Minimally Invasive Spine Surgery

Minimally invasive spine surgery is an advanced surgical technique that uses specialized instruments to access the spine through tiny keyhole incisions.

 GOALS

  • Smaller incision.
  • Minimal injury to the back muscles.
  • Less postoperative pain.
  • Less bleeding
  • Faster recovery and shorter hospital stay.

THE PROCEDURE: STEPS

  • The patient is positioned to lie on his/her belly and made unconscious with the help of anesthesia.
  • One or two small incisions are made over the affected portion of the vertebral column.
  • A tube retractor (an instrument that helps to hold muscles apart) is inserted through this incision, down to the spinal column. Thus a tunnel is created, from the outside to the backbone.
  • Small instruments that fit through the center of the retractor are inserted and the procedure is performed.
  • Diseased portions of the disc are separated and removed out through the retractor. Screws and rods needed to stabilize the backbone are inserted through this retractor tube and secured to the backbone.
  • During the procedure, a continuous X Ray beam is passed through the spine. The beam projects real time images of the patient’s spine, on to a TV screen. This procedure is known as fluoroscopy and provides guidance to the surgeon.
  • A surgeon may also use an operating microscope to magnify his direct view through the retractor.
  • Once the procedure is complete, the retractor is removed and the muscles return to its original position.
  • The wound may or may not be sutured. The site is covered with clean gauze.

TYPES OF MINIMALLY INVASIVE SPINE SURGERY (MISS)

  • Anterior longitudinal ligament resection (ALL resection): This is the minimally invasive treatment of choice for spinal cord deformities.
  • Lumbar Interbody fusion: The procedure can be performed from the front, through the belly or from the sides of the body, depending upon the disease condition. The procedure is used for the correction of spinal cord deformities or other conditions that result in damage to the intervertebral disc.
  • Endoscopic Discectomy: Using a tiny camera attached to a tube (endoscope), bulging discs that compress upon nerves are identified and removed.
  • Balloon Kyphoplasty: This is a minimally invasive procedure, used in the treatment of fractures of the vertebra that result from thinning of bones with age. In this technique, through a tiny incision, a tiny balloon is inserted into the affected vertebrae. Cement is injected into the space created by the balloon. This helps to fix the fractured bone.
  • Laminectomy: Certain age related changes or tumor in the backbone result in compression of spinal nerves. This in turn causes increased pressure in the spinal column. This can be relieved by removing part or whole of a tiny piece of bone called the ‘lamina’ making the roof of the vertebral bone.
  • Laser Discectomy: Laser is used to destroy portions of the disc that is compressing upon the nerves.

The time taken for minimal invasive spine surgery ranges from 1-3 hours, depending on the type of procedure performed.  The patient is usually discharged in a day or 2 but can return to work after a week.

CARE AFTER SURGERY

Upon discharge, patients are advised to:

  • Keep surgical site clean and open.
  • Start physical therapy and muscle strengthening exercises.
  • Start doing light activities initially and gradually increase as tolerated.
  • Avoid strenuous work and heavy weight lifting.

Dr Kodeeswaran in India Setting the Standard for Minimally Invasive Neurology Care