Minimally Invasive Spinal Surgery

What is Minimally Invasive Spinal Surgery (MISS)?

The goal of minimally invasive spine surgery (MISS) is to stabilise the vertebral bones and spinal joints and/or relieve pressure being applied to the spinal nerves — often a result of conditions such as spinal instability, bone spurs, herniated discs, scoliosis or spinal tumours.

Minimally Invasive Spinal Surgery vs. Open Surgery

As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. Because of the reduced trauma to the muscles and soft tissues (compared to open procedures), the potential benefits are:

• Better cosmetic results from smaller skin incisions (sometimes as small as several millimetres)
• Less blood loss from surgery
• Reduced risk of muscle damage, since less or no cutting of the muscle is required
• Reduced risk of infection and postoperative pain
• Faster recovery from surgery and less rehabilitation required
• Diminished reliance on pain medications after surgery

Conditions treated using Minimally Invasive Spinal procedures

• Degenerative disc disease
• Herniated disc
• Lumbar spinal stenosis
• Spinal deformities such as scoliosis
• Spinal infections
• Spinal instability including spondylolisthesis
• Vertebral compression fractures
• Spinal tumours

A number of specific techniques have been deployed for MISS surgery. Though the field continues to develop, the list below highlights some of the most common options.

• Discectomy: Spinal discs are essentially elastic rings with soft material inside that serve as cushions between the vertebral bones. If the elastic ring becomes weakened, the soft tissue inside can extrude — or herniate — outside of the elastic ring. The herniated disc material can compress the nerves passing by, thus causing pain. If surgical treatment is recommended to trim or remove the herniated disc, it may be possible to perform this procedure with MIS surgery using tubular dilators and a microscope or endoscope.
• Spinal decompression: Spinal stenosis, which is a narrowing of the vertebral canal, is a common condition that can result in compression of the nerves. This can produce a variety of symptoms, including pain, numbness and muscle weakness. If surgery is recommended, it may be possible to remove the bone and soft tissues causing the nerve compression through an MIS approach using tubular dilators and a microscope or endoscope. The more common decompressive procedures include laminectomy and foraminotomy.
• Transforaminal Lumbar Interbody Fusion (TLIF): This is a MISS technique that is performed for 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. Utilising two small incisions, screws and rods are placed between two or more vertebral levels. The intervertebral disc is removed and a cage filled with bone is placed in that void with the goal of stabilising the levels affected.

Dr Parkinson has a strong interest in minimally invasive surgery. This aspect of neurosurgery is constantly growing, and becoming more popular. It must be noted that not all spinal conditions can be treated through this process, including some tumours, and severe stenosis or scoliosis.

Minimally invasive spinal surgery generally has better results as there is a much greater accuracy in diagnosis and treatment of pain is very precise. For this reason, MIS is also a safer way to operate.