What Is Minimally Invasive Spine Surgery?

Using innovative techniques, cutting-edge technology, and evidence-based medicine, minimally invasive spine surgery (MISS) may be a treatment option for your spinal disorder or chronic back and neck pain.

Compared to traditional open spine surgery, minimally invasive spine surgery utilizes the knowledge of important anatomy, along with cutting-edge technology, to treat your spinal condition without causing undue injury to the surrounding soft tissues. Computer-assisted technology (such as computer navigation and nerve monitoring) and highly specialized tools and instrumentation provide for the safe and effective treatment of your pain.

Advantages of MISS include:

  • Less post-operative pain
  • Quicker recovery
  • Reduced blood loss
  • Less soft tissue damage
  • Improved function
  • Smaller surgical incisions
  • Less scarring

Minimally Invasive Surgery is done by using muscle sparing approaches and smaller incisions. As a result, patients benefit with decreased pain and faster return to activity.Minimally invasive spinal fusion can be done as well.  Intraoperative x-ray and nerve monitoring is used to safely place spinal instrumentation "percutaneously" through small incisions. Special retractors and instruments are used to remove the intervertebral disc and place a spacer with bone graft for fusion.

Procedures that may be performed via minimally invasive spine approach include:

  • Posterior Spinal Decompression
  • Posterior Lumbar Fusion
  • Lateral Lumbar Fusion
  • Anterior Lumbar Interbody Fusion (ALIF)
  • Anterior Cervical Discectomy and Fusion (ACDF)
  • Posterior Cervical Laminotomy
  • Posterior Cervical Laminectomy and Fusion
  • Posterior Cervical Laminoplasty
  • Balloon Kyphoplasty

FAQ About Minimally Invasive Spine Surgery


When should I consider 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.

Am I a candidate for minimally invasive spine surgery?
The field of minimally invasive spine surgery continues to grow. Most surgeries today can be treated with some aspect of minimally invasive surgery. However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumors and some infections.

The best options should be individualized to the patient’s diagnosis and overall patient condition. We perform both minimally invasive spine surgery, as well as open-surgery, and choose the type of treatment that is best suited for the individual patient.


Why do I need to get an MRI, CAT Scan and an XRay before I have surgery?
The integration of our newest technolgies that assist in MISS surgery often require that radiologic procedures be tailored to fit each operation and will often require a new scan.


How long will I be in the hospital?
In general, minimally invasive spine surgery decreases the hospital stay by one-half. In a typical endoscopic discectomy, the surgeries are performed in the same day, and the patients go home shortly after surgery on the same day.

For various types of lumbar fusion surgery, the patient typically goes home in 2-3 days, where previously they stayed in the hospital 5-7 days. Furthermore, the immediate post-operative period is marked by much less pain when using minimally invasive techniques.


When can I go back to work after minimally invasive back surgery?
The decision to return to work should be individualized to the patient, as well as the patient’s occupation. For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks. For a larger surgery such as a fusion, this may take 4-6 weeks. Again, return to work is much faster using minimally invasive surgery vs. standard open surgery but this decision is individualized to special needs of each patient.


How long is the recovery?
Recovery from each surgery is different. Some patients return to full activity in 6 weeks while other patients require more time. We encourage all patients to participate in a physical therapy program to safely begin the process of returning to all normal activities.


After surgery, how long will my pain last?
On average, patients who have had minimally invasive spine surgery are discharged in half the time of traditional surgery and the pain usually follows this rule. Each procedure will have a differnent rate of recovery.

Will I have to take pain medication after my surgery? Will I become dependant?
There is no evidence that post-operation pain treatment leads to addiction.


Do I have to wear a brace?
Although most patients are provided a brace, this is for comfort only. The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as an internal brace, allows one to avoid having to wear a brace. Most patients find that the brace improves their pain for about 1-2 weeks, and thereafter it is only worn occasionally.


Will I need physical therapy after I get minially invasive spine surgery?
Physical therapy is an important component of a rapid recovery. This is individualized to the patient, but in most cases, physical therapy started 2-6 weeks after surgery, depending on the surgery performed and the patient’s overall condition.

Do you use lasers for minimally invasive back surgery?
Minimally invasive spine surgery utilizes a wide variety of advanced techniques, including lasers, endoscopes, operating microscopes, as well as computer-assisted navigation systems, so that procedures typically done with a large, open decision can be done through small openings.

By necessity, advanced technologies are needed to accomplish the same task that we would otherwise do with an open procedure using more basic equipment. The decision to use one or other types of advanced technologies depends on the individual condition and the surgery performed.


What are the disadvantages of MISS compared to traditional, open surgery?
Minimally invasive spine surgery holds significant promise, in terms of less pain and more rapid recovery. However, it is important to keep in mind that this is relatively new technology, and all new techniques are associated with some degree of uncertainty.

Furthermore, certain minimally invasive techniques are highly technical and require significant training, and in cases where there is a lack of training, complications may occur. Such complications can include inadequate decompression, nerve injury, infection or persistent pain.

However, these are all risks that are associated with open surgery as well. Occasionally, due to the complexity and technical challenges of minimally invasive surgery, the surgeries may take a longer period of time to complete.


Which type of surgery has a greater success rate?
At present, the long-term results of minimally invasive surgery are not well studied. These assessments are ongoing. The short term success of minimally invasive spine surgery is well established. It is clear that minimally invasive surgery allows more rapid recovery and return to work/sports. There is less post-operative pain and shorter hospital stay.


Is minimally invasive spine surgery experimental?
No. MISS has been used sucessfully for many years. However, the scope, complexity and procedures available continue to evolve at a rapid rate.

Why aren’t more hospitals and surgeons performing MIS surgeries?
Minimally invasive surgery is highly technical. This requires significant training of the surgeon as well as the OR staff. Furthermore, the equipment needed to perform these procedures safely and effectively can be very expensive. 


MISS

Minimally Invasive Spine Surgery (MISS) has been evolving for more than 4 decades and includes more than 40 techniques with new techniques being added daily. In fact, there is more research involving MISS than all other types of spine surgery combined. This rapidly expanding base of peer reviewed medical literature is now mainstream medicine. MISS techniques improve outcome, reduced risk, and lower overall cost.

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