Minimally invasive spine surgery (MISS) refers to a technique utilizing specialized instruments that provide access to the spine through small incisions (less than 2cms) as opposed to open surgery, wherein the incisions are 5-6 inches long.
MISS can be used for spine surgeries in the following surgeries:
- Discectomy - the surgical removal of a prolapsed intervertebral disc that puts pressure onto the surrounding nerve roots causing pain and pressure symptoms.
- Foraminotomy- an operation is done to decompress the nerve roots being pressed in the intervertebral space called the foramina.
- Laminectomy- a procedure in which a portion of vertebra called lamina is resected as it compresses the spinal cord.
MISS provides an excellent alternative for treating infections of the lumbar spine such as tuberculosis spine and vertebral osteomyelitis.
There are 3 main invasive techniques used:
- Mini open- this is similar to an open procedure. This has the advantage of less risk of infection, less blood loss during the procedure as only small incisions are made.
- Tubular – in this technique, a tubular retractor is passed through the small incision. This creates a tunnel that holds back the muscles and tissues separating them, giving the surgeon direct access to the spine. This approach also has less blood loss and reduces the chances of muscle damage.
- Endoscopic- this procedure uses a tiny video camera called an endoscope that is passed through small incisions to access the spine. This allows the surgeon to visualize the internal view of the spine on the screens in the operating room.
Sometimes a fluoroscope is used during minimally invasive spine surgery. Fluoroscopes are like x-ray machines that are used to get better views of the spine.
The MISS procedure is less time consuming and thus can shorten a hospital stay. Because it has minimal invasion, the risk of complications such as pain and infection is reduced. The patient can then start rehabilitation much earlier when compared to open surgery. A physiotherapist who guides patients through exercises can help the patient resume his daily activities.
This technology promises not only improved efficiency but is also typically safer, with better results.
Penned by Dr. Rachita Narsaria, MD
Geis WP, Kim HC, McAfee PC, Kang JG, et al. Synergistic benefits of combined technologies in complex, minimally invasive surgical procedures. Clinical experience and educational process. Surg Endosc. 1996 Oct; 10(10):1025-8.