Minimally invasive spine surgery

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Minimally invasive spine surgery, also known as MISS, is any minimally invasive procedure that targets conditions specifically within the spine through the use of small incisions as opposed to traditional open-spine surgery which typically requires a 5-6 inch incision. This technique utilizes modern technology, advanced imaging techniques and special medical equipment to reduce tissue trauma, bleeding, radiation exposure, hospital stays and recovery by minimizing the size of the incision.

MISS can be used to treat a number of spinal conditions such as degenerative disc disease, disc herniation, fractures, tumors, infections, instability and deformity.[1] It also makes spine surgery possible for patients who were previously considered too high risk for traditional surgery due to previous medical history or the complexity of the condition.

Methods[edit]

Traditionally, spine surgery has required surgeons to create a 5-6 inch incision down the affected portion of the spine and to pull back the tissue and muscle using retractors in order to reveal the bone. The wound itself takes a long time to heal; the aim of minimally invasive surgery is reduce tissue trauma and the associated bleeding and risk of infection by minimizing the size of the incision.[2][3]

Minimally invasive spine surgery is performed by an orthopedic surgeon and a trained medical team. Typically, they will begin the operation by delivering a type of anesthesia that numbs a particular part of the body in conjunction with sedation or simply give a general anesthesia that prevents pain and allows the patient to sleep throughout the surgery.[2][3]

Next the surgeon will begin taking continuous x-ray images in real time, a process called fluoroscopy, of the affected portion of the spine. This allows them to see what they're operating on, in real-time, throughout the surgery without creating a large incision.[3]

At this point, the surgeon will begin performed the operation percutaneously, meaning "through the skin", by creating an incision in the skin above the affected portion of the spine and then using a device called an obturator to push the underlying tissue apart; the obturator is inside a tube, which is left behind after the obturator is removed, leaving a channel down to the spine. Small operating tools as well as endoscopic cameras and a light are used through this tube. In other surgeries this is called a trocar; in spine surgery it is called a "tubular retractor."[2][3][4]

The surgeon makes the necessary repairs to the spine, extracting affected disc material out through the tubular retractor and inserting medical devices, like intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices and artificial discs, through the retractor.[2][3][5]

Robot-assisted surgery is another technique that is used occasionally in minimally invasive spine surgery[6]

When the procedure is done the tube is removed, and the wound is stitched, stapled, or glued shut.[2][3]

Specific procedures[edit]

There are many spinal procedures that make use of minimally invasive techniques. They can involve cutting away tissue (discectomy), fixing adjacent vertebrae to one another (spinal fusion), and replacing bone or other tissue. The name of the procedure often includes the region of the spine that is operated on, including cervical spine, thoracic spine, lumbar spine.[7] These procedures include:[2][3]

Risks and benefits[edit]

Risks include damage to nerves or muscles, leaking spinal fluid, and risks that accompany any surgical procedure, such as infection or a failure to resolve the condition that prompted the surgery.[8]

Claims are made that MISS has better outcomes than open surgery with respect to fewer complications and shorter hospital stays, but data supporting those claims is weak.[9][10]

History[edit]

Humans have been trying to treat spinal pain for at least 5,000 years. The first evidence of spine surgery appeared in Egyptian mummies buried in 3,000 BC.[11] However, Hippocrates is often credited with being the father of spine surgery due to the extensive amount of writing and proposed treatments he produced on the topic.[12] The first operative spine surgery is credited to Paul of Aegina who lived during the 7th century.[13]

However, only within the last 50 years have advances in digital fluoroscopy, image guidance, endoscopy and minimally invasive surgical tools allowed minimally invasive spine surgery to rise to the forefront of spinal procedures.[14][15]

References[edit]

  1. ^ Kanter, Adam S.; Mummaneni, Praveen V. (2008-08-01). "Minimally invasive spine surgery". Neurosurgical Focus. 25 (2): E1. PMID 18673038. doi:10.3171/FOC/2008/25/8/E1. 
  2. ^ a b c d e f "Minimally Invasive Spine Surgery". American Academy of Orthopaedic Surgeons. Retrieved 2016-12-15. 
  3. ^ a b c d e f g "Minimally Invasive Spine Surgery". American Association of Neurological Surgeons. Retrieved 14 June 2017. 
  4. ^ Kim, YB; Hyun, SJ (October 2007). "Clinical applications of the tubular retractor on spinal disorders.". Journal of Korean Neurosurgical Society. 42 (4): 245–50. PMC 2588212Freely accessible. PMID 19096551. 
  5. ^ Oppenheimer, Jeffrey H.; DeCastro, Igor; McDonnell, Dennis E. (2009-09-01). "Minimally invasive spine technology and minimally invasive spine surgery: a historical review". Neurosurgical Focus. 27 (3): E9. PMID 19722824. doi:10.3171/2009.7.FOCUS09121. 
  6. ^ Shweikeh, Faris; Amadio, Jordan P.; Arnell, Monica; Barnard, Zachary R.; Kim, Terrence T.; Johnson, J. Patrick; Drazin, Doniel (2014-03-01). "Robotics and the spine: a review of current and ongoing applications". Neurosurgical Focus. 36 (3): E10. PMID 24580002. doi:10.3171/2014.1.focus13526. 
  7. ^ Banczerowski, P; Czigléczki, G; Papp, Z; Veres, R; Rappaport, HZ; Vajda, J (January 2015). "Minimally invasive spine surgery: systematic review.". Neurosurgical review. 38 (1): 11–26; discussion 26. PMID 25199809. doi:10.1007/s10143-014-0565-3. 
  8. ^ Ghobrial, GM; Theofanis, T; Darden, BV; Arnold, P; Fehlings, MG; Harrop, JS (October 2015). "Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature.". Neurosurgical focus. 39 (4): E8. PMID 26424348. doi:10.3171/2015.7.FOCUS15266. 
  9. ^ Goldstein, CL; Macwan, K; Sundararajan, K; Rampersaud, YR (March 2016). "Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review.". Journal of neurosurgery. Spine. 24 (3): 416–27. PMID 26565767. doi:10.3171/2015.2.SPINE14973. 
  10. ^ Quirno, M; Vira, S; Errico, TJ (March 2016). "Current Evidence of Minimally Invasive Spine Surgery in the Treatment of Lumbar Disc Herniations.". Bulletin of the Hospital for Joint Disease (2013). 74 (1): 88–97. PMID 26977554. 
  11. ^ Perez-Cruet, MJ; Balabhadra, RSV; Samartzis, D; Kim, DH (2004). "Historical background of minimally invasive spine surgery". In Kim, Daniel H.; Fessler, Richard G.; Regan, John J. Endoscopic spine surgery and instrumentation. New York: Thieme. pp. 3–18. ISBN 978-1588902252. 
  12. ^ Marketos, SG; Skiadas, P (1 July 1999). "Hippocrates. The father of spine surgery.". Spine. 24 (13): 1381–7. PMID 10404583. 
  13. ^ Knoeller, SM; Seifried, C (1 November 2000). "Historical perspective: history of spinal surgery.". Spine. 25 (21): 2838–43. PMID 11064533. 
  14. ^ Snyder, LA; O'Toole, J; Eichholz, KM; Perez-Cruet, MJ; Fessler, R (2014). "The technological development of minimally invasive spine surgery.". BioMed research international. 2014: 293582. PMC 4055392Freely accessible. PMID 24967347. 
  15. ^ Jaikumar, S; Kim, DH; Kam, AC (November 2002). "History of minimally invasive spine surgery.". Neurosurgery. 51 (5 Suppl): S1–14. PMID 12234425. doi:10.1097/00006123-200211002-00003.