What is minimally invasive spine surgery?

Minimally invasive spine surgery (MISS) is a type of surgery on the bones of your spine (backbone). This type of surgery uses smaller incisions than standard surgery. This often causes less harm to nearby muscles and other tissues. It can lead to less pain and faster recovery after surgery.

The standard method of spine surgery is called open or mini-open surgery. This uses longer incisions down the back, your side, or your belly. The muscles and soft tissue around the spine would need to be moved away.

During MISS, the healthcare provider makes one or more smaller incisions. They then insert a device called a tubular retractor. This is a stiff, tube-shaped tool. It creates a tunnel to the problem area of the spine. It gently pushes aside the muscle and soft tissue around the area. The surgeon can then put small tools through the tunnel to work on the spine. The surgeon also uses a special operating microscope, high-resolution cameras, computer-assisted and robotic guidance, and real-time X-rays of the spine.

Surgeons can use MISS for some types of spine surgery. These include lumbar or cervical discectomy, decompressive laminectomy, and spinal fusion with metal rods and screws.

Why might I need minimally invasive spine surgery?

Most people who have back pain will not need surgery. Your healthcare provider might advise spine surgery if you have a back problem that hasn't gotten better with another treatment, such as medicine, chiropractic care, or physical therapy. If you still have a lot of pain, surgery on your spine might fix the problem. Spine surgery can’t fix all types of back problems, though. Your healthcare provider will advise spine surgery only if you have a type of problem that surgery may help. This includes conditions such as:

• Herniated disk

• Spinal stenosis (narrowing of the spinal canal)

• Spinal deformities (like scoliosis)

• Spinal instability

• Spondylolisthesis (when a vertebra slips forward)

• Spondylolysis or pars defect (a defect in part of a lower vertebrae)

• Fractured vertebra

• Removal of a tumor in the spine

• Infection in the spine

If you are thinking about spine surgery, ask your healthcare provider if MISS is a choice for you. Not all types of spine surgery can be done with MISS. And not all hospitals or other surgery facilities are equipped for MISS.

What are the risks of minimally invasive spine surgery?

Every surgery has risks. The risks of MISS include:

• Infection

• Excess bleeding

• Pain at the graft site

• Nerve damage

• Blood clots

• Complications from anesthesia

• Leaking of spinal fluid. This may cause headaches or other problems.

• Not enough relief of your back pain

Your own risks may vary according to your age, your general health, and the type of surgery you have. Having the surgery at a facility that is experienced in the method can help lower your risks. Talk to your healthcare provider about the risks that most apply to you. Also ask about the qualifications of the surgeons who use MISS. This includes certification on the use of specialized surgical technologies such as robotics, the number of times they have used it, and the patient outcomes.

How do I get ready for minimally invasive spine surgery?

Talk with your healthcare provider about how to prepare for your surgery. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke or use nicotine products, you’ll need to stop before your surgery. Nicotine can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Before your surgery, you may need imaging tests. These may include X-rays or MRI.

Follow any directions you are given for not eating or drinking before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever.

What happens during minimally invasive spine surgery?

MISS is done by an orthopedic surgeon or neurosurgeon and a trained medical team. The details of MISS vary depending on what part of the spine is being treated, and other factors. Your healthcare provider can help explain what to expect for your surgery. The following is an example of how MISS is done:

• You may have a type of anesthesia that numbs part of your body. You’ll also be given sedation. This will make you relaxed but awake during surgery. Or you may be given general anesthesia. This prevents pain and causes you to sleep through the surgery.

• A healthcare provider will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.

• You may be given antibiotics before and after the surgery. This is to help prevent infection.

• During the procedure, your surgeon will use a special type of X-ray to view the surgery.

• Your surgeon might inject numbing medicine (local anesthesia).

• The healthcare provider will make a small incision on your back in the area that needs to be treated. A tubular retractor is put into this incision. This will expose the part of the spine to be treated.

• The surgeon will then pass small tools through this retractor. This includes a tiny camera and a light.

• Your healthcare provider will then make the needed repairs to the spine.

• When the repairs are done, the tools and retractor are removed. The incision or incisions are closed with stitches, glue, or staples. A small bandage is put on the wound.

What happens after a minimally invasive spine surgery?

Some types of MISS can be done as an outpatient procedure. This means you can go home within 23 hours or less. You will need to stay for a couple of hours after the procedure so your healthcare provider can watch for problems. Or you may need to stay one or more nights in the hospital. When you’re ready to go home, you’ll need to have someone drive you. If a drain was placed in your wound, it usually comes out 1 to 3 days after the surgery.

You will have some pain after the surgery. This can be relieved with pain medicines, cold packs, and walking regularly. Ask your healthcare provider if there are any over-the-counter pain medicines you should not take. Often, the pain will go away fairly quickly.

You can resume a normal diet as soon as you are able to.

You will be encouraged to do breathing exercises with a spirometer during the first few days post-surgery. This allows all parts of your lungs to re-expand and clear the secretions.

A small amount of fluid may leak from your incision. This is normal. Tell your healthcare provider right away if the amount of fluid increases, or if you have a fever or pain that gets worse. Call your healthcare provider right away if you have severe symptoms, such as trouble breathing or a severe headache.

Your healthcare provider will give you instructions about how you can use your back after surgery. You may need to limit lifting or bending. You may need to wear a back brace for a time after the procedure. And you may need physical therapy after the surgery. This is to help strengthen muscles around the spine and help you recover. Your recovery time will vary depending on the type of surgery you had and your general health. You may be able to go back to normal activities in a few weeks.

Make sure to follow all of your healthcare provider’s instructions about treatment and follow-up appointments. This will help make sure the surgery works well for you.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure