Minimally Invasive

Minimally Invasive Spine Surgery & Its Benefits

Thus the development of Minimally Invasive spine surgery was done with the motive to improve on these side effects. Minimally Invasive Spine surgery is different from routine spine surgeries in:

• A small incision is made instead of the routine big ones
• We use microscopes and other instruments for visualization hence the outcome of the surgery is much better
• The muscles retraction is very less and hence muscle damage is less
• Blood loss is minimal as we remove only the damaged structures and do not disturb the normal structures
• Post operatively the surgical site pain is very less, hence the patient can be mobilized very quickly

Various Minimally Invasive Surgical procedures done are:

• Micro-Lumbar Discectomy / Decompression: This is unlike the routine open Laminectomy/Decompression. Here a small incision is placed over the skin, about 3-4 cm long. With the aid of microscope the entire surgery is performed and there is very little blood loss or muscle damage
• Tubular Decompression / Discectomy: The innovation of tubes helped in further progressing the boundaries of minimally invasive spine surgery.These tubes are passed through the skin in sequential order to dilate the muscles around the space that needs to be operated. The benefit of these tubes are that they don’t cut any muscles, so not much bleeding, also less muscle damage means less pain postoperatively
  A graphical depiction of
  tubular discectomy

  Actual depiction of tubular
  discectomy steps

  Actual image of a tubular
  microdiscectomy surgery
  
  
  Image depicting the size of incision
  not more than 3cms

  The size of the skin cut is not more than 3 cm in length, this is 50% more smaller than a routine open spine surgery. Even though the incision is small, but a complete removal of the pathology can be done as we use highly specialized instruments to magnify the field, so not just the naked eyes but additional instruments help in visualizing the operating field better. This reduces the chances of complication or any injury by 90%.
  
  After a tubular endoscopic discectomy or decompression the patient can be made to walk and stand 6 hrs after the surgery if he is comfortable and no medical comorbidities are there.
  
  Patients are usually discharged 36-48 hrs after surgery, can resume light work, if he is involved in heavy work, 3 weeks after the surgery.
• Endoscopic Discectomy / Decompression: This procedure involves using scopes like in laparoscopic surgery, the benefits of this approach are surgeries can be done without anesthesia also, only under sedation and local anesthesia. Thus the patients are awake during the surgery are conversing with the surgeon and can tell for an immediate improvement after the surgery. patients are mobilized immediately after the surgery and can be discharged if they are comfortable the same day of the surgery
  An endoscopic procedure done
  under local anesthesia

  Depiction of size of incision
  for endoscopic discectomy
• Minimally Invasive Instrumentation: Putting screws in the spine involves taking a big incision and removing most of the normal structures for approach to put the screws, in a Minimally invasive approach, we make small holes in the skin, though these holes the muscles are dilated and screws are inserted under X-ray guidance, this is more precise and very less painful for the patient. Thus the patient is benefitted in that he is able to resume all his normal activities very quickly after surgery, since the post operative pain is very less
  A Minimally Invasive procedure
  for screw insertion

  Size of incisions are not more
  than 4-5cm with minimal blood loss
• Minimally Invasive Deformity Correction: Some deformities of the spine are not very rigid, these can be corrected by percutaneous screw insertion, the benefit being that there is very less muscle destruction, hence post-operative healing from the surgery is also very quick
• Vertebroplasty & Kyphoplasty: In osteoporotic fractures, where the fracture does not heal, due to weak bones. The patient suffers from severe pain and can be debilitated and non-ambulatory. These all factors in old age patients can be troublesome, hence we can do a minimally invasive procedure like vertebroplasty or kyphoplasty, wherein we inject bone cement into the bones. This procedure does not involve any anesthesia and only 1 stitch incision is taken
• Usually the patient can be discharged the same day after the procedure
  Kyphoplasty procedure being
  done by needle insertion

  One stitch procedure

  Vertebroplasty procedure with
  one needle insertion