Minimally invasive spine surgery (or MISS) is a procedure where the surgeon gains access to the spine through much smaller incisions than those used in traditional open surgery. Patients can gain the same benefit as open surgery, depending on the condition and the procedure required. Compared to open surgery, a patient can expect more rapid recovery, less post-operative pain and smaller scars. What I believe is most important about MISS surgery is the ability to preserve vital musculature that supports the spine that is usually severely damaged during traditional, open spine surgery.
MISS procedures for fusion and decompression are performed using tubular retractors. The surgeon makes a small incision in the skin and soft tissues and inserts the tubular retractor until it reaches the spinal column, creating a tunnel through which the surgeon can access the spine. The retractor allows devices such as screws and rods to be inserted. Fluoroscopy allows the surgeon to see a real-time x-ray image of the patient’s spine, and an operating microscope can also be used to allow the surgeon to see the procedure. When the tubular retractor is removed, the muscles can return to their original positions, limiting muscle damage. Contrary to popular belief, lasers are rarely used in MISS procedures.
The techniques used in MISS do not disrupt the patient’s muscles and soft tissues, resulting in less post-operative pain compared to traditional open procedures. While some pain does occur, it lessened with medication. Following the surgery, less rehabilitation is usually required. MISS also results in reduced scarring compared to open procedures.
The risks involved with MISS are similar to those caused by open spinal surgery, but undergoing MISS can result in a reduced risk of infection, with antibiotics being prescribed regularly for before, during and after the surgery. Other risks include bleeding, pain at the site of the surgery and at the site of bone graft. Some recurrences of the original symptoms may occur after surgery such as pseudarthrosis, a condition in which there is not enough bone formation, nerve damage and the formation of blood clots in the legs.
Your doctor is best able to tell you if you are a candidate for MISS. Depending on the patient and the condition, MISS may not be as safe or effective than open surgery.
MISS can be used to treat conditions such as lumbar spinal stenosis, herniated disc, degenerative disc disease, deformities of the spine (such as scoliosis), spinal infections, spinal instability, compression fractures of the vertebrae and spinal tumors.
The length of the hospital stay varies depending on the patient and the procedure. Microdiscectomy patients go home the same day and almost all patients who undergo MISS are back at home after one to two days. Following surgery, physical therapy may be recommended to help the patient gain enough strength to continue work and other daily activities. For simple decompression procedures, outpatient surgery is generally performed and patients usually go home the same day. (For larger fusion surgeries, patients usually go home in the range of 24-72 hours. )
A spinal fusion surgery is used to correct spinal deformities or instability and prevent their progression. By using powerful modern surgical techniques, we are now able to correct spinal fractures, scoliosis and congenital abnormalities along with resection of tumors that involve the spine. A lot of these procedures can now be done in a minimally invasive manner.
In short, the spine fusion surgery aims at fusing together curved or unstable vertebrae so that they heal into a single and solid bone. This prevents the curve of spine or instability from getting worse. The procedure typically involves some bone material called a bone graft that promotes fusion and prompt healing. Metal rods can also used to support the spine for better fusion typically with the help of screws.
Most of the spinal fusion surgeries last from 90 minutes to 10 hours, depending on the magnitude of the surgery, the size of the patient's curve and how much of the spine needs to be fused.
Infection, bleeding, nerve and spinal cord injury, failure of the fusion to heal, hardware failure and the development of continued deformity above or below the spinal fusion site are some of the more common risks involved. But these risks have decreased dramatically due to the development and use of modern spinal cord monitoring techniques.
The intensity of pain felt after surgery varies for every individual. Since this surgery involves moving muscles and realigning the skeleton, a reasonable amount of pain is anticipated every time. The first few days are especially uncomfortable, with slight progression in comfort from day four onwards. Most people can return to school or work, depending on their type of work, 2-3 weeks after their surgery.
It is not mandatory to remove the hardware after successful spinal fusion. Some people, though, may require rod removal for various reasons after their surgery.
Fortunately, the spinal fusion surgery does not cause lifetime restriction on the patient’s activities. Most patients tend to return to their favorite activities, from running to weight lifting to exercising, after 6 months of surgery. Please note, though, that the spine needs to fully recover before the commencement of any heavy activity to avoid post-surgical complications.
For most adults, spinal fusion surgery is required if they are experiencing nerve root symptoms from spinal stenosis (leg or arm pain) associated with a deformity or instability.
You will be closely monitored in the hospital for the first few days after your surgery. When you’re at home, avoid heavy lifting (no more than 10 pounds), twisting and bending. Your doctor may recommend that you wear a back brace while you recover. Gradual rehabilitation with some medications will help you recover faster and more effectively. This may include walking, riding a bike, swimming, etc. You can return to your routine activities within 4-6 months.
Non-responsiveness to conservative treatments can greatly lower a patient’s quality of life, and because of this a patient should look into spine surgery when his or her back pain has not decreased following months of non-surgical back treatment. Neurological problems such as cervical myelopathy (or “foot drop”) require urgent attention. The key is to choose surgery if the pain is so severe that it interferes with your quality of life.
Sometimes surgery is the only permanent way to alleviate back pain and other limiting factors. However, spine surgery should be looked into carefully, as the procedure can be invasive. Some spine surgeries like a microdisectomy for a herniated disc are minimally invasive, but other types of spine surgery can be more invasive.
With advancements in medical science, spine surgery has become increasingly safe. Today, it is one of the safest types of surgery performed in the US.
Spine surgery can greatly improve the quality of one’s life. A successful spine surgery results in the alleviation of pain, which brings about an increase physical fitness and activity. It also causes an improved mood and increases productivity at work. Spine surgery can give your life back.
Like all surgeries, there are some risks involved in undergoing spine surgery. These risks include a reaction to the anesthesia, infection, blood clots, recurrent disc herniation and nerve damage. In some extreme cases a stroke, heart attack and death may occur.
Patients should make sure that they have an acute diagnosis of their condition. After which they should be mentally prepared to take time off work, and they should take it easy in their daily routine. A patient should listen to his or her doctor’s advice when it comes to taking medicines, doing exercises and maintaining a certain type of diet.
The recovery period depends on the type of spine surgery a patient undergoes. Procedures such as discectomy, surgery to remove all or part of your disk, and foraminotomy, surgery to widen the opening in your back where nerve roots leave your spinal column, have a recovery period of a few days. However, surgeries like spinal fusions, the fusion of two bones together in your back or neck to alleviate pain, may have a recovery period of several weeks (although you generally will be up and moving fairly quickly). You will want to avoid heavy lifting, bending or twisting until adequate healing has occurred.
Again, this depends on the type of surgery the patient undergoes. Patients that undergo minimally invasive spine surgery may feel discomfort for a few days. Patients that undergo invasive spine surgery may feel uneasy for a few weeks following the procedure. However, patients will mostly likely be prescribed non-steroidal anti-inflammatory drugs (NSAIDs), such as Tylenol, ibuprofen, or Celebrex to alleviate inflammatory pain after the surgery.
In order to recover from spine surgery patients would have to forgo all physical activities that put a stress on their back. These include bending, twisting and lifting heavy objects.
As we age, our bones and muscles eventually lose their elasticity and tone. They become weak and are less able to properly protect the vertebrae and have more tendency to break and spasm. When a spinal disc bulges or ruptures, it puts pressure on its surrounding nerves, which sends out pain signals to the brain. Other factors that contribute to back pain include poor posture, obesity, lack of sleep and smoking.
Back pain is caused by a number of factors. It can result from an injury, spinal degeneration, repetitive sports- or work-related injury, arthritis or a developmental defect like scoliosis. Other conditions that cause back pain include injuring a muscle, tendon, or ligament in your lower back; a rupturing or bulging of a disc between your vertebrae; arthritis or other disc problems; lumbar facet joint syndrome; inflammation of your sacroiliac joint, which joins your hip to your spine; sciatica, which is a result of herniated discs or spinal stenosis; and cervical radiculopathy, which is having a “pinched nerve” in the neck that can cause numbness, weakness and pain.
It is never a good sign when you experience persistent back or neck pain, weakness, or numbness that you feel radiating out to your arms or legs for more than a couple of days, so when you do you should immediately set an appointment with a spine specialist. When you feel pain as a result of a traumatic injury, you should immediately seek medical attention.
Always use good posture and never slouch. Make sure to keep your weight balanced on both feet when standing. Do not forget to stretch before and after doing a strenuous activity. Take frequent breaks when sitting for longer periods of time. Keep a healthy weight and avoid unnecessary weight gain as this can take a lot of toll on your back. Avoid smoking at all times as smoking speeds up the degeneration of the spine.
Exercises for a healthy back can be categorized into three basic groups: strengthening exercises that include repetitive muscle contractions until the muscles grow tired, flexibility or stretching exercises that include sustained lengthening of one’s muscles and aerobic exercises that include those steady exercise patterns using large muscle groups. Walking, swimming, stretching, cross-country skiing, dancing, yoga and tai chi greatly help improve your overall spine health.
Observing proper posture is a crucial factor in preventing oneself from any spinal pain and injury. Keeping a balanced posture, both when standing and sitting, greatly helps maintain your joints in a neutral position, making your body flexible enough for smooth, safe and strong movements.
Work closely with a doctor who specializes in back and neck care to save yourself time in finding the most appropriate pain management solutions for your back or neck pain. Research and ask for referrals for credible doctors who have received advanced training in the diagnosis as well as treatment of back and neck pain problems. There is a wide range of spine care specialists that you can approach for various phases or severities of your back or neck pain, from neurosurgeons and pain management physicians to interventional radiologists and physical therapists.
When nonsurgical treatments including physical therapy, bed rest, exercise, ice and heat therapy, medications and injections have not proven to be effective, your doctor may recommend surgery. For most situations regarding neck and back pain, it can be treated successfully without surgery. Consider surgery only after exhausting the appropriate non-operative measures including physical therapy, exercise, weight loss and injections.
Definitely. Sudden weakness in the extremities, sway disturbance or other neurological symptoms are reasons to immediately seek a back pain expert. When it comes to choosing a surgeon make sure you choose a surgeon who has additional fellowship training in spine surgery.
Surgery should always be the last resort when it comes to treating spinal conditions in the neck and back. However, if various non-operative treatments have been attempted without improvement or worsening over a 6-12 month period, then surgical treatment seems reasonable for certain specific conditions such as spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis. The decision for surgery should be individualized to the patient and the patient’s symptoms, along with their level of function.