What is Minimally Invasive Spine Surgery (MISS)?
Normally, standard spinal procedures are done using long incisions down the back. This process is called “open surgery.” When using open procedures on the spine, the soft tissues and muscles need to be moved away. In some cases, tissues even need to be removed. There are many more risk factors involved with this method and the recovery time can be much longer.
(MISS), on the other hand, uses much smaller incisions than standard open surgery. In minimally invasive surgery, microscopic cameras and guiding instruments make use of these smaller incisions. As a result, less trauma is caused during (MISS) than in open procedures.
With these minimally invasive surgical techniques, it is less likely that nearby muscles and tissues will be harmed. This leads to less pain and faster recovery time after surgery. Generally speaking, the goal of (MISS) is to stabilize the spinal joints and vertebral bones. On top of this, (MISS) can also be used to relieve pressure from the spinal nerves, which is often caused from bone spurs, herniated discs, or spinal tumors.
The number of minimally invasive techniques are many. The commonality between all of these methods is that they cause less muscle damage through the use of small incisions. (MISS) can be used for procedures such as spinal fusion and lumbar decompression. With spinal fusion, problems with the small bones of the spine are corrected by fusing painful vertebrae together so that they heal into a single bone. Decompression, on the other hand, removes portions of bone to relieve pressure on the spinal nerves. This article will focus on a number of minimally invasive techniques that may or may not be right for you.
How (MISS) Works
The vertebrae, discs, and spinal nerves are located deep inside of the body. Because of this, surgeons must move muscle tissue out of the way so that the spinal area can be accessed. In (MISS), small incisions are used as a gateway for guiding instruments and microscopic cameras. There are many methods used to minimize trauma during (MISS), such as the following:
Tubular Retractors (TR)
This technique is commonly used during decompression procedures and (MISS) fusions. During the procedure, a (TR) is inserted through a small incision on the back to create a passageway to the spine. This passageway then acts as an access tunnel to the location of the problem. Instead of the muscles being cut, the (TR) holds the muscles open and keeps them in place. (TR) placement is guided by fluoroscopy, which displays live images on a screen throughout the process. Then, the surgeon can access the spinal canal by using small instruments that fit through the center of the (TR). Bones, disc material, screws and rods used for the procedure, are all removed and inserted through the (TR). It is important to note that some surgeries may or may not require multiple incisions and/or retractors.
Once the procedure is finished, the (TR) is removed which releases the muscles back to their original position. This results in minimal trauma to the muscles, as they are only moved instead of cut.
Placement of Rods and Screws
In some cases, it may be necessary to place screws and rods to either stabilize or immobilize the spine (as is the case with fusions). Normally, this process requires removing many muscles and tissues from the surface of the spine. However, (MISS) uses a different method. In (MISS), screws and rods are inserted through small incisions in the skin which eliminates the need to cut any underlying muscle. This is made possible through guidewires, which are placed using x-ray images through the skin and into the spinal column along the desired paths. This allows for the easy placement of screws, which simply follow the path of the placed guidewires. Screws in this procedure have removable extenders that are retrieved after being used as a guide for the rods to connect and secure the screws.
Depending on the condition of the patient, approaching the spine from the side of the body reduces pain as there are less muscle tissues blocking this path. This is commonly used for problems concerning the lumbar region of the spine. Once the patient has been placed on their side, a (TR) is used to gain access to the spine’s bones and discs.
In some cases–such as with accessing the frontal thoracic region–it may be best to approach the spine through the chest. In traditional approaches, this involves opening the chest using large incisions that often require the removal of ribs. With (MISS), access to this region is instead granted through several smaller incisions that act as gateways for cameras and working ports during surgery.
Should I Consider (MISS)?
Surgery is often not used as a first line of defense. A healthcare provider may recommend spinal surgery to a patient with a back problem that has not improved through other treatments, such as physical therapy or medicine. If a patient is experiencing persistent pain, surgery might be able to fix the issue. That being said, a healthcare provider will only recommend spinal surgery to a patient who has a problem that only surgery may help. Such conditions are as follows:
- Spinal stenosis
- Fractured vertebra
- Spinal infection
- Tumor removal
- Herniated disc
- Spinal instability
If you are considering spinal surgery, it is important to ask your healthcare provider if (MISS) will work for you. Not all surgical facilities are equipped for (MISS) and not all spinal surgeries can be done using (MISS).
Complications of (MISS)
All forms of surgery come with risks. Risks associated with (MISS) may include:
- Excessive blood loss
- Nerve damage
- Blood Clots
- Anesthetic complications
- Spinal fluid leakage
- Graft site pain
Risks will vary from person to person. However, it is important to note that the risks of MISS are still much lower than the risks associated with open procedures. Factors such as one’s age, general health, and the type of surgery can all affect the risks of (MISS). It is important to have the surgery at a facility with experienced staff who are well-versed in minimizing these risks.
Considering (MISS)? To find out if (MISS) is right for you, contact our board-certified spine surgeons today. Our team has earned international recognition, fellowship-training, and numerous Patient’s Choice and Top Doctor awards for their excellence in patient care. If you are considering (MISS), contact our team of spine specialists at The Advanced Spine Center today!