MISS, an abbreviation for minimally invasive spine surgery, is now one of the latest surgical treatments for various spinal conditions in Turkey. This article explains its benefits, features, and future.
Facts about minimally invasive spine surgery
Minimally invasive spine procedures in Turkey have brought a scientific revolution in the past two decades in the field of back and spine surgeries, resulting in better outcomes and shorter recovery times.
Today, over a million spinal surgeries are performed worldwide each year, many of which are done using minimally invasive spine surgery (MISS) techniques.
The rate of minimally invasive spine surgery has increased with the advancement of three-dimensional imaging techniques. In 2010, it was one out of six spinal surgeries in the United States. After just six years, in 2016, this number approached one out of every three. Current estimates indicate that more than half of spinal surgeries now utilize minimally invasive techniques.
Unsurprisingly, minimally invasive spine surgery is now available to many candidates who were not previously considered viable. With continued technological advancements, many patients suffering from various spinal conditions have achieved remarkable results through this technique.
What is minimally invasive spine surgery (MISS)?
The term “minimally invasive” is relative. It refers to the least invasive procedure compared to traditional open spine surgery. Although there is no clear definition of minimally invasive surgery (MIS), the goals are always the same: to provide the same results as open surgeries with less pain, fewer complications, and shorter recovery times.
Minimally invasive procedures may require special imaging before spine surgery. The surgeon will then upload these images to integrate with computer programs to create three-dimensional representations of the spinal anatomy.
The surgeon can then use the pre-loaded images to determine the precise method to be followed in the operating room.
This way, surgical instruments and any necessary equipment can be specifically identified and ready for use.
The imaging technique also allows the surgeon to see what they are doing on a computer screen during the operation.
Minimally invasive spine surgery can sometimes be performed through a small, one-inch incision.
How does minimally invasive spine surgery differ from open spine surgery?
Open spine surgery involves making an incision, typically about five to six inches long, and then removing the muscles to perform an operation on the bones.
On the other hand, minimally invasive spine surgery requires an incision of about one inch in length and uses a special tool called a retractor to move the muscles aside. This causes less shock to your muscles, meaning less pain after surgery and faster recovery.
During open spine surgery, the surgeon wears a pair of surgical magnifying glasses and small magnifying lenses attached to a pair of glasses to help them see their work without any unique technology to allow visual access to the site of spine surgery.
Traditional surgery generally requires a larger incision, and because this incision cuts off blood supply to many muscle tissues, the recovery time is longer.
The focus is on the bone itself at the expense of surrounding tissues. Individual focus on muscular and bony stability often leads to compromised function and higher levels of post-surgical pain.
In minimally invasive spine surgery, more preparation and image review are required to understand three-dimensional anatomy better.
Reviewing the anatomy before spine surgery is worth the additional time. Before surgery, the surgeon has a three-dimensional view of the spine, which gives them more information than directly visualizing the anatomy.
Access to this technology means that surprises in the operating room are rare.
Surgical tools used in minimally invasive spine surgery
Generally, the tools required for less invasive procedures are longer, thinner, and have curved edges as the surgeon works through a tiny incision.
Magnifying glasses: Typically used during open procedures rather than minimally invasive ones, these are a pair of small magnifying glasses that are attached directly to the surgical glasses.
They help your surgeon see your body and their tools during their work.
- Retractor: This is a long tool with a curved end designed to hold tissues like muscles, organs, or other body tissues away from the path so the surgeon can access your spine with minimal impact on different tissues.
- Endoscope: This tool is used for endoscopic spine surgery, a type of minimally invasive spine surgery. It consists of a camera mounted on a long, narrow lens, a cable, and a light source. The cable connects to a screen through which the surgeon can see the area they’re working on.
- Tubular retractor: In some cases, the retractor used by the surgeon to hold other tissues away from the path is a tube, the tubular retractor. It acts as a tunnel through which the microscope and surgical tools are passed, passing through the tunnel of back muscles rather than separating them from the spine, as in open surgeries. This minimally invasive approach reduces muscle damage and blood loss during spine surgery.
Benefits of minimally invasive spine surgery
In addition to shorter recovery periods and improved function associated with MISS, other benefits include:
- Shorter hospital stays
- Reduced risk of infection
- Less postoperative pain
- Less blood loss during spine surgery
- Less damage to soft tissues
- Reduced scarring
- Faster return to daily activities, including work, self-care, and leisure time
- Less rehabilitation after spine surgery
- Better quality of life after spine surgery
Is endoscopic spine surgery considered “minimally invasive”?
There are many types of minimally invasive spine surgery, including Endoscopic spine surgery (ESS), which offers the same benefits mentioned above.
Additionally, small incisions and the ability to precisely target the surgical site lead to less blood loss and faster recovery.
Moreover, most endoscopic spine procedures can be completed in less than an hour.
During the procedure, the endoscopic spine surgeons make a small incision about an inch long through which they insert a tube-like instrument called a tubular retractor into your back. A small camera is then inserted through the retractor into the surgical area.
While the retractors keep the incision open so the surgeon can access the surgical site.
The number of procedures that can be done endoscopically is continually increasing, although some still require other approaches, and ESS may not be suitable for conditions such as scoliosis, spinal instability, or cancer.
Furthermore, since it is still considered an innovative procedure, finding a surgeon with enough experience to be highly skilled in this technique may be challenging.
Am I a candidate for minimally invasive spine surgery in Turkey?
Almost all spinal surgeries involve freeing nerves and removing bone or other compressive structures away from the nerves to relieve them.
When spinal movement becomes painful due to nerve damage or compression, spinal fusion may be needed to restore stability and immobilize the spine. This involves using devices to fuse the vertebrae.
On the other hand, relieving pressure on the nerves requires removing bone spurs, damaged discs, or tissues pressing on the spinal nerves, causing back pain or radiculopathy (a nerve disorder that can cause limb pain or weakness).
While diagnosis alone is insufficient to determine the suitability for minimally invasive spine surgery, procedures typically performed using minimally invasive surgical techniques include:
- Spinal fusion
- Decompression of spinal nerves
- Microscopic disc removal between vertebrae
- Fewer hole procedures to relieve pressure on nerve roots and nerves
- Excision of herniated spinal disc (herniated disc)
- Laminotomy
- Spinal vertebrae repair
- And spinal alignment surgery
Your specific condition, including the diagnosis, surgical goals, general health status, and lifestyle determine your surgeon’s surgical approach.
However, one key consideration is the extent or area of the procedure; often, the least invasive method for a localized problem at a single level can be addressed through a small incision.
At the same time, individuals with more severe problems, such as certain cases of scoliosis or spinal issues affecting more than one vertebra, may require traditional open surgery. The fewer levels involved, the more localized the disease, the more likely a minimally invasive approach is.
However, your diagnosis is not the only factor to consider. Considering your lifestyle and surgical goals, a comprehensive assessment of the condition is essential to the surgical decision-making process.
Whatever type of spine surgery you ultimately undergo, you should make the decision in collaboration with your surgeon. Your specialist will explain the risks, benefits, and alternatives to surgery.
MISS has become more common in recent years because patients tend to recover much faster and with less pain than with open surgeries.
MISS may be performed in outpatient clinics, while open surgeries are generally performed in hospitals, where they come with greater risks, including more blood loss, more pain, and a greater need for intravenous pain relief.
While the surgical precautions are usually the same in either scenario, patients should avoid bending, lifting, and twisting for six weeks. Minimally invasive surgeries cause less damage to muscles and soft tissues. This generally means greater ease of movement, significantly less pain, and a faster and easier return to previous levels of function.
A 2020 study found that patients who underwent non invasive back surgery for decompression and fusion resumed work and driving within three weeks of the surgery. Meanwhile, open decompression and fusion surgeries may require months of recovery.
Although uncommon, minimally invasive procedures also have some potential drawbacks, such as not being completed as planned, which can lead to a second or fully open surgical procedure. Additionally, as a newer technique, some surgeons may lack the training or experience to ensure a strong chance of a positive outcome.
In any spine and spinal cord surgery, whether open or minimally invasive, there are some potential risks. These include:
- A potential adverse reaction to anesthesia
- Unexpected blood loss during surgery
- Infection at the surgical site
Robots in minimally invasive spine surgery in Turkey
Robotic-assisted surgeries have been increasingly growing. Currently, the central prominent role of robots in spine surgery is assisting in placing screws accurately and precisely in the spine. A descriptive study in 2018 found that robotic assistance in this manner is sufficiently accurate on a highly consistent basis.
However, one downside of this technology is that the surgeon cannot feel what they do during the surgery. During open surgery, they can easily feel whether the screw is engaging with a hard piece of bone and creating a solid connection with it or not.
Issues can arise when the robot replaces the surgeon’s hands, mainly when operating on patients with decreased bone density.
Additionally, it is still unclear how robot assistance affects exposure to radiation, length of hospital stay, and operation time. Robots are not yet ready for “full adoption,” but the field is moving in that direction. Research suggests that robots’ role may expand to include more complex surgical interventions, such as nerve decompression and spinal disc removal. It is also expected that while future robots will not replace surgeons, they will assist surgeons in making minimally invasive spine surgery safer and more effective.
Artificial intelligence (AI), augmented reality (AR), and virtual reality (VR) in minimally invasive spine surgery
While these technologies can potentially improve outcomes in minimally invasive spine surgery, their widespread use has not yet been implemented.
A 2019 study found that artificial intelligence can assist in navigating surgical procedures, enhance surgical workflow, and ensure patient safety.
Similarly, studies indicate that augmented reality and virtual reality also have specific potential; they have been shown to improve surgical accuracy and patient outcomes while reducing radiation exposure.
However, while these technologies are still considered nascent, little research has explored their effectiveness so far.
As minimally invasive spine surgery technology continues to evolve, one thing we can rely on is the increasing number of surgeries requiring shorter recovery periods.
As the pandemic taught us, hospitals can become overwhelmed with patients. The future of spine surgery is the ability to quickly and safely return patients to their home environments.
As you well know, back pain can seriously interfere with your quality of life. Limited movement, discomfort, spasms, and sleepless nights associated with back problems can affect your work, hobbies, and relationships.
Don’t wait to ask your doctor if you are a candidate for minimally invasive spine surgery.
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