Spine surgery is traditionally done as "open surgery," meaning the area being operated on is opened with a long incision to allow the surgeon to view and access the anatomy. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique.Because minimally invasive spine surgery (MISS), does not involve a long incision, it avoids significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a faster recovery.
For
herniated discs:
Laminectomy/discectomy: In this operation, part
of the lamina, a portion of the bone on the back of the vertebrae, is removed,
as well as a portion of a ligament. The herniated disc is then removed through
the incision, which may extend two or more inches.
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Laser surgery: Technological advances in recent
decades have led to the use of lasers for operating on patients with herniated
discs accompanied by lower back and leg pain. During this procedure, the
surgeon inserts a needle in the disc that delivers a few bursts of laser energy
to vaporize the tissue in the disc. This reduces its size and relieves pressure
on the nerves. Although many patients return to daily activities within 3 to 5
days after laser surgery, pain relief may not be apparent until several weeks
or even months after the surgery. The usefulness of laser discectomy is
still being debated.
For
spinal stenosis:
Laminectomy: When narrowing of the spine
compresses the nerve roots, causing pain and/or affecting sensation, doctors
sometimes open up the spinal column with a procedure called a laminectomy. In a
laminectomy, the doctor makes a large incision down the affected area of the
spine and removes the lamina and any bone spurs, which are overgrowths of bone
that may have formed in the spinal canal as the result of osteoarthritis. The
procedure is major surgery that requires a short hospital stay and physical
therapy afterwards to help regain strength and mobility.
For
spondylolisthesis:
Spinal fusion: When a slipped vertebra leads to
the enlargement of adjacent facet joints, surgical treatment generally involves
both laminectomy (as described above) and spinal fusion. In spinal fusion, two
or more vertebrae are joined together using bone grafts, screws, and rods to
stop slippage of the affected vertebrae. Bone used for grafting comes from
another area of the body, usually the hip or pelvis. In some cases, donor bone
is used.
Although the surgery is generally successful, either type of
graft has its drawbacks. Using your own bone means surgery at a second site on
your body. With donor bone, there is a slight risk of disease transmission or
rejection. In recent years, a new development has eliminated those risks for
some people undergoing spinal fusion: proteins called bone morphogenic proteins
are being used to stimulate bone generation, eliminating the need for grafts.
The proteins are placed in the affected area of the spine, often in collagen
putty or sponges.
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