Minimally Invasive Spine Surgery (MISS)

Traditional, open-spine surgery required surgeons to create a five- to six-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. Patients would spend a long time in the hospital, the wound took a longer time to heal and rehabilitation was delayed.

Today, minimally invasive spine surgery (MISS) uses a 2mm to 1-inch skin opening, modern technology, advanced imaging techniques and special medical equipment.

Minimally invasive spine surgery offers several advantages over open surgery, which typically requires large incisions, muscle stripping, more anesthesia, a long hospital stay, and a long recuperation period.

The benefits of MISS include:

• A few tiny scars instead of one large scar
• Reduced trauma to the muscles and soft tissues
• Reduced risk of muscle damage since less or no cutting of the muscle is required
• Shorter hospital stay – a few days instead of a week
• Reduced postoperative pain
• Shorter recovery time – a few months instead of a year – and quicker return to daily activities, including work
• Less blood loss during surgery
• Reduced risk of infection
• Diminished reliance on pain medications after surgery

In addition, some MIS surgeries are performed as outpatient procedures and utilize only local anesthesia — so there is less risk for an adverse reaction to general anesthesia.

Semmes Murphey Clinic pioneered MISS and our clinicians invented several of the tools and techniques that make this surgery possible.

When is MISS Suitable?

In certain cases of degenerative discs, scoliosis, kyphosis, spinal column tumors, infection, fractures, and herniated discs, minimally invasive techniques may speed recovery, minimize post-operative pain and improve the final outcome.

Many types of minimally invasive spine surgery are performed at Semmes Murphey Clinic or in area hospitals by Semmes Murphey physicians. Typically these include:

• Spinal fusion, which is often performed on degenerative disks
• Deformity corrections, such as for scoliosis
• Repair of herniated disks
• Decompression of spinal tumors
• Repair and stabilization of vertebral compression fractures
• Degenerative disc disease,
• Spinal stenosis
• Infections
• Instability

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.

Because the spinal nerves, vertebrae and discs are located deep inside the body, any approach to gain access to the spinal area requires moving the muscle tissue out of the way. In general, this is facilitated by utilizing a small incision(s) and guiding instruments and/or microscopic video cameras through these incisions.

Key to this phase is the tubular retractor which progressively dilates the soft tissues, as opposed to cutting directly through the muscles. By using tubes to keep the muscles out of the way, the surgeon can work through the incision without having to widely expose the area.

Sometimes, the surgeon will also utilize an endoscopic or microscope focused down the tube to assist with performing the surgery through a minimal access strategy. The endoscope is attached to a tiny video camera – smaller than a dime – which projects an internal view of the patient’s body onto television screens in the operating room to help guide the surgeon while he or she is working.

Once the procedure is complete, the instruments and tubular retractor can be removed, allowing the dilated tissues to come back together. The small entries are closed and covered with surgical tape.

Contrary to popular belief, lasers are very rarely used in MIS surgeries.

Not every patient, however, is a candidate for a minimally invasive approach to spine surgery.

To see if you are a candidate for this approach for spinal tumors, deformity, trauma, or degenerative disease you must be fully evaluated by a surgeon knowledgeable and experienced in these minimally invasive techniques. The spine surgeons at Semmes Murphey Clinic are leaders in the field and have been instrumental in advancing these techniques.

As with any surgical procedure, no matter how minimal, there are certain risks associated that include but are not limited to:

• Possible adverse reaction to the anesthetic
• Unexpected blood loss during the procedure
• Localized infections, no matter how small the incision area
• Though uncommon, there is always a small chance that the initial MISS surgery cannot be completed, requiring either a second procedure or full open surgery

Be sure to discuss risks with your physician.

Talk with your healthcare provider how to prepare for your surgery. Please follow your specific instructions, but there are some general preparations:

• Do not eat or drink after midnight the night before your surgery
• Tell your healthcare provider about any recent changes in your health, such as a fever
• Tell your physician about all the medicines you take. (This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners.) Your nurse or doctor will inform you of which of your regular medications to take or avoid the day of your procedure
• If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking

If you are having outpatient surgery, you must arrange to have someone remain at the Surgery Center until you are discharged and to drive you home afterward.

Before your surgery, you may need imaging tests. These may include X-rays or magnetic resonance imaging (MRI). Your SMC team will set these up in advance.

Some types of MISS can be done as an outpatient procedure. This means you can go home the same day. You will need to stay for a couple of hours after the procedure so your healthcare provider can watch for problems. You will need someone to drive you home and stay with you during your recovery.

Or, you may need to stay one or more nights in the hospital. When you’re ready to go home, you’ll need to have someone drive you.

You will have some pain after the surgery which can often go away fairly quickly. Ask your healthcare provider if there are any over-the-counter pain medicines you should not take.

You can resume a normal diet as soon as you are able to.

Your healthcare provider will give you instructions about how active you can be and how you can use your back after surgery.

• You may need to limit lifting or bending
• You may need to wear a back brace for a time after the procedure
• You may need physical therapy after the surgery to help strengthen muscles around the spine and help you recover

Your recovery time will vary depending on the type of surgery you had and your general health. You may be able to go back to normal activities in a few weeks.

Make sure to follow all of your healthcare provider’s instructions about treatment and follow-up appointments, including physical therapy. This will help make sure the surgery works well for you.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.