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Minimally Invasive Spine Surgery only Starts with the size of the Incision

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The 35 Minute MIS TLIF w/ Dr. Zeshan Hyder Dr. Zeshan Hyder is a pioneer in the field of minimally invasive spine surgery and renowned for his skill in helping patients return to life before their bac...

Minimally Invasive Spinal Surgery: Questions and Answers

Expert Contributor: Dr. Zeshan Hyder

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Recent technology advances in spinal surgery have paved the way for the use of minimally invasive surgical techniques for certain back and neck procedures. Traditionally, open surgery has been used to treat back and neck conditions, which can at times require a large incision so that the surgeon can access the spine. Minimally invasive techniques allow the surgeon to perform most of the same surgeries without the need for such a large incision. Patients who undergo minimally invasive surgery often experience less pain, have smaller scars, and recover faster than those who undergo traditional spine surgery.



What Is Minimally Invasive Surgery?

The goal of minimally invasive surgery is to minimize the injury to the muscles and other structures in the spine, while maintaining the same surgical goals. These techniques allow the surgeon to view only the portions of the spine involved in the surgery, without disturbing the other areas. This means that the surgery requires a smaller incision, and often results in less blood loss and a shorter hospital stay following surgery.

Open surgery often requires an incision as large as five to six inches. The muscles need to be pulled aside, or “retracted,” for the surgeon to access the spine. However, retracting the muscle can affect the soft tissue and muscles, leading to an extended recovery time.



The Procedure

Minimally invasive spine surgery is usually performed using a tool called a retractor: a hollow, or tube- shaped device. The surgeon makes a small incision, then inserts the retractor down to the spinal column. The retractor creates a small tunnel to the problem area, keeping the muscles out of the way during the operation.

The surgeon will use small instruments that fit through the center of the retractor. Any materials removed from the spine will exit through the retractor, and likewise, any forms of fixation (rods, screws, or plates) necessary for fusion are inserted through the retractor.

Surgeons use fluoroscopy or intraoperative X-ray to pinpoint where to make the incision and insert the retractor. An operating microscope can also be utilized with the retractor to magnify the view. When the procedure is complete, the surgeon will remove the tubular retractor, and the muscles can return to their original positioning.



Recovery

Although the length of time spent in the hospital or ambulatory surgical center varies for each person, most patients who undergo minimally invasive spinal surgery can go home earlier than those who undergo open procedures, sometimes within 24 hours. Patients will generally experience less pain following surgery than those who undergo traditional spine surgery, because minimally invasive techniques do not disturb the muscles and soft tissues surrounding the spine. You will likely feel some discomfort, but your doctor can help to manage your pain.

Physical therapy may also be recommended to help you regain strength. Depending on the type of procedure you’ve undergone, and your general physical condition, specific exercises will be

recommended. If you underwent a spinal fusion, it can take several months for the bone to completely heal and solidify. You will need to be sure to keep the fused spine in proper alignment until you are properly healed. You will be instructed on how to move, walk, sit, and stand so that the alignment is not disturbed.

Your doctor will evaluate you following surgery to determine when it is safe to resume your normal activities. Recovery times depend on the individual patient and the procedure(s) performed. Maintaining a healthy weight, smoking cessation and an exercise regimen pre-operatively can decrease recovery time during the post-op period.