Minimally Invasive 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.

 

• 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 lasers, 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.

 

• 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.

 

• Lumbar Fusion-Lumbar fusion can be performed MIS using several of the approaches below.
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. This can be done through MIS.
Transforaminal (TLIF) is done with muscle dissected from the mid spine outward to one side, sparing trauma to the opposite side. This can be done through MIS
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. This is a MIS procedure.
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. This is a MIS procedure. ABC News recently did an indepth report on this procedure