Surgical procedure is required for patients who complain of weakness, numbness, back pain or leg pain and have failed conservative treatments like medical management or physiotherapy,etc. Such cases have evidence of instability or disc degeneration based on MRI result and are thus advised surgery.
Minimally invasive method of surgery is done through small incisions and involves special instruments like microscope, tubular retractors and intraoperative X-ray to evade any widespread damage to muscles at the back. This method has several advantages over open (traditional) technique of spine surgery. Major ones include:
Barely Visible Scars!!
On the day of surgery, patient is shifted to operation theatre on scheduled time and is given general anesthesia. Single level surgery is of usually around 3 to 4 hours. After that two small incisions of around 2 inches is made, one on each side of the midline. Surgery is performed through this incision only.
Once the incision is made, the surgeon then accesses the spine through a sequence of dilators that separate muscle fibers and help in providing access to the spine without cutting through the muscles. This is followed by placing a retractor over the dilators. This retractor gives a working channel to perform the surgery. A close up view is then provided by a microscope during the surgery. Now the surgeon first removes bone spurs and overgrown ligaments to make space for nerves in the spinal canal. After that most of the disc between the vertebrae is also removed to make space for fusion of the bones. The surgeon then inserts a synthetic spacer between the vertebrae. This spacer is made up of synthetic material and patient's own bone chips. It gives support to the spine and helps in bone fusion. In order to stimulate bone growth, extra synthetic material is placed around the spacer.
Next, the surgeon inserts titanium screws above and below the spacer into the vertebrae, and connects them together with the help of titanium rods. These provide hold to the spine whereas the bones fuse together with time.
Note: The rods and screws need not be removed. They are not located by the metal detector at the airport.
After the surgery is over, the surgeon closes the incisions with sutures. These sutures remain under the skin and would get dissolved over a period of time. Thus suture removal is not required. Sterile dressings are put that remain for two days.
Please note that in case the surgery is performed for two or more levels or if there is a risk of fusion not taking place, then the patient is asked to wear a lumbar brace or a bone growth stimulator for around six weeks post surgery, or else the brace is not required.
The patient may typically need to stay in the hospital for three to four days. The major restrictions include:
Normally, most of the patients return to daily routine or office work in 4 to 6 weeks time, to medium effort involving work in 3 to 6 months, and to heavy effort activities in 9 to 12 months. If required, physiotherapy is initiated between 6th and 12th week.
As we know by now that the main motive of this surgery is to improve back or/and leg pain, the chances of successful recovery depends on several factors, including the nature of problem diagnosed on MRI, duration of current symptoms, and the extent to which nerve is damaged. Patients who are suitable candidates for a MITLIF surgery , experience remarkable improvement in their back and/or leg pain after recovering from surgery.
The patient is usually seen in one week after discharge from hospital, and then at time interval of 6 weeks, 3 months, 6 months, and 1 year after surgery. The treating doctor asks for X-rays to done frequently to assess development of fusion.
As with any other surgical intervention, there are significant risks associated with Minimally Invasive Spine Surgery. The complications are similar to that of open spinal fusion surgeries, though some studies have shown a reduced rate of infection for MISS.
So it is advisable to discuss the following points with your treating doctor before going ahead with surgery:
Persistent symptoms. There may be chances of experiencing a recurrence of the original symptoms
Bleeding. Some amount of bleeding can be expected, though this may not be typically significant.
Infection. There are chances of infection too. So, your treating doctor would prescribe certain antibiotics to be regularly given before, during, and quite often after surgery to reduce the risk of infections.
Blood clots. Another unusual complication may be the formation of blood clots.
Pain at bone graft site. Few patients also experience constant pain at the graft site.
MISS (Minimally Invasive Spine Surgery ) also sometimes known as Less Invasive Spine Surgery. uses specialized instruments to access the spine with the help of small incisions.
Whereas, in a traditional open surgical method, the surgeon makes an incision of around 5 to 6 inches long and shifts the muscles to the side so that he can see the spine. Since the muscles get pulled to the side, this helps the surgeon in accessing the spine and thus remove the damaged/diseased bone or intevertebral disc.
One of the main disadvantages of open surgery is that the retraction or pulling of the muscle can lead to damage of the soft tissue. And thus, there are higher chances for muscle injury, and patient may also have pain after surgery . This pain is different from the back pain that he/she used to feel before surgery. This may result in a lengthier recovery period!
MISS was primarily developed for treating spine problems with lesser injury to the muscles and also other normal structures in the spine. It also assists the surgeon in seeing the exact area of the spine where the problem exists.
Other advantages of Minimally Invasive surgery includes: lesser bleeding, shorter hospital stay and smaller incisions and thus smaller scars.
Minimally Invasive TLIF