Minimally Invasive Spinal Surgery

What is Minimally Invasive Spinal Surgery?

Minimally Invasive Spinal Surgery (MISS), also known as minimally invasive spine surgery or minimally invasive spinal procedures, is a surgical approach used to treat various spinal conditions with less disruption to the surrounding tissues compared to traditional open surgery. The goal of MISS is to achieve the same therapeutic outcomes while minimising trauma, reducing pain, shortening recovery times, and lowering the risk of complications associated with open surgeries.

A tubular retractor is used to create a passageway for the surgeon to reach the problem area of the lower back.

Key features of minimally invasive spinal surgery include:

  • Smaller Incisions: MISS involves making smaller incisions compared to traditional open surgery. These incisions are typically less than an inch long.
  • Visualisation: Surgeons use advanced imaging techniques, such as fluoroscopy or intraoperative navigation, to visualise the affected area of the spine during the procedure. This allows for precise and accurate placement of instruments and implants.
  • Minimal Muscle Damage: The approach involves spreading or gently moving muscles rather than cutting through them, which helps preserve muscle integrity and function.
  • Reduced Blood Loss: Smaller incisions and less tissue disruption usually result in reduced blood loss during surgery.
  • Shorter Hospital Stay: Patients undergoing MISS often have shorter hospital stays compared to those who have open surgery. In some cases, MISS procedures are performed on an outpatient basis.
  • Faster Recovery: Because MISS causes less trauma to the tissues, patients typically experience less postoperative pain and a faster recovery. They may be able to return to their regular activities sooner.
Open surgery involves a much larger scar on the patient when compared to modern MISS surgry, which requires much small access area to perform surgery.

Conditions treated using Minimally Invasive Spinal procedures

  • Degenerative disc disease
  • Herniated discs
  • 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.

  • Herniated Disc (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 MISS surgery using tubular dilators and a microscope or endoscope.
  • Spinal Stenosis (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 MISS approach using tubular dilators and a microscope or endoscope. Other common decompressive procedures include laminectomy and foraminotomy.
  • Spinal Fusions (ALIF, PLIF, DLIF, 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. 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 (bone graft) is placed in that void with the goal of stabilising the levels affected.

Dr Parkinson has a strong interest in minimally invasive spine 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, MISS is also a safer way to operate.