusion procedure is a very routinely done surgery for degenerative spine problems like listhesis (slipping of a vertebra) or Spinal canal stenosis (compression of spinal nerves). Minimally invasive Fusion procedure involves inserting screws through small incisions on either side. And Fusion procedure is done by a small 2-3 cms incision on one side of the spine. Small incision and shorter time ensure a quick recovery and faster rehabilitation.
- Vertebroplasty and Kyphoplasty: Osteoporotic Spinal fractures can be treated by percutaneous cement augmentation by procedures called “Vertebroplasty and Kyphoplasty”.
Consult your Spine Surgeon to know about Minimally invasive spine surgery. It is important to understand that every spine problem can not be cured by MISS. Your doctor will choose the best option for your surgery (MISS vs Open surgery) based on your clinical presentation and investigations.
Dr. Hrutvij Bhatt, Visiting Consultant – Orthopaedics, Narayana Multispeciality Hospital, Ahmedabad
