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...
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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 than 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 more safely, 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.
Before doctors can say yes, they must know what they are expected to treat during the procedure. Even if you have had your MRI reviewed, a free second opinion is one of the best investments you can make for your spine.