What Is minimally invasive spine surgery?

What is spine function and dysfunction?

The bones and nerves of the spine are designed to be good neighbors. Each vertebra of the spine surrounds and protects the spinal cord and spinal nerves. These nerves branch off from the spinal cord through openings in the vertebrae to communicate with the rest of the body, regulating movement and sensation.

Spongy discs lie between vertebrae to cushion the spine, and tiny holes and passageways in the bones allow the nerves and spinal cord to pass through. When problems with the spine interfere with the peaceful coexistence of the bones and nerves, it can lead to symptoms such as pain, numbness, and weakness that affects the back, neck, arms, or legs.

Spinal conditions that may, in some cases, be treated by minimally invasive spine surgery include:

• Degenerative disc disease — occurs when soft tissue inside a spinal disc bulges out of place, irritating nearby nerves. You may be told you have a herniated disc, disc bulge, disc extrusion, or disc protrusion.
• Radiculopathy — a compressed nerve in the spine; may also be called a pinched nerve. Sciatica is a lay term for a type of low back (lumbar) radiculopathy.
• Spinal stenosis — a narrowing of the spinal canal or exit ways that can cause nerve compression.
• Spondylolisthesis — a condition in which a vertebra slips forward out of its proper position above the bone below it.

Conservative treatments, such as physical therapy, medication, and injections, can often relieve pain and other symptoms of spinal dysfunction. However, surgery may be necessary if symptoms continue to interfere with normal functioning.

When surgery is performed to remove part of a bone or spinal disc to relieve pressure on the spinal cord or nerves, it is called decompression surgery. A spinal fusion creates a solid union between two or more vertebrae to strengthen and stabilize the spine. When possible, both decompression and fusion surgeries can be performed with less invasive techniques.

How does minimally invasive spine surgery work?

Some patients wonder if minimally invasive spine surgery is experimental, but it has actually been around for quite some time. The Denver spine surgeons at Neurosurgery One all have trained in these procedures and use them whenever possible as they can offer benefits in terms of faster recovery and less pain for patients.

In traditional open spine surgery, surgeons make a large incision and muscles are pulled away from the bone so the surgeon can access the spine. This can cause patients additional short-term pain during surgery recovery. Some research suggests the disruption to surrounding tissue may increase the risk of future problems in nearby areas of the spine, called adjacent level disease.

By contrast, minimally invasive spine surgery uses a muscle-preserving technique, dilating the muscles instead of cutting through them. A series of tubes called tubular retractors progressively spreads apart the muscles until the surgeon has a small hole to work through. Specially designed surgical instruments are used to allow the surgeon to see and work in the narrow surgical field.

The benefits can include:

• Smaller incision
• Shorter operative time
• Decreased blood loss
• Less muscle damage
• Reduced incidence of infection
• Less post-surgical pain and faster recovery

Minimally invasive spine surgery is most commonly performed on the low back (lumbar spine). The spinal cord does not run through the lumbar spine, so surgeons are only maneuvering around spinal nerves, not the spinal cord itself. The neck (cervical spine) is the next most common location for these procedures.

What are benefits of minimally invasive spine surgery?

The benefits of minimally invasive spine surgery can include improved outcomes and reduced complications. For lumbar decompression, research suggests minimally invasive and open procedures may have similar outcomes. Complications result in less significant problems for patients in the minimally invasive group. For fusion, minimally invasive techniques have shown benefits over traditional open surgery in outcomes and complication rates in some studies.

Not everyone can or should have minimally invasive spine surgery, Neurosurgery One spine surgeons emphasize. For example, a fusion surgery of more than three levels is too complex to perform minimally invasively. Talk to your Denver spine surgeon to find out what surgical approach is best for you and your condition.

Do spine surgeons need to be specially trained to perform minimally invasive spine surgery?

While less invasive surgery can be easier on the patient, it’s actually harder for the surgeon. Because of the challenge presented by operating through a smaller working channel, it’s important to find a surgeon who is trained and experienced in these techniques.

All of the Denver spine surgeons at Neurosurgery One have been specially trained in minimally invasive spine surgery and use it when appropriate.

If you are considering spine surgery, consider asking your spine surgeon these questions:

• Will my spine surgery be done minimally invasively? If not, why? If so, what is minimally invasive about the procedure?
• Are you using a muscle-sparing technique? How are you limiting damage to adjacent structures?
• How many of these types of procedures have you done? How often do you do them?