What is Minimally Invasive Spine Surgery?

Thanks to advances in technology, you don’t need open back surgery to get relief from back pain. Minimally invasive spine surgery (MISS) can treat most spine problems. Traditional open back surgery requires the doctor to make a large incision down the back. The surgeon has to cut into muscle and soft tissue. 

Minimally invasive spine surgery uses a small incision, using a tubular retractor to hold it open. It’s different than an open surgery retractor in that it gently pushes aside muscle and soft tissue that surround the spine. Its tubular shape creates a tunnel, giving surgical tools access to the problem area.

There are many benefits to having minimally invasive surgery instead of open surgery.

  • Less bleeding.
  • Less scarring.
  • Less damage to surrounding tissue.
  • Faster recovery – some procedures allow you to return home the same day.

Types of Minimally Invasive Spine Surgery

Foraminotomy

When we get older, the space for nerves in the spine can become narrower. Severe back pain can result from the compression of nerves running through these openings, causing layers of fibrous tissue pinch or squeeze spinal nerves.

A foraminotomy removes some of the material from the openings to give the nerves more room thus eliminating the compression causing pain.

Laminectomy

With aging, the nerve canal in the center of the spine narrows. This can cause compression of the spinal cord and peripheral nerves, which often leads to intense back pain.

This condition is called stenosis. To decompress the nerves, a laminectomy removes the lamina, the back part of one or more vertebrae.

Kyphoplasty

Some back pain results from a fractured vertebra. This may be from trauma or weakening of bones due to age. Kyphoplasty uses a catheter to insert a surgical balloon into a fractured joint. The balloon is inflated to make space between vertebrae.

The surgeon injects surgical cement to strengthen the fractured vertebra. The cement sets in about 10 minutes. Once set, the doctor deflates the balloon and removes it from the joint.

Microdiscectomy

Spinal discs act as cushions between vertebrae. They have an outer layer of cartilage and a core filled with a gelatin-like substance. As we age, the outer layer becomes brittle and dry. It starts to crack and tear. This often leads to problems that can cause back pain.

  • Bulging disc. The material in the disc’s core presses through a weakened part of the outer layer and extends outside of the spinal joint. 
  • Disc degeneration. A disc flattens and can’t provide proper cushion.

Damaged discs don’t always cause back pain. A lot of people have disc damage and don’t know it. However, sometimes bulging or degenerated discs can irritate nearby nerves. This can cause debilitating back pain. Usually, back pain from a bulging disc or disc degeneration heals on its own. If it doesn’t get better in a couple of weeks or if it gets worse, you may need a microdiscectomy.

In a microdiscectomy, the doctor removes all or part of the disc.

Spinal Fusion

A doctor may recommend spinal fusion when back pain results from moving a spinal joint.

The doctor removes the disc from the spinal joint between two vertebrae and injects bone graft material into the area. Then he or she attaches a cage or brace held in place with screws. In a few weeks, the two vertebrae fuse together and act as one bone.

How To Prepare For Minimally Invasive Spine Surgery

  • NPO (Nil per os) after midnight. NPO means “nothing by mouth.” You’ll need to have an empty stomach when you go into surgery. This reduces the risk of pulmonary aspiration while you’re under a general anesthetic. In other words, this will prevent digested food or liquids from traveling up the esophagus and down into your lungs.
  • Tell your orthopedic surgeon what medicines you take. This includes over-the-counter meds such as aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil).
  • Report any recent changes in your health. If you’ve caught a cold or developed a fever before surgery, for example, your surgeon needs to know about it.
  • If you smoke, stop. Smoking interferes with oxygen supply to your cells. This can hinder healing after surgery.

What Happens During Minimally Invasive Spine Surgery?

You’ll be given an anesthetic so that you don’t feel the pain during surgery.

  • General anesthetic. It makes sure you’re asleep during the operation. It also blocks pain.
  • Local anesthetic. This numbs the site of the procedure. A lot of minimally invasive spine surgeries let you remain awake during the operation.

During minimally invasive spine surgery, the doctor works with a team of assistants:

  • A surgical technician prepares the surgery room and assists the surgeon during the operation.
  • A surgical assistant will perform a preoperative exam, prep you for the operation, and keep records. He or she cleans and sterilizes surgical tools and performs side tasks during the surgery.
  • An operating room registered nurse monitors your vital signs during the operation. The OR nurse also supervises the surgical technician and surgical assistant.
  • The operating room nurse manager oversees the staff of assistants and makes sure they follow proper hygiene and sterilization processes. He or she also supervises “OR” scheduling and makes sure that supplies are fully stocked.
  • A nurse anesthetist makes sure that you remain asleep during surgery and monitors your breathing.
  • The scrub tech keeps track of the tools and supplies during surgery. He or she passes the tools and supplies to the surgeon when requested.
  • A circulating tech moves around the operating room performing a variety of “non-scrub” tasks. That is, he or she handles supplies and medications that don’t have to be sterilized. The circulating tech may fill out the paperwork required during the operation.
  • One or more students may also be present during your minimally invasive spine surgery. They may assist with minor tasks, and are there to observe for educational purposes.

The surgeon uses specialized tools to perform minimally invasive spine surgery:

  • Endoscope – a small camera and light at the end of a tube. It’s inserted into the incision to guide surgical tools.
  • Calipers and gauges.
  • Tubular retractor – holds the incision open to allow entry of tools and endoscope.
  • Scalpels.
  • Forceps.
  • Scissors.
  • Suction tubes.
  • Needle holders.
  • Dissectors and probes.
  • Hooks.
  • Elevators and spreaders – for separating or dissecting bones.
  • Curettes – used for scraping tissue.
  • Screwdriver and ratchet.
  • Bone cutters.
  • Probes.
  • Osteotome – similar to a chisel, this tool is used to cut bone.


At the end of the surgery, the doctor or an assistant closes the incision with stitches, glue, or staples.

What Happens After Minimally Invasive Spine Surgery?

Recovery

  • Hospital stay. With a lot of minimally invasive spine surgeries, you only need to stay a few hours for observation. This is to watch for postoperative complications. However, more complex procedures need up to four days.
  • Recovery time. Most patients are able to return to work two weeks after minimally invasive spine surgery. For others, it might take up to six weeks.
  • Pain. Since minimally invasive spine surgery requires less cutting into tissue than open surgery, pain is easier to manage. The surgeon will likely prescribe meds to keep pain under control.

Resuming Normal Activity

Typically, you can return to work in 2-6 weeks, but what about returning to a normal life? Some patients are concerned that they won’t be able to do things they enjoy like golfing or playing tennis. There’s good news. You can start moving around shortly after minimally invasive back surgery. For example, after a lumbar fusion, which is one of the more complex surgeries, you’re ready to perform physical activities in a short time:

  • Bending, stooping and lifting exercises – 4 weeks.
  • Running, jogging, treadmill exercises – 4 to 6 weeks.
  • Swimming laps – 4 to 6 weeks.
  • Twisting exercises – 8 weeks.
  • High-impact sports or training – 4 to 6 months.

Follow Up Appointments

You’ll need to see the doctor a few times after minimally invasive spine surgery.

  • Remove stitches or staples – 10 to 14 days.
  • Follow up to check progress – 4 to 6 weeks.
  • Other follow-ups every 2 to 3 months over the next 2 years.
  • Some surgeries may need ongoing follow-ups.

Final Thoughts

When non-surgical treatments fail to give relief from back pain, you might benefit from minimally invasive spine surgery. The experts at Oasis are here to help you find out if surgery is right for you.

Start your diagnosis with our Pain Assessment Tool.

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