For most patients hearing that you may need a spinal fusion is not welcome news. However, spinal instability causing nerve impingement and pain is a frequent problem. Conditions that may lead to chronic instability include:
- Previous laminectomy where prior removal of bony elements or lamina may lead to instability and chronic pain.
- Spondylolisthesis or chronic slipping vertebra which often create a mal-alignment that results in nerve impingement. Severe degenerating discs where the disc and surrounding ligaments have become deteriorated and therefore unstable.
- Recurrent disc herniations that may require additional removal of stabilizing bony structures in order to complete a decompression.
- Spinal stenosis which is often caused by thickening of the lamina or roof of the spinal canal along with abnormally thickened ligaments.
In many cases there are combinations of one or more of these conditions that an individual patient may have. The purpose of most spinal surgeries usually involves decompressing nerves that are impinged along with stabilizing the spine in many cases. With any patient the treatment plan is individualized for that particular condition. Simple problems such as a disc herniation can be treated with a minimal invasive laminectomy and excision of the herniation, often performed as an outpatient procedure. However, for more complex conditions simple decompression or laminectomy will not result in a stable spine that can withstand the demands of every day life or even sports without having recurring symptoms.
Back surgery has developed a poor reputation in the past due to missing a coexisting instability problem in the diagnosis. In other cases, when instability is recognized, surgeons were reluctant to include a spinal fusion with the procedure because it involved a much larger incision and prolonged recovery time. Traditional spinal fusions typically require large incisions where the muscles are stripped away from their attachments to bone but that also damages the blood nerve supply to those muscles affected. Although the muscles are repaired or sewn back together, they are invariably damaged to some extent.
Minimal invasive techniques involve inserting progressive dilators through the muscle fibers so that a larger tubular retractor can be inserted for the actual procedure. When the tubular retractor is removed the muscle fibers simply close back to their original form with minimal tissue damage. It is very similar to an endoscopic gall bladder surgery as opposed to open gallbladder surgery through a large abdominal incision. I have personally performed several hundred of these specialized procedures over the past 6 years, and I am convinced that minimal invasive techniques represents the future of most spinal surgery.
Why Choose MIS For Your Spinal Procedure?
- Minimal hospital stay, usually overnight
- Rapid return to activity and work
- Extremely low complication rate. Infection rate close to 0%
- Blood transfusion almost never needed
- Medical complications are very low due to rapid mobility and avoiding prolonged bed rest
- Avoiding damage to adjacent structures that could lead to long-term problems in the future (adjacent segment disease)
- Minimal Invasive Surgery (MIS) has been shown to be as safe as major open surgery
- Spinal MIS can also treat certain scoliosis and deformity conditions