Minimally Invasive, Endoscopic and Laser Spine Surgery

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.

Open Surgery and Minimally Invasive Surgery

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 operated 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.

Laser Spine Surgery

Laser is 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 incision.

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.

Transforaminal Endoscopic Discectomy

This is a technique that is being performed by some of the surgeons at OrthoGeorgia 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.

The patient remains awake during the procedure. After a local anesthetic is administered, a small needle is inserted into the disc space. A 7mm (1/4 inch) “keyhole” skin incision is made and a tube is slipped over the needle into the abnormal disc. Muscle and tissue is dilated rater than being cut when accessing the disc and a laminotomy does not have to be performed. The endoscope is then inserted through the tube into the disc. Using x-ray guidance and endoscopic visualization, micro-instruments are used to remove the damaged disc. A laser may be used to further remove and shrink the disc (disc decompression) and to tighten the outer layers of the disc (annulus). On average, the procedure takes about 30 minutes to one hour per disc. Upon completion of the procedure, the probe is removed and a small bandage is applied over the incision.

Summary

Minimally invasive surgery is emerging as an alternative, reliable method of treatment 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 may not be as predictable. Not every patient is a candidate for minimally invasive surgery. Each patient needs evaluation by a knowledgeable and experienced surgeon in this technique to determine their eligibility.

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