Thankfully, traditional open neck or back surgery in properly selected patients can have excellent outcomes in the long term. In the short term, however, traditional open surgery can have longer recovery periods when compared to newer techniques. Recent technological advances in spinal imaging and instrumentation have allowed spine surgeons to address an evolving array of diagnoses with less invasive techniques that achieve the same goals, though with shorter hospital stays and quicker return to activity. This type of surgery for the spine is called minimally invasive spinal surgery (MISS) or less invasive spinal surgery (LISS) and is a significant part of our practice here at Desert Orthopedic Center.
In order to understand minimally invasive spinal surgery, it is helpful to understand what is involved in traditional spine surgery and how minimally invasive surgery is different. The traditional way we get to the
spine is via a posterior (coming from the back) incision down the middle of the neck or back. These incisions are made shorter and longer depending on how many levels within the spine needs to be addressed surgically. In this incision, the back muscles are detached from the spine, split down the middle and then elevated off the bone. You can think of it as peeling or scraping the muscle off of the back of the spine and off to the side. Unfortunately, the muscles detached from the bone are unable to be easily repaired back to the bone, and thus this healing process is painful. Much of the recovery pain after posterior cervical (i.e. neck) and lumbar (i.e. back) surgery actually relates to the healing of these back muscles and not the spinal bones. The advantage of this approach, though, is it allows for the most direct path to the spinal canal, and there are no major nerves or blood vessels in the way. This approach is the workhorse for low back surgery.
Minimally invasive approaches, in contrast, rely on minimizing the amount of muscle that is detached from the spine. These less invasive approaches use smaller incisions that pass through the muscle fibers instead of the traditional technique of detaching the muscles. These procedures can be done through thefront of the neck or abdomen (i.e. anterior approach), through the side of the abdomen (i.e. lateral approach) as well as through the back (i.e. posterior approach). Although they avoid the stripping of muscle off the spine associated with traditional techniques, specialized training is required to safely pass the nerves, blood vessels and other organs located in the path between the skin incision and the spine
and to operate through these smaller incisions. Specialized retractors are then used to maintain a safe tunnel through which the surgeon operates on the spine using specialized light sources and instruments. These procedures typically have less blood loss, decreased infection rates (because less tissue is damaged) and significant advantages in recovery time when compared with open procedures. However, these procedures are not able to address all spinal problems.
So why do we not perform minimally invasive spine surgery on all of our patients? Unfortunately, for a variety of reasons, not everyone is a candidate for MIS surgery. For some, the problem is too large to be
handled effectively by minimally invasive techniques. In others, the patient’s anatomy is not suitable for minimally invasive techniques. Thankfully when we must use traditional techniques, the outcomes are
just as good, it is just that recovery is longer. Ultimately, whether or not MIS surgery is an option is a decision we make based on an individualized assessment of the relative advantages and disadvantages of the different techniques for each patient.
At Desert Orthopedic Center, we strive to be the absolute best at what we do, and our results and outcomes bear this out. Our experience with the multitude of minimally invasive options now available
allows us to individualize our approach to our patients. We pride ourselves on staying at the forefront of technology, adding options to our armamentarium in order to have a wide array of safe options for our
patients. We understand there is no substitute for a caring, technically proficient, personalized approach to patient care, and we promise to do our best to bring that to you.