The trend in spine surgery has moved
toward minimally invasive procedures. Minimally invasive spine surgery
(MIS) involves surgical treatment of the spine through small incisions with
minimal disruption of the surrounding muscle tissue. The benefits of
minimally invasive spine surgery include decreased pain, shorter hospital
stays, and quicker recovery.
Surgical procedures of the spine are
often referred to as an “open” procedure or minimally invasive. An
open procedure involves making a skin incision and retracting (moving aside)
any tissues overlying the anatomy that is to be worked on so that the surgeon
can directly view the desired anatomy. The surgeon will view the
anatomy either with the naked eye, magnifying telescopic eyeglasses called
loupes, or a magnifying microscope. Traditionally, open procedures have
required larger incisions and more muscle tissue distraction than minimally invasive
surgery.
Minimally invasive surgical
techniques utilize specialized retractors which allow a surgical procedure to
be done through smaller incisions with much less tissue disruption. One of
these specialized retractors is called a tubular retractor, which is a series
of gradually expanding tubes that gently and progressively dilate and separate
muscles and soft tissues to expose the operative field. Using specialized
instruments, surgery is performed through the tube.
Lasers are one of many specialized tools
that can be used during minimally invasive spine surgery. There is a
common misconception that if a laser
is used during surgery, no incisions need to be made.
Unfortunately, this is not the case. A laser is like any other surgical
tool. In order for it to be used, it has to be placed into the
appropriate area of the body through an inicision.
A second misconception is that
lasers can be used to remove arthritis. Spinal arthritis is a condition
in which the facet joints degenerate and become inflamed. Unfortunately,
there is no cure for arthritis and it cannot be "lasered away".
Finally, many people think that laser
surgery is always better than surgery without a laser. Although the laser
is helpful for certain procedures, not all spinal conditions can be safely
or appropriately treated with a laser, and using a laser does not always
provide advantages over other techniques.
Endoscopic
("Arthroscopic") Spine Surgery
An endoscope is a very thin
fiber-optic video camera which can be used to visualize internal portions
of the body. The endoscope is made with built-in magnification and a
light source, and the camera sends the images to a video screen
similar to a television.
Transforaminal endoscopic discectomy is a technique that is being performed by some fo the
surgeons at Resurgens Spine Center to treat herniated discs in the lumbar
spine. Transforaminal literally means "through the
foramen". The foramen is the "window" or "tunnel" through
which the nerve exits from the spinal canal at each disc level. The
foramen are located on the sides of the spinal canal, and provide a
natural window through which the spinal canal can be accessed without having to
remove any bone or ligament tissue.
Summary
Minimally invasive surgery is
emerging as an alternative, reliable method of treatmetn for a variety of
spinal disorders. Like "building a ship in a bottle", there is
a steep learning curve for surgeons learning to do these procedures. Although
the recovery is often faster, the complication rate during surgery can be
greater and the results not as predictable when the surgery is performed by
surgeons who have not become totally skilled in these newer techniques.
Minimally invasive surgery is certainly "the wave of the future" for
many spinal procedures and will continue to develop as new
techniques continue to evolve. Not every patient, however, is a
candidate for minimally invasive spinal surgery
There is a rapid increase in technology that allows the MIS physician to treat patients with minimally invasive spine surgery procedures. Some of these techniques are now well established, while others remain new and continue to evolve. The best MIS (Minimally Invasive Spine Surgery) technique will depend on the specific character of the problem. While the list of MIS (Minimally Invasive Spine Surgery) techniques continues to expand, the most commonly employed today include:
- Minimally Invasive Tubular Microdiscetomy
- Minimally Invasive Lumbar Laminectomy
- Cervical laminoforaminotomy
- Endoscopic Discectomy
- Minimally Invasive Transforaminal Interbody Lumbar Fusion (TILF)
- Minimally Invasive Transforaminal Interbody Lumbar Fusion (TILF)
- Minimally Invasive eXtreme Lateral Interbody Fusion (XLIF)
- Minimally Invasive eXtreme Lateral Interbody Fusion (XLIF)
- Microsurgical Discectomy
- Posterior Lumbar Interbody Fusion (PLIF)
- Kyphoplasty
- Nucleoplasty or Percutaneous Discectomy
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