Most of the people over the age of 50 begin to develop the lumbar spine (lower back) problems due to natural aging of the spine. This is called degenerative spine conditions that usually occur from increased weight gain and vertebrae compression on the discs and joints in the spine. It can results in chronic pain in the lumbar spine and radiating pain in the buttocks and leg. These symptoms could become worse if not treated on time and restricting a person from performing daily activities. If a person is diagnosed with a lumbar spine condition, the doctor will suggest traditional treatment methods to reduce the pain and discomfort. Traditional treatment is often effective for mild spine problems. If a person is having more severe spine condition that cannot be treated with non-surgical treatments such as medications and physical therapy, surgeon will recommend surgical option (spine surgery) to reduce the pain and treat the conditions like spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis.
Spine surgery is an open surgery and requires a long incision to allow the surgeon to view and access the area that needs to be operated. Recently, technological advances and innovative techniques have allowed doctors to treat back and neck conditions caused by a variety of spinal disorders with a minimally invasive surgical technique as it doesn’t involve a long incision and avoid possible damage to the surrounding muscles and often results in less pain and faster recovery post surgery.
Some advantages of minimally invasive surgery include:
• Less blood loss
• Reduce trauma to the muscles and soft tissues
• Faster recovery and less rehabilitation
• Better cosmetic results due to smaller incisions
• Faster, safer and less recovery time
Minimally invasive spine surgery is used for wider range of spine procedures such as spinal fusion and decompression resulting from spinal instability, bone spurs, infection in the spine, fractured vertebra, herniated discs, scoliosis or spinal tumors. Decompression releases pressure from spinal nerves by removing portions of bone and a herniated disk. Spinal fusion corrects problems with the small bones of the vertebrae (Spine) by fusing together the painful spine so that they merge and heal into a single strong bone.
There are different types of minimally invasive spine surgery techniques:
1. Mini- open – is similar to an open surgery procedure but has fewer risks such as less blood loss during surgery and less infection risk as the incision is much smaller.
2. Tubular – this involves a tubular reactor which acts as a tunnel that passes through the back muscles to access the spine. It is commonly known as a “muscle-splitting” approach. There is less muscle damage and blood loss as compared to the open spine surgery.
3. Endoscopic – this procedure is commonly known as “keyhole surgery” because an endoscope (a tiny camera) allows the surgeon to view inside the body and treat the problem through a small surgical incision made to access the spine.
4. Fluoroscope – device that uses X-rays to see inside the body structure on a screen while operating.
These techniques can be used in specific spine surgeries such as facet thermal ablation, discectomy, foraminotomy and laminectomy and laminotomy.
Before the surgery, patient may require to undergo few tests that may include X-rays, MRI or CAT scan. Minimally invasive surgery can be done through the skin (percutaneous) or mini-open method. Spinal and decompression methods are done with tubular retractors during which a small incision is made and the tubular retractor is placed to expose the part to be treated. These tubular retractors hold the muscles open and are kept in place throughout the surgery. Surgeon will then pass small tools including operating microscope to magnify the view to treat the spinal problem through tubular retractor. Once the surgery is done, the tools and retractor will be removed and the incisions will be closed with stitches, skin glue, or staples. A bandage will be placed to cover the wound.
In minimally invasive surgery, patient may require short stay in the hospital depending on the procedure e.g. in case of endoscopic discectomy, patient can go home shortly after the surgery on the same day whereas in various types of lumbar fusion surgery, the patient may require to stay at the hospital for 2 to 3 days. Doctor will suggest some pain medications, antibiotics or some specific exercises as a part of the postoperative treatment plan to help patient to recover soon.
There are some potential risks or complications involved with these surgeries:
• Infection on the wound site
• Unexpected Blood loss
• Pain at the graft site
• Recurring symptoms
• Nerve damage
• Blood clots
• Adverse reaction to anesthesia