Minimally Invasive Spine Surgery

What is minimally invasive spine surgery?
Minimally invasive spine surgery is a technique in which the spine is operated upon to treat various disorders such as herniated discs, stenosis and instability while disturbing the supporting musculature as little as possible. In traditional spine surgery, the muscles that support the spine are stripped off their bony attachments in order to expose the spine. Once this is done, heavy retractors are placed to hold back and stretch the musculature. The vast majority of postoperative pain that patients experience is usually directly related to the trauma inflicted upon this musculature.

Using advanced techniques, the surgeons in our practice are able to expose the bony spine by utilizing a series of dilators placed through a small one-inch incision that gently dilates a corridor through the paraspinal musculature and then maintains that exposure utilizing a tubular retractor through which the surgeon works. This technique eliminates the need to strip the muscles off their attachments to the bone and also eliminates the need for aggressive retraction and stretching of the musculature.

What types of operations can be performed utilizing minimally invasive spine surgery?
The techniques are most applicable to lumbar spine surgery. These techniques can be employed to remove herniated discs, decompress lumbar stenosis and perform fusions with bone grafts and pedicle screws.

How are you able to remove a herniated disc or decompress the spine using minimally invasive spine surgery?
The most important thing to remember is that the actual operation of removing a herniated disc or decompressing the spine is the same as a traditional operation. What is different is the approach and how the corridor is obtained. The best analogy to help understand this relates to cholecystectomy (gall bladder removal). Today this operating is performed utilizing a laprascope in which the surgeon only has to make a few small incisions in the abdomen and no longer has to make a large incision under the rib cage. The gallbladder is still taken out the exact same way but patients recover much quicker because the “approach” to the gallbladder is less invasive. In minimally invasive spine surgery the approach to the spine is much less invasive but once the herniated disc or area of stenosis is exposed, it is dealt with the same way as a more traditional approach utilizing essentially the same instruments and drills. The end result is that the success rate is the same as more traditional approaches because it is still the same operation done less invasively.

How can you perform a fusion through such a small incision?
The exposure and placement of the bone grafts is able to be easily achieved through the tubular retractors. The pedicle screws are then placed through small openings under X-ray guidance without having to do any additional dissection to the muscles. The rods are then passed through the screws using an apparatus that connects to the screw heads and guides the rods into place. This is also done under X-ray guidance.

Prevention of Neck and Back Problems

How do I prevent back and neck pain?

  • Practice correct lifting techniques.
  • Use telephones and workplace computers and other equipment properly.
  • Maintain correct posture while sitting, standing, and sleeping.
  • Participate in regular exercise (with proper stretching before participation).
  • Avoid smoking.
  • Maintain a healthy weight.
  • Reduce emotional stress which may cause muscle tension.

Spinal Disorders

Why is my spine so important?
Your spine is composed of 24 bones (seven cervical, 12 thoracic, five lumbar) called vertebrae and between each of these are discs. The discs serve as cushions and also play an important role in allowing your spine to bend and twist in many different directions. Attached to the spinal column are many muscles and ligaments that provide support and stability to the spine. Running through the center of the spinal column is the spinal canal which houses and protects the spinal cord and nerve roots. The nerve roots branch off from the spinal cord and exit from the spinal column through spaces at each level called foramen. These nerves carry the impulses back and forth to the brain enabling you to move your muscles and feel things with your skin.

What is a herniated disc?
Sometimes a portion of the disc at a particular level will protrude into the spinal canal and put pressure on either the spinal cord or the nerve roots. This can occur as result of chronic wear and tear or as the result of an acute injury like a fall, motor vehicle accident or a sporting injury. When the herniated disc pushes against a nerve root it usually results in pain in the area of the body that that nerve supplies. This is what is known as a "pinched nerve." For example, a pinched nerve in the neck (cervical) region will result in arm pain, while a pinched nerve in the lower back (lumbar) region then results in leg pain (sciatica). Depending upon the severity of the compression there may also be weakness and/or numbness in the area supplied by that nerve. If the disc is pushing against the spinal cord then the symptoms may be more generalized and may result in weakness and numbness in the arms and legs.

What are CT scans, MRI scans and myelograms?
CT is an abbreviation for computed tomography and utilizes X-rays to produce a series of pictures or "slices" of the area that was scanned. CT scans are excellent at analyzing the bones and bony changes, but give less detail regarding the soft tissues such as the muscles, nerves and ligaments.

MRI stands for magnetic resonance imaging and does not involve any X-rays. Instead, a powerful magnet and a computer work together to make a series of images or slices, just like the CT, of the area being scanned. MRI is very good at imaging the soft tissues such as the nerves, muscles and ligaments, but is not as good as CT at imaging bone.

A myelogram is a study in which the radiologist injects dye into the spinal canal in order to outline the nerve roots and spinal cord. A set of X-rays and then a CT scan is performed of the area that is being studies. A myelogram is very good at showing the distribution and position of the nerves and spinal cord and is helpful at detecting compression of these structures.

How long will I be in the hospital after my discectomy or laminectomy?
While each patient is different, a typical hospital stay following a microlumbar discectomy is one to three days. Patients undergoing a laminectomy will typically be in the hospital for three to seven days. Since everyone is different, your doctor will discuss with you how long you should expect to be in the hospital.

What is an anterior cervical discectomy?
Patients who have a herniated disc in the cervical region as the cause of their symptoms may require a cervical discectomy. The common approach is an anterior cervical discectomy. This is an operation under general anesthesia in which a small incision is made in the front of the neck to gain access to the front of the spine. The disc along with its herniated portion is then removed to relieve the pressure on the nerve and spinal cord.

How long will I be in the hospital following my anterior cervical discectomy?
While each person is different, patients typically stay in the hospital for one to three days following an anterior cervical discectomy.

Will I need physical therapy after my spinal surgery?
Depending upon your symptoms before surgery it is not uncommon for patients to require physical therapy following surgery. This is particularly true if you had weakness in the arms or legs prior to surgery. In these cases, physical therapy can be very helpful in restrengthening those weakened muscles. 

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