Minimally Invasive Spine Surgery (MISS)

Minimally Invasive Spine Surgery (MISS) is a set of advanced surgical techniques used to treat a variety of spinal conditions while minimizing the trauma to the body compared to traditional open spinal surgery. Over the past few decades, advances in technology, imaging techniques, and surgical tools have revolutionized the field of spine surgery, offering patients a safer, faster, and less painful alternative to conventional procedures.

In this article, we will explore the fundamentals of minimally invasive spine surgery, its benefits, common procedures performed using MISS, the technologies involved, and the future outlook of this evolving field.

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 spinal treatments and provide the highest-quality care in surgical and non-surgical spine care.

To learn more about minimally invasive spine surgery, call the office today or request an appointment online.

What is Minimally Invasive Spine Surgery?

Minimally invasive spine surgery refers to a group of surgical procedures aimed at treating spinal conditions with smaller incisions, fewer disruptions to muscles and tissues, and the use of advanced tools like endoscopes and microscopes. MISS techniques reduce the need for large cuts, muscle dissection, and lengthy recovery times, which are typical of traditional open surgeries.

Unlike traditional spine surgery, which often requires a large incision and extensive muscle retraction to access the spine, MISS is performed through smaller incisions (often less than 1 inch in length). Surgeons use specialized instruments, such as small cameras (endoscopes), to visualize the affected area and perform the necessary procedures. These techniques have gained popularity due to their ability to reduce complications, minimize blood loss, and shorten hospital stays, often allowing the surgery to be performed as an outpatient.

Key Benefits of Minimally Invasive Spine Surgery

1. Smaller Incisions: The primary advantage of MISS is the reduction in the size of incisions, which helps minimize trauma to the body.  Smaller cuts mean less tissue disruption, which results in less postoperative pain and a faster recovery.
2. Reduced Blood Loss: Because the procedure requires smaller incisions and fewer disruptions to muscles and blood vessels, the risk of significant blood loss is significantly reduced compared to open surgery.
3. Faster Recovery and Shorter Hospital Stays: Patients undergoing minimally invasive spine surgery tend to experience faster recovery times, with many returning to normal activities within a few weeks.  Hospital stays are often much shorter, and most patients can even go home the same day.
4. Lower Risk of Infection: With smaller incisions, there is a reduced risk of infection at the surgical site.  Additionally, because the procedure is done using a more controlled and precise method, there is less exposure of internal tissues to potential contaminants.
5. Less Muscle and Soft Tissue Damage: Traditional spine surgeries often require the retraction or cutting of muscles to access the spine.  This can result in prolonged pain, weakness, and a slower recovery time.  MISS minimizes muscle and soft tissue disruption, leading to less postoperative discomfort.
6. Improved Cosmetic Outcomes: Smaller incisions also result in less visible scarring, which can be a significant consideration for patients concerned with aesthetics.
7. Better Precision: The use of advanced imaging technologies like fluoroscopy and intraoperative navigation systems enhances the surgeon’s ability to precisely target the problematic area, leading to better outcomes and fewer complications.

Common Procedures Performed with MISS

Most spinal conditions can be treated with minimally invasive techniques. Others still require open or hybrid (combination of traditional and minimally invasive) techniques.  Some of the most common procedures include:

1. Discectomy: A discectomy is a procedure in which part of a herniated disc is removed to relieve pressure on the spinal cord or nerves.  Using MISS, surgeons make small incisions and use specialized instruments to access and remove the herniated portion of the disc.  This approach is associated with less tissue damage and a quicker recovery compared to traditional methods.
2. Spinal Fusion: In cases of degenerative disc disease, spinal fractures, or instability, spinal fusion may be necessary.  MISS techniques allow surgeons to perform fusion through smaller incisions, which involves inserting a bone, plastic, or metal graft or implant to promote healing and stabilization of the spine.  The procedure may be enhanced using various navigation systems to ensure accurate placement of screws and rods.
3. Laminectomy: A laminectomy involves the removal of part of the vertebra (the lamina) to relieve pressure on the spinal cord or nerves.  In a minimally invasive laminectomy, smaller incisions and specialized instruments are used to remove the lamina with minimal disruption to surrounding tissues.
4. Spinal Decompression: This procedure is designed to relieve pressure on the nerves caused by conditions such as spinal stenosis, herniated discs, or bone spurs.  By accessing the spine through smaller incisions, the surgeon can remove or trim the structures causing the compression, helping to alleviate pain and improve function.
5. Balloon Kyphoplasty: These procedures are used to treat vertebral compression fractures, often caused by osteoporosis, trauma, or tumors.  A balloon kyphoplasty entails placement of a balloon to create space within the vertebra before injecting cement to stabilize the fracture fragments to provide instant and lasting stability, pain control, and reduction of fracture angulation.  These rapid and highly safe and effective procedures are performed with minimal incisions and guided by imaging.
6. Foraminotomy: In this procedure, the surgeon removes part of the bone or tissue from the foramen (the opening where the spinal nerves exit the spinal canal) to alleviate nerve compression.  MISS techniques make it possible to perform this surgery with minimal disruption to surrounding tissues.

Technologies Used in MISS

The success of minimally invasive spine surgery relies heavily on the use of advanced technologies and specialized instruments.  Some of the most commonly used tools include:

1. Endoscope: An endoscope is a small, flexible or rigid tube equipped with a light and a camera.  It allows the surgeon to visualize the inside of the body without making large incisions.  The camera transmits images to a monitor, giving the surgeon a clear view of the spinal structures during the procedure.
2. Fluoroscopy: Fluoroscopy is a form of real-time X-ray that helps the surgeon view the spine while performing the surgery.  It is commonly used in endoscopic, MISS , hybrid, and even open procedures to target the pathology as well as to guide the placement of screws, rods, and other instruments with high precision.
3. Computer-Assisted Navigation Systems: These systems provide 3D imaging and real-time guidance, helping surgeons accurately navigate the spine and place instruments or implants with greater precision.  The technology allows for better preoperative planning and more predictable outcomes.
4. Microsurgical Instruments: Specialized instruments such as microscopes, retractors, and lasers are often used in minimally invasive spine surgery to perform delicate procedures with enhanced precision.
5. Robotics: Robotic-assisted surgery is an emerging field in spine surgery.  Robotic systems, such as the Medtronic Mazor, Globus Excelcius, and other robotics platforms assist the surgeon in guiding instruments with pinpoint accuracy.  This technology enhances the precision of procedures like spinal fusion and screw placement.

Recovery and Outcomes

One of the major benefits of minimally invasive spine surgery is the faster recovery time.  Most patients experience less postoperative pain, and can return to light or normal activities within days to a few weeks.  For more complex procedures, the recovery period may be slightly longer, but it is still significantly shorter than that for traditional open spine surgery.

Patients typically follow a rehabilitation program to strengthen their muscles and regain full function.  Physical therapy may be recommended to improve mobility and reduce the risk of future spinal problems both before and after surgery.

The long-term outcomes of MISS are generally very positive.  Studies have shown that patients who undergo minimally invasive spine surgery experience a reduction in pain, improved function, and a quicker return to work and normal daily activities.  In some cases, the results may even be better than those of traditional surgery, as the smaller incisions and reduced tissue disruption contribute to faster healing and fewer complications.

Future of Minimally Invasive Spine Surgery

The future of MISS looks promising, with continued advancements in technology and techniques on the horizon.  As robotic-assisted surgery and artificial intelligence (AI) continue to develop, the precision and efficiency of spine surgeries are expected to improve even further.  In addition, new minimally invasive techniques are being explored for a wider range of spinal conditions, including complex deformities and tumors.

As surgeons become more skilled with these advanced techniques, and as more research is conducted, it is likely that minimally invasive spine surgery will become the standard of care for most, if not all, spine-related issues.  With ongoing innovation, the potential to further reduce risks, improve outcomes, and make recovery even more efficient is enormous.

Conclusion

Minimally invasive spine surgery represents a significant step forward in the treatment of spinal disorders. By reducing the size of incisions, minimizing muscle and tissue damage, and improving precision, MISS offers a range of benefits, including faster recovery, reduced complications, and improved outcomes for patients. As technology continues to evolve, the future of MISS is bright, and it promises to make spinal surgery even more effective and accessible.

To learn more about the our expertise and patient-centered care of back pain, call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.