• 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) – Introduction

Surgeons perform Minimally Invasive Spine Surgery (MISS) using smaller incisions, causing less tissue damage and enabling faster recovery than traditional open spine surgery. They increasingly use this approach to treat herniated discs, spinal stenosis, degenerative disc disease, and vertebral fractures. By using specialized instruments, microscopes, and imaging guidance, surgeons can precisely target the affected area while preserving surrounding muscles and tissues. Patients undergoing MISS generally experience reduced pain, shorter hospital stays, faster recovery, and an earlier return to normal daily routines and activities.

What you need to know?

How is Minimally Invasive Spine Surgery performed?

It is an endoscopic procedure where the surgeon makes only 3–4 small back incisions, instead of one large traditional incision. Through these incisions, the surgeon inserts an endoscope with a camera and small instruments, all controlled externally for precision and safety. The surgeon actively visualizes the spine and monitors the corrections using real-time X-ray imaging.

What kind of spine conditions can be treated with MISS?

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. This causes disc shape and structural abnormalities, resulting in irregular lumbar spine movements that ultimately cause pain and discomfort in the lower back.
• Disc herniation –

  A herniated disc occurs when part of the intervertebral disc protrudes into the spinal canal, pressing nerves and causing 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 –

  Scoliosis is a spinal deformity causing an “S” or “C” shaped curve, commonly affecting children and impacting posture and movement.

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. Surgeons perform minimally invasive spinal fusions on the thoracic and lumbar spine, with the most commonly performed minimally invasive surgeries being:

• Minimally invasive spine lumbar discectomy – Surgeons perform this procedure to treat herniated discs in the lumbar region that cause lower limb pain, such as in sciatica. They make a small incision in the back where the herniated disc is located and use endoscopic tools to remove part of the disc.
• Surgeons perform minimally invasive lumbar spine fusion to join two or more lumbar vertebrae in the spinal column. 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 – The surgeon makes the incision on the patient’s back but approaches the vertebral column from the side.
  

  Why should I opt for MISS and not open surgery?

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

How safe is this procedure?

Endoscopic techniques have been practice for many, many years. Initially, surgeons used endoscopic instruments only for diagnostic purposes, but later they began using them therapeutically as well. Surgeons undergo specialized training to handle these precision tools, which provide high accuracy during minimally invasive procedures. Therefore, surgeons consider minimally invasive spine surgery (MISS) a safe and effective method, and its popularity is growing worldwide.

What risks might I face when undergoing MISS?

Undergoing any type of surgery in the spine comes with its potential risks and with MISS too. Here are some potential risks you may face when choosing to undergo Minimally Invasive Spine Surgery (MISS) for spinal conditions.

• Complications of anesthesia
• Injury to the nerves or spinal cord
• Excessive bleeding
• Formation of blood clots
• Leakage of cerebro-spinal fluid
• Infection

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 you have addressed these aspects, you are ready to undergo 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.

How do I recover from minimally invasive spine surgery?

The recovery from minimally invasive spine surgery depends on individual factors. Since it is minimally invasive, hospital stay usually lasts 1–2 days, compared to 5–7 days for traditional open surgery. During the recovery period, a physical therapist will guide you and help improve your mobility. After surgery, your doctor usually encourages walking unassisted the next day, but advises taking it easy for 4–6 weeks. Doctors will perform follow-up investigations, including X-rays and other imaging studies, to determine the success of the surgery.