To prepare for spine surgery, quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have. Most types of minimally invasive surgery rely on a thin telescope-like instrument, called an endoscope, or on a portable X-ray machine, called a fluoroscope, to guide the surgeon while he or she is working.
The endoscope is inserted through small incisions in the body. Small surgical instruments are passed through one or more half-inch incisions, which are later closed with sutures and covered with surgical tape. The fluoroscope is positioned around the patient to give the surgeon the best X-ray views from which to see the anatomy of the spine. All doctors at Cleveland Clinic Center for Spine Health are fellowship-trained and board-certified or board-eligible in orthopaedic surgery, medical spine or neurosurgery. In addition, our surgeons have subspecialty training and years of experience in spine surgery.
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Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Appointments Minimally Invasive Spine Surgery Fundamentals Minimally invasive spine surgery is an endoscopic procedure that uses specialized video cameras and instruments that are passed through small incisions less than 2 cm in the back, chest or abdomen to access the spine and perform the needed surgery.
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Minimally invasive spine surgery: What are suitable conditions? Many types of minimally invasive spine surgery are performed at Cleveland Clinic including: Spinal fusion, which is often performed on degenerative disks Deformity corrections, such as for scoliosis Repair of herniated disks Decompression of spinal tumors Repair and stabilization of vertebral compression fractures What are the benefits of minimally invasive spine surgery?
The benefits of spine surgery include: A few tiny scars instead of one large scar Shorter hospital stay — a few days instead of a week Reduced postoperative pain Shorter recovery time — a few months instead of a year — and quicker return to daily activities, including work Less blood loss during surgery Reduced risk of infection What are the risks of spine surgery? Is the surgery safe?
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Minimally invasive techniques can be used for common procedures like lumbar decompression and spinal fusion. Decompression relieves pressure on spinal nerves by removing portions of bone or a herniated disk. Spinal fusion corrects problems with the small bones of the spine vertebrae. The basic idea is to fuse together the painful vertebrae so that they heal into a single solid bone. This article focuses on decompression and spinal fusion with a minimally invasive technique. For a complete overview of spinal fusion including approaches, bone grafting, complications, and rehabilitation: Spinal Fusion.
Minimally invasive spine surgery MISS is sometimes called less invasive spine surgery. In these procedures, doctors use specialized instruments to access the spine through small incisions. In a traditional open surgery, the doctor makes an incision that is 5 to 6 inches long, then moves the muscles to the side in order to see the spine.
With the muscles pulled to the side, the surgeon can access the spine to remove diseased and damaged bone or intervertebral disks. The surgeon can also easily see to place screws, cages, and any bone graft materials necessary to stabilize the spinal bones and promote healing. Left In traditional open surgery, muscles surrounding the spine are pulled back to reveal the bones.
Right After removing portions of the bone a decompression procedure called laminectomy , bone graft material and screws are placed along the sides of the vertebrae. One of the major drawbacks of open surgery is that the pulling or "retraction" of the muscle can damage both the muscle and the surrounding soft tissue.
Minimally Invasive Spine Surgery at UPMC
Although the goal of muscle retraction is to help the surgeon see the problem area, it typically affects more anatomy than the surgeon requires. As a result, there is greater potential for muscle injury, and patients may have pain after surgery that is different from the back pain felt before surgery. This can lead to a lengthier recovery period. The larger incision and damage to soft tissues may also increase both blood loss and the risk for infection.
Minimally invasive spine surgery was developed to treat spine problems with less injury to the muscles and other normal structures in the spine. It also helps the surgeon to see only the location where the problem exists in the spine. Other advantages of MISS include smaller incisions, less bleeding, and shorter stays in the hospital. Right The minimally invasive incisions typically used for a lumbar spinal fusion. Both the decompression and the placing of screws and rods are accomplished through these small incisions.
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MISS fusions and decompression procedures such as diskectomy and laminectomy are performed using many different approaches. The most commonly used technique involves using a tubular retractor. During the procedure, a small incision is made and the tubular retractor is inserted through the skin and soft tissues down to the spinal column. This creates a tunnel to the small area where the problem exists in the spine. The tubular retractor holds the muscles open rather than cutting them and is kept in place throughout the procedure. A tubular retractor is used to create a passageway for the surgeon to reach the problem area of the lower back.
Accessed January The surgeon accesses the spine using small instruments that fit through the center of the tubular retractor. Any bone or disk material that is removed exits through the retractor, and any devices necessary for fusion — such as screws or rods — are inserted through the retractor. Some surgeries require more than one retractor or more than one incision. In order to see where to place the incision and insert the retractor, the surgeon is guided by fluoroscopy.
This method displays real-time x-ray images of the patient's spine on a screen throughout the surgery. The surgeon typically views the important structures of the spine during surgery using a microscope. An operating microscope provides excellent illumination and magnification during minimally invasive spine procedures. At the end of the procedure, the tubular retractor is removed and the muscles return to their original position.
Options to consider when conservative treatments don't bring relief.
This limits the muscle damage that is more commonly seen in open surgeries. New techniques for minimally invasive spine surgery continue to evolve. For example, some surgeons are now using an endoscope a small camera similar to that used in knee and shoulder surgery to access the problem area in the spine.
The most common types of anesthesia used for MISS are general you are asleep for the entire operation and regional you may be awake, but you will have no feeling from your waist down. Left Cross-section view of a healthy intervertebral disk. Right Cross-section MRI scan showing the anatomy surrounding an intervertebral disk. The red rectangle shows placement of the tubular retractor through the muscle. The dotted lines show the positioning of small surgical instruments. A herniated disk in the lower back that pinches a nerve may cause severe leg pain, numbness, or weakness.
To surgically relieve these symptoms the disk is removed. This procedure is called a diskectomy. For the surgery, the patient is positioned face-down and a small incision is made over the location of the herniated disk. The surgeon inserts the retractor and removes a small amount of the lamina bone. This provides the surgeon with a view of the spinal nerve and the disk.
The surgeon carefully retracts the nerve and removes only the damaged disk. This minimally invasive technique can also be used for herniated disks in the neck. A standard open lumbar fusion may be performed from the back, through the abdomen, or from the side. Minimally invasive lumbar fusions can be done the same way. A common MISS fusion is the transforaminal lumbar interbody fusion TLIF Using this technique, the surgeon approaches the spine a little bit from the side, which reduces how much of the spinal nerve must be moved.
This approach prevents disruption of the midline ligaments and bone. Using the two retractors, the surgeon can remove the lamina and the disk, place the bone graft into the disk space, and place screws or rods to provide additional support. Sometimes the surgeon will use additional bone graft besides the patient's own bone to improve the likelihood of healing.