Consultant Brain and Spine Surgeon:
Consultant Brain and Spine Surgeon, Park Clinic
Hony. Professor of Neurosurgery:
VIMS (Calcutta University)(Telemedicine Consult Available)
MBBS (Cal), FRCS. Ed., DNB(Surg.)
MNAMS(Neurosurg.), FRCS(Neurasurg.)
Minimally Invasive Neurosurgery Minimally invasive spine surgery (MIS) was first performed in the 1980s, but has recently seen rapid advances. Technological advances have enabled spine surgeons to expand patient selection and treat an evolving array of spinal disorders, such as degenerative disc disease, herniated disc, fractures, tumors, infections, instability, and deformity.
One potential downside of traditional, open lumbar (back) surgeries is the damage that occurs from the 5- to 6-inch incision. There are many potential sources for damage to normal tissue: the muscle dissection and retraction required to uncover the spine (which contributes to the formation of scar and fibrotic tissue), the need for blood vessel cauterization, and the necessity of bone removal. Disrupting natural spinal anatomy is necessary to facilitate decompression of pinched nerves and the placement of screws and devices to stabilize the spine. This may lead to lengthy hospital stays (up to five days or longer), prolonged pain and recovery periods, the need for postoperative narcotic use, significant operative blood loss, and risk of tissue infection.
Smaller incisions
Smaller scars / less scar tissue
Reduced blood loss
Less pain
Less soft tissue damage
Reduced muscle retraction
Decreased postoperative narcotics
Shorter hospital stay
Possibility of performing on outpatient basis
Faster recovery
Quicker return to work and activities
This is a MIS technique that is performed in patients with refractory mechanical low back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The procedure is performed from the back (posterior) with the patient on his or her stomach.
Using x-ray guidance, two 2.5-cm incisions are made on either side of the lower back. The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by rod and screw placement. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed. This procedure typically takes about 3 to 3 ½ hours to perform.
