- What you need to know?
- How is MISS performed?
- What kind of spine conditions can be treated with MISS?
- Why should I opt for MISS and not open surgery?
- How safe is this procedure?
- What are the possible risks involved with MISS?
- Is there any preparation required before I undergo MISS?
- How do I recover from minimally invasive spine surgery?
Minimally invasive spine surgery (MISS) is a new found, alternative method to the traditional open surgery which was used to manage various spinal conditions. Of late the use of MISS is becoming increasingly popular due to the many benefits that it has over open surgery.
It is an endoscopic procedure, which means that the surgeon will only make 3-4 small incisions on your back, compared to the tradition large incision. Through these incisions the surgeon will then pass the endoscope, a thin tube fitted with a camera, as well small instruments, which can all be controlled from the outside. The surgeon will also make use of real time X-ray imaging to visualize the spine and the corrections which are being done.
The following spinal disorders can be successfully treated using MISS:
- Degenerative spinal disease – which occurs as a result of wear and tear in the discs. Which leads to abnormalities in the shape and structure of the disc, which then leads to abnormal movements of the lumbar spine leading to pain.
- Disc herniation – is a condition where part of the intervertebral disc is pushing into the spinal canal and pressing on the nerves which are exiting the vertebral column leading to pain. This herniation can occur as a result of degeneration or due to sudden lifting of a heavy weight.
- Canal stenosis – is the narrowing of the spinal canal which can be caused as a result of disc herniation, or swelling and bone spur formation due to osteoarthritis. Stenosis will lead to nerve compression and pain.
- Scoliosis – is a spinal deformity arising as a result of the sideward curving of the spine resembling an ‘’S’’ or ‘’C’’, and is a condition which commonly affects children.
For all of the above mentioned conditions, surgeons prefer to opt for MIS fusion procedures, which is stabilizing the spine using bone grafts to make the vertebral column more stable, using minimally invasive techniques. Minimally invasive spinal fusions are done on the thoracic and lumbar spine, and the most commonly performed minimally invasive surgeries are:
- Minimally invasive spine lumbar discectomy – which is performed for herniated discs in the lumbar region which cause pain in the lower limbs such as what occurs in sciatica. A small incision is made in the region of the back where the herniated disc is located, and using the endoscopic tools the surgeon will remove a part of the herniated disc
- Minimally invasive spine lumbar fusion - are surgeries where two or more lumbar vertebrae that make up the column are joined together. It involves the preparation of the intervertebral disc space by removing the disc and replacing it with Peek Cage, Bone, allograft or other implants which will hold the adjacent vertebrae in place. Rods and screws might also be used following this in order to provide further stability. There are three common approaches to this surgery, which include:
- Posterior Lumbar Interbody Fusion (PLIF) – where the incision is made on the patient’s back
- Anterior Lumbar Interbody Fusion – where the incision for access to the vertebrae is made on the patient’s abdomen anteriorly
- Transforaminal Lumbar Interbody Fusion – where the incision is made on the patient’s back, but the vertebral column is approached from the side.
The reason more and more people are opting for MISS than open surgery is because of the many benefits it has to offer both the patient and the surgeon. These include:
- Few small incisions and scar instead of one large incision and scar, which is thought to be a better option cosmetically
- Less damage to surrounding tissue and less blood loss during surgery
- Reduced risk of infection
- Reduced post-operative pain
- Shortened recovery period and hospital stay, with quick return to daily activities and work
Endoscopic techniques have been practice for many, many years. Initially they were used only for diagnostic purposes, but later came into use therapeutically as well. Surgeons undergo special training to learn how to handle the instruments used in endoscopic procedures, and these instruments themselves are considered precision tools which have a very high accuracy rate. Therefore minimally invasive spine surgery (MISS) is considered to be safe method of spine surgery, which is becoming popular world over.
Undergoing any type of surgery in the spine comes with its potential risks and with MISS too. Listed below are some of the possible risks you will be taking if you decide to undergo minimally invasive spine surgery (MISS).
- Complications of anesthesia
- Injury to the nerves or spinal cord
- Excessive bleeding
- Formation of blood clots
- Leakage of cerebro-spinal fluid
Preparing yourself for minimally invasive spine surgery can be daunting, and there are a few preliminaries which you need to get done before you are ready for surgery. These include:
- Discuss all the medication you are taking with your doctor, for pre-existing conditions such as hypertension and diabetes.
- Stop smoking if you do
- Follow the instructions given by your doctor, such as fasting for a period of 8 hours before the surgery, taking any premedication, undergoing any investigations to assess your level of fitness for surgery as well as avoiding any medication prior to surgery.
Once these aspects have been taken care of, you are ready for surgery.
Always have a detailed discussion with your doctor regarding your condition, and the different treatment options available to you. So that you can make a well informed decision on how you want to go forward with your treatment plan.
The recovery from minimally invasive spine surgery depends on individual factors. But since this is minimally invasive the hospital stay is usually around 1-2 days compared to the 5-7 day stay that you will have if you undergo traditional open spine surgery. During the recovery period you will be introduced to a physical therapist, who will help you with mobility. Usually your doctor will ask you to walk unassisted the very next day following surgery although you will be asked to take things easy for about 4-6 weeks following surgery. Follow-up investigations such as X-rays and other imaging studies will be done in order to determine the success of surgery.