Endoscopic Laser Spine Surgery
People are looking for alternatives to traditional open spine surgery. They witnessed friends and family who underwent unsuccessful back surgeries leaving them the same or at times worse, often requiring more pain medicine then before surgery. This unhappiness with open back surgery led patients to demand alternative treatments. Doctors and scientists researched and developed new techniques and technologies to perform back surgery safer, better and more effectively. This required better visualization of spinal structures and less collateral tissue destruction to the body.
Initially, spine surgery was done with the naked eye. Skin incisions had to be large to allow enough light to reach the surgery site. Furthermore, the re-tractors and spinal surgical instruments were very large, further necessitating a large incision.
This changed with the adoption of the operating microscope. The microscope magnified and shined bright light down to the surgical site illuminating critical structures. This was an important step forward since it allowed the incision to be slightly smaller yet still exposing large areas of the spine. To visualize this, tThink of the operative site as an “upside down triangle”: the base was the skin incision and the apex was the spine.
To decrease the size of the skin incision and continue to have the same access to the spine a straight tube retractor was developed called the METRX. This made the skin incision smaller and the surgeon was still able to do the same operation on the spine as the open and microscopic surgery. The tube retractor had the added advantage of splitting back muscles rather then retracting them decreasing muscle damage, back weakness and chronic back pain. This type of surgery is called Minimally Invasive Spine Surgery (MISS). It has been found to decrease skin and soft tissue damage leading to less blood loss, tissue inflammation, pain and quicker recovery.
Open, microscopic and minimally invasive spine surgery require the removal of the back of the spine to reach the spinal sac, nerves and disks. This is done by direct posterior approach to the back of the spine through removal of the lamina (called a laminotomy or laminectomy). This bone removal may weaken the spine and lead to the development of instability or abnormal spine movements and pain. After the bone is removed, the spinal sac and nerves must be retracted out of the way to reach the disk. This may lead to spinal fluid (CSF) leaks, nerve damage and scar tissue. Laser Spine Surgery, which is more appropriately called Endoscopic Spine Surgery, was developed to minimize these risks.
Laser spine surgery is advanced surgical treatment for the neck and back. It is state-of-the art minimally invasive spine surgery done through an endoscope. An endoscope is a very small high definition video camera that is placed into the damaged or abnormal area of the spine. Tiny instruments are placed through the endoscope to fix disks, bone spurs, stenosis or fuse the spine. Advantages of the endoscope are it’s very small size; it is the size of a pencil significantly decreasing damage to skin, muscle and bone. The skin incision is smaller then a fingernail (7-8 mm) making the scar difficult to see. The muscles are dilated and pushed to the side by the small tube rather then retracted minimizing muscle damage and back pain. The endoscope is placed through the side of the spine rather then the back decreasing bone removal. Little to no bone has to be removed which is much, much less then a laminotomy or laminectomy. These advantages add up to decreased post-operative pain and quicker recovery.
Minimally Invasive Spinal Surgery Versus Endoscopic Laser Spine Surgery
Some of our patients find the distinction between minimally invasive spine surgery and endoscopic spine surgery to be confusing. Although these two procedures are similar, there are a few important differences that should be clarified.
Minimally Invasive Spine Surgery
Minimally invasive spinal surgery (MISS) is an alternative to traditional open spine surgery and the large incisions that open spine surgery involves. After using a scalpel to make a 1-inch incision, Dr. Spivak will insert a dilation tube and visualize the spine through the surgical microscope. Dr. Spivak will be able to see directly into the spinal area, pinpoint the precise location of the injury and complete the surgery.
Endoscopic Laser Spine Surgery
Endoscopic spine surgery is an extremely minimally invasive spine surgery. Endoscopic spine surgery may be done awake under twilight sedation. Dr. Spivak uses a very small, 1/4-inch incision to insert the endoscope into the spine. A radio-frequency device or laser is then used to burn and remove soft tissues in the surgical area; other surgical instruments are used to remove disks, ligaments and bone.
When Is Spinal Surgery Indicated?
Back surgery of any kind is an option of last resort. Non-operative treatments are always applied first. If there is no improvement in twelve weeks, or if the injury begins to get worse, then surgery should be considered.
What Are The Benefits Of Minimally Invasive Surgery?
Most MISS procedures can be completed in one day, so a patient can usually return home on the same day that the surgery is performed. Patients with desk jobs might be able to return to work part time within 1-2 weeks. With a good physical therapy program, many patients can resume a full activity level within two to 12 weeks. A brace may be necessary initially, but it is primarily used for comfort and pain relief. Most patients need it only for a week or two. MISS reduces trauma to the tissues surrounding the area where the surgery is performed. That means a shorter recovery time, a faster healing process, reduced bleeding, and less pain.
Are MISS Procedures Risky?
Compared to traditional open spine surgery, minimally invasive spine surgery is like a walk in the park. Although the short-term results have been promising, it’s important to remember that because MISS is a newer technology that has not been studied in depth over time, there will be some degree of uncertainty about its long-term effectiveness.
Minimally invasive spine surgery is highly technical in nature. For that reason, it should be performed only by an experienced and competent physician who thoroughly understands the ins and outs of this cutting-edge technology. If your physician lacks a thorough understanding of these procedures, serious complications like persistent pain, nerve injury and infection can result.
As a board-certified neurosurgeon and the president of Executive Spine Surgery, P.C., Dr. Carl Spivak specializes in the use of high-tech spinal surgery technologies including endoscopes, operating microscopes and computer-assisted navigational systems.