Minimally Invasive, Endoscopic, and Laser Spine Surgery: Facts & Fiction
The trend in spine surgery has moved toward minimally invasive procedures. Minimally invasive spine surgery (MIS) involves surgical treatment of the spine through small incisions with minimal disruption of the surrounding muscle tissue. The benefits of minimally invasive spine surgery include:
Small incisions and minimal scar tissue formation
Less damage to surrounding muscle and soft tissues
Decreased blood loss
Decreased pain and reduced need for pain medication
Quicker recovery and faster return to regular activities
Shorter hospital stays
Many procedures can be performed as outpatient surgery
Decreased risk of postoperative infection
“Open” Surgery and Minimally Invasive Surgery
Surgical procedures of the spine are often referred to as either an “open” procedure or minimally invasive. An open procedure involves making a skin incision and retracting (moving aside) any tissues overlying the anatomy that is to be worked on so that the surgeon can directly view the desired anatomy. The surgeon will view the anatomy either with the naked eye, magnifying telescopic eyeglasses called loupes, or a magnifying microscope. Traditionally, open procedures have required larger incisions and more muscle tissue distraction than minimally invasive surgery.
Minimally invasive surgical techniques utilize specialized instruments, which allow a surgical procedure to be done through smaller incisions with much less tissue disruption. One of these specialized instruments is called a tubular retractor, which is a series of gradually expanding tubes that gently and progressively dilate and separate muscles and soft tissues to expose the desired anatomy. Using specialized tools, surgery is performed through the tube.
Percutaneous Surgery
Percutaneous is a term that literally means “through the skin." Percutaneous surgery involves procedures that are performed through tiny incisions or punctures in the skin without the surgeon having a direct view of the anatomy that he or she is working on. Since the surgeon cannot see the instruments beneath the skin, the surgeon has to use a portable x-ray machine (fluoroscope) or other image-guidance technology to see where the surgical instruments are located within the body.
There are several physicians and facilities that now offer Percutaneous Disc Decompression procedures for treatment of lumbar disc herniations. These facilities often claim that these procedures provide all the benefits of traditional surgery with none of the risks.
Percutaneous disc decompression involves placing a long needle into the disc and passing some type of instrument through the needle to remove small channels of disc material from within the disc. The instrument may be a mechanical device, laser or other tool. The theory behind this treatment is that by removing disc material from within the disc, pressure on the outer wall is relieved, reducing the symptoms caused by the disc bulge.
Although the concept of treating herniated discs with these procedures is attractive, the results have not been as good as what was hoped. Percutaneous disc decompression techniques do not allow for direct visualization of the disc herniation, nerve root, or other anatomy. Because of this, it is very difficult for the surgeon to selectively remove the portion of disc that is directly pressing on the nerve without injuring the nerve.
Therefore, percutaneous techniques are non-selective, meaning that disc material is removed from within the disc, but the disc protrusion or herniation itself is often not necessarily removed directly from the nerve. Also, percutaneous discectomy is only indicated for small, contained herniations, which will typically respond to non-surgical treatment with therapy, medications, and epidural steroid injections. Because these results of percutaneous discectomy are less satisfactory than those achieved with other techniques, these procedures have largely fallen out of favor.
Percutaneous disc decompression procedures also go by the names:
Dekompressor Discectomy
Nucleotome Discectomy
LASE procedure
Percutaneous Laser Disc Decompression
Percutaneous Laser Discoplasty
Percutaneous Disc Nucleoplasty
Plasma Disc Decompression
Endoscopic and Endoscopically-Assisted Spine Surgery
An endoscope is a very thin fiber-optic video camera, which can be used to see internal portions of the body. The camera sends the images to a monitor similar to a television. The endoscope is made with built-in magnification and a light source. Surgery is performed by passing instruments through the endoscope to remove disc material or bone spurs. The major advantage of the endoscope is that it allows for the procedure to be done through a very small incision with minimal tissue damage, while allowing direct visualization of the desired anatomy via the camera.
There are different types of endoscopes. Endoscopes that are used to view the abdominal c