Minimally Invasive Spine Surgery: Types, Recovery, How is it Done?
What is the Meaning of Minimally Invasive Spine Surgery?
In the times gone by, any spine surgery was considered as a major surgery which required a lot of thought process on the part of the patient keeping in mind the hospital stay and then the long process of rehab and recovery period and the time that it used to consume.
Spine surgeries were done as an open surgery in which a long incision was made in the area of the spine being operated so that the surgeon is able to view the area well and access the damaged part of the anatomy. However, with the advances that technology and medical science has made, it is possible to treat for more and more cervical and lumbar spine problems with what is termed as Minimally Invasive Spine Surgery.1 This type of surgery is also called as less invasive spine surgery. In these procedures, surgeons use specialized tools to access the spine by making very small incisions only and correct the problem.
In open surgery or the traditional form of surgery, not only the incision is long and the surgeon has to move the muscles in order to get access to the spine but by doing this soft tissue damage can occur because of muscle retraction and it does more harm than good as it may result in patient having pain after surgery which will be different from the pain for which he or she was operated for.
An open surgery also has a lengthy recovery period. Minimally Invasive Spine Surgery treats spine problems with a lot less risk to the adjoining structures and muscles and soft tissues.
Minimally Invasive Spine Surgery pinpoints the exact area of the problem so that it becomes easier for the surgeon to correct the problem. Minimally Invasive Spine Surgery also calls for shorter hospital stays and even less time needed for recovery. Even though Minimally Invasive Spine Surgery has many advantages, yet it has been seen that in some cases these types of surgeries are not effective or minimally effective in giving relief for the patient.
How is Minimally Invasive Spine Surgery Done?
As stated above, Minimally Invasive Spine Surgeries are done utilizing specialized tools called tubular retractors. The procedure begins with the surgeon making a small incision at the area of the spine that needs treatment. Through this incision, the tubular retractor is inserted through the skin and the soft tissues into the spinal column thus making a small tunnel from the surface of the skin to the problem area in the spine.2 This retractor is kept in place for the entirety of the procedure.
The next step towards Minimally Invasive Spine Surgery is the surgeon accesses the spine using small instruments that may pass through the tunnel created by the tubular retractor. Any bone or disc material that is removed is taken out through this tunnel and any implant that needs to be inserted is also done through this tunnel only. In some cases multiple tunnels may be required needing insertion of more than one tubular retractor and more than one incision. Now, the question arises as to where exactly to make the incision and insert the retractor. This is done by utilizing fluoroscopy which guides the surgeon as to where to make the incision and insert the retractor. Fluoroscopy displays live x-ray images of the spine throughout the procedure on a screen assisting the surgeon.
What are the Different Types of Minimally Invasive Spine Surgeries?
The different types of Minimally Invasive Spine Surgeries are:
Minimally Invasive Spine Lumbar Discectomy: This surgery is done for a herniated disc in the lower back which compresses a nerve causing low back pain, numbness, and weakness in the lower extremities. For relief of these symptoms, the disc causing the compression is removed permanently. It is medically termed as a discectomy. Coming to how this surgery is done, as mentioned above under fluoroscopic guidance a small incision is made over the herniated disc and a retractor is inserted which allows the surgeon access to the herniated disc. This disc is then removed and replaced with bone graft material. This surgery is not limited to the lumbar spine. It can also be done for the cervical spine and is termed as cervical discectomy.
Minimally Invasive Spine Lumbar Fusion: The most common minimally invasive lumbar fusion is called the TLIF or transforaminal lumbar interbody fusion. In this procedure, the surgeon uses two retractors and hence two small incisions are made on either side of the spine. Using two retractors prevents any malalignment of the bones and ligaments from their midline. The two retractors are then used to remove the disc, place bone graft material and even screws and rods for additional support for the spine. A drawback of this approach is that since it is being done from the sides a full view of the spine is not there for the surgeon and hence complete removal of the disc is a tough ask and hence this may make it difficult for the fusion to heal and hence additional bone grafts may be required to improve healing rate.
What are the Complications of a Minimally Invasive Spine Surgery?
As inherent with any surgical procedures, Minimally Invasive Spine Surgery also has its own risks and complications. Some of the complications of a Minimally Invasive Spine Surgery are:
Infection: This is a complication in any surgery and hence antibiotics are given to the patient pre-surgery, during the surgery, and postsurgery to cut down the risk of infection.3
Bleeding: There may be some bleeding but it is not that significant in Minimally Invasive Spine Surgery.4
Recurring Symptoms: Some patients complain of recurring symptoms even after successful completion of surgery.
Pseudarthrosis: This complication is for those who are smokers. This is a condition in which there is reduced bone formation and hence such patients may need a second procedure so as to obtain the desired result.
What is the Recovery Period for Minimally Invasive Spine Surgeries?
Minimally Invasive Spine Surgery has a very fast recovery period than an open surgery.5 A patient who has undergone Minimally Invasive Spine Surgery needs to stay in the hospital for a maximum of four days. There may still be some discomfort that may persist for a few days but in about four to six weeks the patient can return to activities as tolerated after undergoing Minimally Invasive Spine Surgery.
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