About Minimally Invasive Spine Surgery

Minimally Invasive Spine Surgery (MIS) describes surgical procedures that are performed on the spine with minimal damage to the soft tissue. Compared to traditional spinal surgery, MIS is often a “same day surgery”, and typically uses much smaller incisions. With MIS there typically is less blood loss, less pain, quicker recovery times, and equal or better results than more traditional forms of spinal surgery.

Minimally Invasive Spine Surgery techniques performed at iMIS include:

• X-Stop - This is a titanium implant that fits between the spinous processes. It is one of the minimally invasive procedures used in the surgical treatment of Stenosis.
• Microforaminotomy - The foramen (the opening through which the nerve roots exit the spinal canal) is enlarged to increase space for the nerves.
• Micro/Endoscopic Discectomy/Hemilaminotomy - A minimally invasive technique in which a small opening is made between the laminas and herniated disc material are removed. The goal of the surgery is remove the herniated disc from pressing on and irritating the nerves which cause pain and weakness. There is no need to use laser, which will burn the remaining healthy disc and soft-tissues.
• Kyphoplasty - This is a minimally invasive procedure for people suffering with compression fractures of the spine commonly caused by Osteoporosis. Orthopaedic balloons are used to gently elevate the fractured vertebra in an attempt to return it to the correct position and cement is placed in the void created by the balloon. This procedure is safer than a vertebroplasty, and patients can resume regular activities almost immediately.

Spinal fusion is meant to immobilize the spine to add stability and decrease pain.

• Cervical Fusion
• Anterior Cervical Decompression and Fusion is done either by removing the discs (ACDF-Anterior Cervical Discectomy and Fusion) between two vertebra or by removing the vertebral body and the discs above and below (corpectomy) then placing bone graft or a cage between the remaining vertebral bodies. A plate with screws is then applied to hold the vertebra from moving to allow fusion from one vertebrae to the next. Post-op patients wear a collar for 6 weeks.
• Posterior Cervical Fusion is done through an incision in the back of the neck. Screws are used to fuse the spine anywhere from the back of the skull down to the thoracic spine. Post-op patients wear a collar for 6 weeks.
• Thoracic Fusion
• Thoracic Fusion is done anteriorly between the ribs or by removing one or more ribs to access the spine. The surgery is similar to anterior cervical decompression and fusion. An anterior fusion may be supplemented by pedicle screws in the back through a separate incision. At times only a posterior approach is needed for decompression and fusion if the majority of the problem can be treated from a posterior approach, such as in a benign tumor. Postoperatively, a brace is used for up to 3 months. Patients are allowed to walk as soon as they can tolerate walking, but should wear the brace at all times when walking. They may remove the brace for sitting, lying, or showering.
• Lumbar Fusion
• Posterolateral Fusion (PLF) is a procedure that places bone between the transverse processes. Usually screws are placed into the pedicles along the sides and connected by a titanium rod. The bone graft is either taken from the patient or from donated bone that is treated to prevent infection or rejection by the body.
• Interbody Lumbar Fusion (LIF) is a procedure designed to attempt to eliminate instability of the back, due to degenerative discs and facet joints that cause unnatural motion, pain, pinched nerves and spondolisthesis (slipping of one vertebrate over another. Fusion is accomplished by removal of most of the intervertebral disc to prepare the adjacent ends for implantation of the intervertebral spacer to restore disc height and spinal alignment and bridge the space and fuse the joint.
• There are several surgical approaches for LIF:
• Posterior Lumbar Interbody Fusion (PLIF) approach from the back, dissecting the muscles from the mid spine outward to both sides, allowing direct access to problematic nerves and allows for placement of screws and rods in addition to the intervertebral fusion.
• Transforaminal (TLIF) is done with muscle dissected from the mid spine outward to one side, sparing trauma to the opposite side.
• Anterior Lumbar Interbody Fusion (ALIF) approaches from the front of the body going through the abdomen. This approach spares the spinal muscles, but requires manipulation of the major blood vessels that lie in front of the spine.
• eXtreme Lateral Interbody Fusion (XLIF) approach is from the side of the body. This allows for more complete disc removal and does not require dissection of back muscles, bones or nerves. An animation of this procedure can be viewed here.
• AxiaLIF approach is from between the coccyx and anus. This allows for discectomy and fusion mostly at L5-S1 but can also extend to L4-L5. ABC News recently did an indepth report on this procedure.
• Bone Growth Stimulators are a nonsurgical treatment of the spine that uses a low-strength pulsed electromagnetic field (PEMF) to aid in the healing of bone fusions. Treatment time varies and is based upon a daily therapy schedule, usually 4 hours daily.
• Spinal Cord Stimulators have a lead that is placed within the spinal canal but outside the dura. The stimulator is placed anywhere around the back, sides, or abdomen where a pocket can be created within the subcutaneous soft tissues. Pulses from the stimulator may help patients with chronic pain.
• Pain Pumps also have a tube that is placed percutaneously through the dura. The pain pump is also placed in a subcutaneous soft tissue pocket. The pain pump gives the pain medication directly within the spinal fluid. Postoperatively, patients are allowed gradually increased activities. Wound care is the same as for other spine surgeries.

Selective Endoscopic Discectomy™ - SED™ is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients’ leg and back pain. Thermal annuloplasty is an adjunctive procedure that uses bipolar electro-thermal energy (radiofrequency and/or laser) to ablate or depopulate the sensitized pain nociceptors in the annulus, ablate any inflammatory/grannualtion tissue that has grown into the annulus, and to shrink and tighten the stretched or torn collagen fibers of the annulus. The annulus is the outer portion of the disc and is composed of many concentric layers that are arranged similarly to the plies of a radial tire. Thus, the weakened annulus or defect left by the disc herniation is contracted and possibly sealed from within the disc.

See news story on Dr. Chin and his use of SED/YESS.