Minimally invasive spine surgery is a surgical technique that uses a flexible tube with a tiny camera and a light source to allow the surgeon to look inside the body. The tube, called an endoscope, was first developed in 1910, and its use became common in the 1980s for gallbladder surgery. Spinal surgery, however, is a relatively new endoscopic technique that has become more prevalent in the last 15 years. The endoscope is attached to a television screen, which allows the surgeon to see the surgical area and manipulate small instruments that have been inserted into one or more small incisions in the back. Minimally invasive spine surgery is beneficial to the patient in several ways:
• Smaller incisions - minimally invasive spine surgery uses two incisions that are only about 1 inch long. Depending on the procedure, conventional spine surgery incisions may be 3 to 8 inches long. A smaller incision means less trauma to tissues and less blood loss. A smaller incision also causes less scarring.
• Shorter recovery time - conventional surgery recovery time may take up to a year, while recovery from the endoscopic procedure is shortened to weeks or months. Time in the hospital is also reduced.
Candidates for Minimally Invasive Spine Surgery
Not all spinal surgery can be performed with minimally invasive methods. Surgical procedures that require extensive bone grafts or the application of metal rods cannot be performed endoscopically. The ideal patient for endoscopic surgery, as for most surgeries, is basically healthy, physically fit and does not smoke. The medical conditions for which minimally invasive surgery is used include:
• Degenerated discs
• Scoliosis
• Spinal tumors
• Compression fractures
Spinal surgery procedures that can be performed endoscopically include:
• Laminectomy, or removal of part of the vertebral bone known as the lamina.
• Discectomy, or removal of the piece of cartilage between the vertebrae.
• Cervical foraminotomy, a procedure to open the holes in the bone through which the spinal nerves pass.
• Lumbar interbody fusion, a bone graft between two vertebra in the lower back.
• The insertion of pedicle screws, which are used to help stabilize the spine.
Recovery
As with any surgery, you will need to recover from the anesthetic, which takes an hour or two. You can expect to be up and walking by the evening of surgery or next day. Your surgeon or anesthesiologist will manage your pain while you are in the hospital. Some procedures, such as endoscopic discectomies, are often done on an outpatient basis and you will go home the same day. Most people who have had minimally invasive spinal surgery are able to go home within a few days. Full recovery depends on the procedure; recovery from a fusion may take 4 to 6 weeks, while recovery from a discectomy may only take a week or two. Most surgeons recommend physical therapy to help strengthen back muscles and promote full recovery.
Possible Risks
No surgery is without risks. The most common complications from minimally invasive spine surgery are infection, bleeding, anesthetic reactions and blood clots in the legs. Paralysis is a much less common complication that occurs about once in 10,000 surgeries. Occasionally, a minimally invasive spinal surgery can't be completed as planned and the surgeon must use conventional surgery instead. Since this is a relatively new procedure, there is not much information on the long-term risks and benefits.
Alternative Treatments
Conventional spinal surgery is the primary alternative treatment. In some cases, a ruptured disc can be managed without surgery, but the recovery period is often extensive and not all patients do well. A patient who requires a fusion can opt for either conventional or minimally invasive spinal surgery. For tumors, radiation and chemotherapy are possible alternatives for some patients.
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