Minimally Invasive Spine Surgery: Questions and Answers

  • You can never ask too many questions about surgery.


    If you are considering spine surgery, you might want some answers about minimally invasive spine surgery. The idea of having minimal impact on the body, the environment, and the planet has become more popular these days as if we have suddenly noticed that the footprints left behind can have life-long implications. Huge surgery scars and timber clear-cuts are no longer acceptable. Not even a paper bag at the grocery store is acceptable for fear that too many trees are being lost. Trees can grow back. Surgery scars are forever. So the idea of being "minimally invasive" could be very important when it comes to things like surgery.

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    If you are looking for a minimally invasive spine surgery, you will find many different types. A Microdiscectomy or Microlaminectomy is a microscopically aided surgery that uses tiny incisions and tiny instruments. Percutaneous Endoscopic Discectomy use many small access ports through which tubes are inserted to gain access for the surgical tools and cameras (endoscopes). Spinal Laser Surgery still requires an incision and substitutes a drill or electric knife with a beam of light (laser). Muscle sparing or muscle splitting procedures attempt to gain access to the spine without cutting through muscles. All these different types of surgery are trying to minimize the amount of cutting involved with a spine surgery. Sounds good on paper but what are some real answers about minimally invasive spine surgery.


    What constitutes a minimally invasive surgery?


    Because we humans are very visual, a tiny scar looks very good. Minimally invasive to the skin does not necessarily mean that everything underneath the skin was minimally impacted as well. The skin does not matter as much as the joints, muscles and ligaments of the spine. Thus, a truly minimally invasive spine surgery must involve the least amount impact on the spine, not the skin. In an ideal world of Star Trek proportions, a surgeon would leave no trace of having been inside the human body. But in today's real world, all surgeons leave a trace, some more than others.


    What is the most minimally invasive spine surgery?


    The least invasive spine surgery is the one that is not done. Really! Because surgery cannot be undone, you should think about that statement.  In terms of actual surgeries, the anterior cervical discectomy is the least invasive surgery - the incision is small and the damage to surrounding structures like joints, ligaments and muscles is very minimal.


    What are some potential advantages of minimally invasive spine surgery?


    The idea of a smaller incisions, smaller tools, and smaller footprints is to improve recovery time with less blood loss and less need for hospitalization. However, overall outcomes do not seem to be impacted looking at five and ten year studies. In fact, those who elect not to have surgery seem to do just as well 10 years later as those who do have surgery. Again, this brings up the idea that the least invasive surgery is the one that is not done. Any advantage that a minimally invasive surgery might have really depends on surgeon selection, patient selection, and complexity of the problem needing to be remedied surgically.


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    What are some potential disadvantages to watch out for with minimally invasive spine surgery?


    The good looks on the paper and on the skin may not be very advantageous at all. Even though the skin might be minimally impacted by the surgery, sometimes the access ports can damage critical joints in the spine called the facet joints. Knowing the value of an intact facet joint, some surgeons have developed "facet sparing" surgeries. Ask your surgeon whether or not the facet joints will be impacted by your surgery. That would be a very good question indeed.


    Another question to ask about surgery is how long it will take. Typically minimally invasive surgeries take longer than the open counterpart because the technical challenge of a smaller field of view requires more steps and a slower process. Longer surgeries increase the risk of developing kidney failure or rhabdomyolysis which can occur with minimally invasive spine surgery. Remember, a minimally invasive surgery still has the potential to seriously and gravely impact your life.


    Again, this gets us back to the fact that the least invasive surgery is the one that is not done. So, before you jump onto the "minimally invasive" wagon ask lots of questions and get some real answers. Get a clear understanding what exactly "minimally invasive" means for your situation. Ask about the potential advantages and disadvantages that you can expect. And remember, you cannot ask too many questions when it comes to somebody cutting into you. No matter how minimal the impact might seem, surgery is forever.


Published On: September 26, 2011