Endoscopic and Minimally Invasive Thoracic and Lumbar Spinal Fusion
Introduction
Spinal fusion is a surgical procedure designed to stabilize the spine by permanently joining two or more vertebrae. It is commonly performed to treat conditions such as degenerative disc disease, spinal instability, scoliosis, herniated discs, fractures, and spinal stenosis. Traditional open spinal fusion surgery involves large incisions, significant muscle dissection, and longer recovery periods. However, advancements in surgical techniques have led to the development of endoscopic and minimally invasive spinal fusion, which offer patients reduced pain, shorter recovery times, and less disruption to surrounding tissues.
Minimally invasive spinal fusion techniques are applied to both the thoracic spine (mid-back) and the lumbar spine (lower back), addressing conditions that cause chronic pain and limited mobility. Endoscopic methods further refine these procedures by utilizing a small camera (endoscope) for enhanced visualization, allowing surgeons to operate through tiny incisions with minimal tissue disruption.
At Endoscopic & Minimally Invasive Spine Specialists, minimally invasive surgical principles are at the core of our surgical approaches. We have extensive experience and expertise in minimally invasive spinal fusion, and provide the highest-quality care in surgical and non-surgical spine care.
To learn more about minimally invasive or endoscopic spinal fusion, call our office today or request an appointment online.
Understanding Spinal Fusion
What is Spinal Fusion?
Spinal fusion involves the permanent joining of vertebrae to restrict movement at a painful or unstable segment of the spine. Bone grafts, cages, screws and rods are used to facilitate bone growth and stabilization. Over time, the vertebrae fuse together, eliminating motion and reducing pain caused by movement or nerve compression.
Conditions Treated with Spinal Fusion
- Degenerative disc disease – Wear and tear of intervertebral discs, leading to pain and instability.
- Herniated discs – When the inner gel-like core of a disc protrudes and presses on nerves.
- Spinal stenosis – Narrowing of the spinal canal, causing nerve compression.
- Scoliosis and deformities – Abnormal spinal curvature requiring correction.
- Spondylolisthesis – When one vertebra slips over another, leading to instability.
- Fractures or spinal trauma – Injuries that compromise spinal alignment and stability.
Minimally Invasive Spinal Fusion Techniques
Minimally invasive spinal fusion differs from traditional open surgery in that it uses small incisions, specialized instruments, and minimal disruption to muscles and soft tissues.
Key Techniques
- Endoscopic Spinal Fusion
- Uses a small endoscope (camera) to provide a clear view of the spine through tiny incisions.
- Small surgical tools are inserted through these incisions to remove damaged discs and place bone grafts or implants.
- Ideal for patients requiring fusion but wanting a faster recovery with minimal pain.
- Transforaminal Lumbar Interbody Fusion (TLIF) – Minimally Invasive Approach
- A posterior approach where a small incision is made in the back.
- A portion of the damaged disc is removed, and an implant (cage) filled with bone graft is inserted to promote fusion.
- Titanium screws and rods are placed to stabilize the spine.
- Direct Lateral Interbody Fusion (DLIF), Extreme Lateral Interbody Fusion (XLIF), or Oblique Lateral Interbody Fussion (OLIF)
- A side (lateral) approach is used, avoiding major back muscles and reducing nerve damage risks.
- A small incision is made on the patient’s side to access the disc space.
- An implant and bone graft are inserted to stabilize the spine.
- Thoracic Spinal Fusion (Minimally Invasive or Endoscopic)
- Aimed at stabilizing thoracic vertebrae in conditions like scoliosis, fractures, or tumors.
- Often performed with an anterior approach via small chest incisions or a lateral approach to access thoracic discs with minimal disruption.
Benefits of Minimally Invasive and Endoscopic Spinal Fusion
Compared to traditional open surgery, these techniques offer significant advantages:
- Smaller Incisions & Less Tissue Disruption
- Traditional spinal fusion requires a large incision, while minimally invasive approaches use incisions as small as 1-2 cm.
- Instead of cutting muscles, small dilators separate muscle fibers, preserving tissue integrity.
- Reduced Pain and Faster Recovery
- Less muscle damage results in significantly reduced post-operative pain.
- Most patients go home on the same day, allowing this to become an outpatient procedure. Other patients experience short hospital stays (1-3 days), compared to 5-7 days for open surgery.
- Faster recovery allows most patients to return to normal daily activities within 4-6 weeks, while full recovery and bony fusion can take 3-6 months.
- Lower Risk of Infection and Complications
- Smaller incisions reduce infection risks.
- Less blood loss and reduced need for blood transfusions.
- Lower chances of post-operative complications such as muscle weakness or chronic back pain.
- Improved Stability and Fusion Success Rates
- Modern implants, biologics, and bone graft substitutes enhance fusion success.
- Endoscopic visualization ensures precise implant placement, reducing the risk of future surgeries.
Procedure Overview: What to Expect
Preoperative Preparation
- Medical Evaluation: Imaging tests (MRI, CT scan, X-rays) are performed to assess the condition.
- Medication Adjustments: Blood thinners, aspirin, and anti-platelet medications and some other anti-rheumatic medications may need to be stopped before surgery.
- Anesthesia Consultation: The procedure is typically performed under general anesthesia.
During Surgery
- Incision & Access – Small incisions are made, and a small tubular retractor is inserted to minimize muscle damage.
- Disc Removal & Preparation – The damaged disc is partially or fully removed, creating space for a bone graft or implant.
- Implant & Bone Graft Placement – A cage or bone graft is inserted to facilitate fusion between vertebrae.
- Stabilization – Screws, rods, or plates may be placed to provide support while the bones fuse.
- Closure – The surgical tools are removed, and the incisions are closed with sutures or glue.
Postoperative Recovery
- Most patients can go home the same day.
- Hospital Stay: 1-3 days for more extensive minimally invasive spinal fusions.
- Pain Management: Medications and physical therapy help manage discomfort.
- Activity Restrictions: Avoid heavy lifting, bending, or twisting for several weeks.
- Physical Therapy: Rehabilitation begins within weeks to strengthen the spine.
- Fusion Process: Bone healing takes 3-6 months, with complete fusion occurring over 6-12 months.
Risks and Considerations
While minimally invasive spinal fusion reduces many risks associated with open surgery, potential complications still exist:
- Infection – Though rare, infections can occur, requiring antibiotics.
- Nerve Injury – There is a slight risk of nerve damage, leading to numbness or weakness.
- Fusion Failure (Pseudoarthrosis) – Incomplete bone healing may require a revision surgery.
- Hardware Problems – Screws or rods may shift, requiring correction.
Conclusion
Endoscopic and minimally invasive thoracic and lumbar spinal fusion represent significant advancements in spinal surgery, offering less pain, faster recovery, and improved outcomes compared to traditional open fusion. These techniques have revolutionized spinal care, providing patients with effective, long-term relief from chronic back pain and instability while minimizing surgical risks.
For individuals suffering from spinal conditions requiring fusion, consulting with one of our spine specialists about minimally invasive or endoscopic options can provide a safer, more efficient path to recovery and improved quality of life.
If you are ready to learn more about endoscopic or minimally invasive spinal fusion as a treatment for your neck and back problem, for patient-centered care call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.
