In selected patients, the minimally invasive approach can be used in spinal surgeries. MIS procedures can be used to treat certain types of spinal conditions, including degenerative or herniated disc disorders, lumbar (lower back) spinal stenosis, curvature of the spine such as kyphosis or scoliosis, spinal infections, instability of the spine, and compression fractures of the spine, such as those caused by osteoporosis (thinning of the bones). The minimally invasive approach typically used one or two small incisions and an endoscope to visualize the structures of the spine. MIS reduces patient downtime and the risk of infection with typically excellent results.
MIS - Spinal Fusion Techniques
Minimally Invasive Lateral Interbody Fusion (XLIF and DLIF)
This newly developed fusion procedure is meant for patients who have degenerative disc disorders, or abnormalities in the vertebral structure that limit movement or cause pain. It can also be used to treat conditions where one vertebra slips over another, or when disc degeneration pinches the nerves that exit the spinal cord. XLIF (extreme Lateral Interbody Fusion) and DLIF (Direct Lateral Interbody Fusion) both use small incisions on the side (lateral) of the body to access the spine, and thus can only be used for vertebra that can be reached from the side. These are generally 60- to 90-minute procedures. Most patients are able to get up and walk about within a few hours of the surgery, and some patients report returning to work within a few weeks.
Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)
The PLIF procedure is used to access the lumbar spine, the second lowest region of the spine, just above the sacrum, to relieve pain and discomfort from degenerative or herniated disc disorders. PLIF is also used to reposition vertebra that have slipped out of normal alignment. PLIF uses two small incisions on either side of the lower back to access the spine, and generally takes 3 to 3½ hours to complete. Patients who have undergone PLIF benefit from quicker recovery and bone fusion times, with less blood loss during surgery and a reduced need for narcotic pain medication after surgery.
Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
Minimally invasive transforaminal lumbar interbody fusion is a technique used in the lower (lumbar) spine to treat herniated discs, degenerative disc disease, or vertebra that have slipped over one another. It is used in patients who continue to have problems after disc procedures called laminectomies, which involves trimming a bony section of the vertebra called the lamina. TLIF can also be used to treat spinal injuries and a condition called pseudoarthrosis. The name refers to a “false joint” that results from either an inborn error or from an unsuccessful fusion procedure. “Transforaminal” refers to the foramen, which is the opening in the vertebra through which the spinal nerve passes as it exits the spinal cord. TLIF uses one incision to gain access to the spine, just a few inches away from the middle of the back. Compared with open surgeries, TLIF causes less blood loss during surgery, and results in a shorter hospital stay as well as a reduced need for narcotic pain medication after surgery. TLIF generally takes 2½ hours to perform.
Minimally Invasive Posterior Thoracic Fusion
Minimally invasive posterior thoracic fusion is performed in both the lumbar (lower back) and in the region of the spine located just above the lumbar, called the thoracic spine. The procedure is used to treat spinal injuries or deformities, spinal tumors, and infection. Open surgeries in the thoracic spine are difficult and can cause surgery-related complications, thus minimally invasive approaches are preferred when it is possible to use them. The posterior thoracic approach uses an incision in the middle of the back, and requires x-ray imaging and monitoring to help place instruments in their proper positions. The muscles in this area of the back are also bulkier than in the lower spine and must be held aside with retractors. This procedure can take 3 hours or longer to perform, depending on the complexity of the spinal disorder.
Other MIS Spinal Procedures
Microdiscectomy is used to treat pain and discomfort from herniated discs in the lumbar (lower back) region of the spine, and thus is also referred to as microlumbar discectomy (MLD). Microdiscectomy relieves the pressure on the portion of the spinal nerve that is being affected by the bulging disc. Compared to other minimally invasive spinal surgeries, this is a relatively simple procedure that uses one small incision located right over the affected disc, and requires little or no disruption of the tissue surrounding the spine. The surgeon removes a portion of the disc and a small amount of bone from the vertebra to create room for the spinal nerve, helping to relieve symptoms. Microdiscectomy takes about an hour to perform, and more than 90 percent of patients have a good to excellent outcome, quickly returning to their daily routine.
Microendoscopic laminectomy, or microlaminectomy, is used to treat patients with lumbar stenosis, a condition of the lower back in which the spinal nerves are pinched or compressed by an overgrowth of bone, causing pain and limiting movement. In this procedure, bone is removed from the part of the vertebra called the lamina, and occasionally from the foramen, which is the main opening through which the spinal nerve exits from the spinal cord. Microendoscopic laminectomy uses one small incision located over the affected vertebra, and like microdiscectomy, requires little cutting of muscle or soft tissue. The procedure usually takes about 60 to 90 minutes, and most patients report good to excellent results in the form of quickly reduced pain and a fast recovery.
Minimally Invasive Cervical Foraminotomy
Minimally invasive cervical foraminotomy is used to treat vertebra in the neck, a region called the cervical spine. In this surgery, bone is removed from the foramen, the main opening through which the spinal nerve passes on its way out of the spinal cord. This opening can be obstructed by a herniated disc, an excess growth of bone (bone spurs) on the vertebra, or swollen ligaments or joints. This procedure uses a single incision on the affected side of the neck, through which the surgeon removes enlarged tissue, bone or portions of the herniated disc. It takes about 2 hours to complete.
Vertebroplasty is used to treat compression fractures of the vertebra, which are commonly caused by osteoporosis but can also result from other disease processes or certain drug regimens. The procedure can be done under local anesthetic as an outpatient or under general anesthesia as an inpatient. Vertebroplasty uses a small incision, through which bone cement is injected into the affected portion of the vertebra. The cement hardens in minutes and stabilizes the weakened bone structure, relieving pain caused by the fracture. The procedure generally takes 1 to 2 hours, and can be used to treat multiple vertebrae at one time.
Kyphoplasty is a more complex procedure than vertebroplasty, using two incisions and tools called bone tamps. The bone tamps are balloons that help to create a larger space on each side of the vertebra into which the bone cement is injected. Kyphoplasty can actually add height to the spine, and has a very low complication rate (less than 2 percent).