About Minimally Invasive Back Surgery

Advanced technology now enables surgeons to perform surgical techniques, which formerly required long incisions, with minimally invasive techniques where the incisions are very small. This sophisticated technology is continually being refined but is already available for several back/spine problems that cause chronic pain or disability.

Terminology

• Several forms of minimally invasive surgery exist, each ending in "scopy" to indicate that the procedure is performed through a small scope. Each procedure treats a specific area. Epiduroscopy is the specific surgery for the back and spine. Its name refers to the epidural space and the scope technique. A fiberoptic scope reviews the epidural area around the spinal cord for scarring that can cause irritation and pain on the nerves. Removing the scars from the nerve roots can relieve the pain, often more successfully than other back treatments.

Technique

• The surgeon performs minimally invasive surgery through a series of several incisions or punctures rather than the large incisions of traditional surgery. Each incision is typically less than an inch in diameter. The surgeon then introduces a thin, lighted tube--an endoscope--through one of the incisions. A tiny camera shows a video view of the patient's body on screens. This enables the surgeon to view the surgical area closely. Specially designed, thin surgical instruments also go through other incisions. Computer guidance helps the surgeon navigate precisely and monitor the nerves during the procedure. The small incisions are sutured and protected by surgical tape.

Conditions Treated

• The procedures used in minimally invasive back surgery have improved and expanded over the years to cover a wide variety of back problems. Although not every back problem can be treated this way, many can, and others are being added as the technology and surgical training evolves. Among the conditions that can currently be treated are back pain, neck pain, sciatica, herniated discs, spinal stenosis, deformities such as scoliosis, spondylolisthesis, degenerative disc disease, spine fractures, spinal fusion, infection and tumors.

Advantages

• The small incisions used in minimally invasive spine surgery have numerous benefits for the patient, including less pain after the surgery and less trauma to the surrounding muscles, nerves and soft tissue. In traditional surgeries, these often result in the need for the patient to have physical therapy to regain his strength. Less invasive techniques result in less loss of blood and fewer, lighter scars. Recovery from the surgery is dramatically shorter, from the potential year-long recovery of major back surgery to a few months or less with the patient able to return to work and his normal activities much sooner. In fact, some back procedures can even be performed as outpatient surgery.

Cost

• Minimally invasive back surgery can be less costly as compared to traditional open surgeries. Time in the operating room and spent in the hospital are greatly decreased. The patient requires less pain medication after surgery. Plus, the more rapid recovery permits a faster return to work and normal activity levels with less need for special rehabilitation or caregiving services.

Patient Evaluation

• A specialist in spine surgery will evaluate the patient's condition through a physical examination that will include a medical history and prior test results. The surgeon may request additional tests such as MRI scans, CAT scans, discography or bone scans in order to decide if the patient is a good candidate for minimally invasive surgery to resolve the back problem.

Finding a Surgeon

• Surgeons who perform minimally invasive back surgery must be specifically trained in the equipment and the techniques. Patients should seek a board-certified orthopaedic surgeon or neurosurgeon who has expertise in this field. The Society for Minimally Invasive Spine Surgery consists of specialists in minimally invasive spine surgery, with members maintaining ongoing training.