In general, the goal of minimally invasive spine (MIS) surgery is to stabilize the vertebral bones and spinal joints and/or relieve pressure being applied to the spinal nerves — often a result of conditions such as spinal instability, bone spurs, herniated discs, scoliosis or spinal tumors.
As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. Because of the reduced trauma to the muscles and soft tissues (compared to open procedures), the potential benefits are:
- Better cosmetic results from smaller skin incisions (sometimes as small as several millimeters)
- Less blood loss from surgery
- Reduced risk of muscle damage, since less or no cutting of the muscle is required
- Reduced risk of infection and postoperative pain
- Faster recovery from surgery and less rehabilitation required
- Diminished reliance on pain medications after surgery
Thoracic or Lumbar Micro Discectomy
Surgery for disc herniation usually involves a discectomy, in which a spine surgeon removes the protruding disc fragment. In some cases, a degenerated disc may need to be removed entirely and the adjacent vertebrae fused together to stabilize the spine.
Surgery for thoracic disc herniation is much more complicated than surgery for a cervical or lumbar herniation. The bones that make the thoracic region more stable and less prone to disc herniation—the ribs and sternum—also make it more difficult for a surgeon to access the region. The thoracic cavity also contains vital organs such as the heart and the lungs.
Because of these obstacles, thoracic discectomy carries an increased risk for complications such as pulmonary issues and irreversible spinal cord injury. That’s why many spine surgeons don’t perform the procedure.
Laminectomy with Fusion
Lumbar laminectomy is a surgical procedure to remove bony pressure on the spinal canal and spinal nerves to relieve buttock, hip, and leg pain.
Occasionally disc material needs to be removed. If there is instability of your spine you may require a posterior fusion of the spine. This procedure involves taking either bone graft (from your pelvis or spine), or synthetic bone graft and packing it around the spine to create a solid bony fusion across the unstable segments. Usually titanium screws and rods are placed to increase the stability. Sometimes the lumbar disc is removed and replaced with a plastic cage filled with bone graft.
Instrumentation & Fusion
Instrumented spinal fusion is a procedure in which a surgeon uses instruments such as rods, plates, and screws to help bones in the spine fuse, or grow together.
An instrumented spinal fusion is performed in adult or pediatric patients when the spine has been weakened by degenerative conditions, deformity, trauma, tumor, or surgery. The purpose of the procedure is to restore spinal strength so that the spine can withstand normal day-to-day stresses and can also protect the spinal cord and nerves against more excessive forces that are occasionally encountered.
The basic premise of a spinal fusion is the creation of a bone “bridge” that connects strong and healthy bone above the weakened spinal segment with strong and healthy bone below it. To build this bone bridge, the surgeon places bone graft, or small pieces of bone, across the span where fusion is desired. The graft may be taken from the patient’s own body (an autograft) or from a bone bank (an allograft).
Cervical decompression surgery is a procedure that removes any structures compressing the nerves in the neck. The cervical section of the spine begins at the base of the skull and supports the neck. During surgery, a small section of the bone that is compressing the nerve root is removed to alleviate pressure and allow the nerve root to heal. Sometimes fragments of material from the spine are lodged under the nerve root as well, and are removed during cervical decompression surgery.
If too much of the bony structures pressing on the nerve needs to be removed, it can affect the stability of the spine. In such cases, cervical decompression surgery must be combined with cervical fusion surgery. Spinal fusion corrects the instability by permanently joining (fusing) the vertebrae together to prevent them from moving. If the cervical decompression surgery is minimally invasive, the structure of the spine will stay intact and there will be no need for spinal fusion.
Cervical spinal stenosis is one of the most common reasons for cervical decompression surgery. Cervical spinal stenosis is a condition in which the spinal canal and/or the opening in the vertebra (vertebral foramen) in the neck become narrowed. If the narrowing is substantial it can cause nerve compression and result in pain, loss of balance and coordination, neck stiffness and in severe cases, incontinence.
A compression fracture or a break in one of your vertebra can be painful. It can also make it difficult to move freely. That’s because a break can result in bone fragments rubbing against each other.
Surgery can help treat such fractures. For example, kyphoplasty and vertebroplasty are minimally invasive procedures that are often performed together. Usually, they can be done without a hospital stay.
In vertebroplasty, a doctor injects a cement mixture into the bone to give it strength.
Kyphoplasty makes room for the mixture. In this procedure, a doctor inserts and inflates a balloon to create an opening for the mixture. The balloon is removed after the cement is injected. Kyphoplasty is sometimes referred to as balloon vertebroplasty.
Both of these procedures are more likely to be successful if done within two months of a fracture diagnosis. They can help relieve pain and improve mobility when other measures fail to provide relief.
Sacroiliac Joint Dysfunction
The SI joints are located between the iliac bones and the sacrum, connecting the spine to the hips. The two joints provide support and stability, and play a major role in absorbing impact when walking and lifting. From the back, the SI joints are located below the waist where two dimples are sometimes visible.
Strong ligaments and muscles support the SI joints. There is a very small amount of motion in the joint for normal body flexibility. As we age our bones become arthritic and ligaments stiffen. When the cartilage wears down, the bones may rub together causing pain. The SI joint is a synovial joint filled with fluid. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly.
The SI joint can become painful when the ligaments become too loose or too tight. This can occur as the result of a fall, work injury, car accident, pregnancy and childbirth, hip/spine surgery (laminectomy, lumbar fusion), etc (or you can put “for an unknown reason”).
Sacroiliac joint pain can occur when movement in the pelvis is not the same on both sides. Uneven movement may occur when one leg is longer or weaker than the other, or with arthritis in the hip or knee problems. Autoimmune diseases, such as ankylosingspondyloarthropathy, and biomechanical conditions, such as wearing a walking boot following foot/ankle surgery or non-supportive footwear, can lead to degenerative sacroiliitis.