What Is Minimally Invasive Spine Surgery?
In essence, minimally invasive spine surgery is the performance of surgery through small incision(s), usually with the aid of endoscopic visualization (i.e., very small devices or cameras designed for viewing internal portions of the body).
Why Is Minimally Invasive Spine Surgery Needed?
Minimally invasive spine surgery has developed out of the desire to effectively treat disorders of the spinal discs with minimal muscle related injury, and with rapid recovery.
Traditionally, surgical approaches to the spine have necessitated prolonged recovery time. For example, in the 1990s the state-of-the-art procedure for fusion of the lumbosacral spine has been the instrumented posterolateral fusion. In order to perform this procedure, the back muscles are moved away from their spinal attachments, allowing the surgeon space to place rods, screws, and bone graft.
First, this surgical approach (i.e., dissecting the muscles) produces the majority of the perioperative pain and delays return to full activity. The degree of the perioperative pain necessitates the use of significant pain medication with their inherent side effects. Also, the degree of the perioperative pain delays return to normal daily activities and nonphysical work.
Second, the dissection of the paraspinal muscles from their normal anatomic points of attachment results in a healing by scarring of these muscles. The various layers of the individual muscle scar to one another losing their independent function.
In addition, it has been found that this type of dissection results in the loss of innervation (i.e., the supply of nerve stimulation) of the muscles with subsequent wasting away. A permanent weakness of the back muscles results. This weakness itself may be symptomatic (as a back fatigue-type pain) and/or limit the patient’s function – particularly in those who perform physical work. These side effects of the posterior approach to the lumbar spine have been called fusion disease.
Clearly, with such significant muscle injury associated with surgical approaches to the spine, the need existed for the development of less invasive surgical techniques. It was envisioned that minimally invasive techniques would offer several advantages including: -Reduced surgical complications – Reduced surgical blood loss – Reduced use of postop narcotic pain medicines – Avoidance of fusion disease – Reduced length of hospital stay – Increased speed of functional return to daily activities The Emergence of Minimally Invasive Techniques With the advent of laparoscopic general surgery in the 1980s, other surgical specialties began searching for applications of the visualization technology. It became apparent that sections of the spine, such as the thoracic (chest) and lumbar (lower back) regions could be exposed using minimally invasive technology.