Minimally Invasive Spine Surgery (MISS)
Updated: Nov 26, 2020
Minimally invasive spine surgery (MISS) is an alternative to traditional open surgical procedures performed to treat different spinal disorders, such as degenerative disc disease, herniated disc, scoliosis, and spinal stenosis.
Spine surgery performed minimally invasively offers many potential benefits, such as small incisions, less cutting through soft tissues (eg, ligaments, muscles), outpatient options, less post-operative pain, and faster recovery.
Common Spine Surgery Goals
Whether spine surgery is performed open or minimally invasively, two main goals remain the same.
#1. Decompression: Spinal decompression involves removing tissue that is compressing nerve structures, such as a spinal nerve root and/or the spinal cord. Bone spurs and/or fragments from a herniated disc are examples of tissues that can cause neural compression.
#2. Stabilization: Abnormal movement of one or more levels or segments of the spine can cause back or neck pain. Surgical procedures that stabilize the spine involve spinal instrumentation and fusion.
Minimally Invasive Spine Surgery Techniques
Minimally invasive spine surgery may involve percutaneous (through the skin) or mini-open (small incision) procedures. Instead of cutting through soft tissues, segmental tubular retraction creates an expandable tunnel that passes between muscles to access the spinal column. An endoscope, a tiny video camera, projects visualization of the surgical area on a monitor during the procedure to the spine surgeon. The surgery is performed through the tubular retraction system utilizing specially designed instruments.
Types of surgical procedures performed minimally invasively include discectomy or microdiscectomy, foraminotomy or microforaminotomy, microlaminectomy and microlaminotomy.
Surgical imaging systems and image-guidance technologies, such as fluoroscopy (real time x-ray), are utilized during surgery to pinpoint key aspects of the patient’s spinal anatomy. Furthermore, surgical imaging projects 2D and 3D views and guides placement of instrumentation, such as pedicle screws.
Spinal Disorders Treated Using MISS
Degenerative disc disease Degenerative disc disease (DDD) usually develops gradually in older adults affecting the spine’s intervertebral discs. Normal cellular age-related changes in the body can cause discs to stiffen, lose flexibility, strength, height and shape, and ability to absorb and distribute forces associated with movement. These structural changes may increase risk for disc herniation.
Herniated discs A herniated disc, sometimes called a slipped disc or ruptured disc, occurs when the gel-like inner core of an intervertebral disc breaks through the protective outer layer of the disc. Besides the damaged disc, the interior gel can irritate and inflame nearby spinal nerves and cause back pain.
Spinal stenosis Spinal stenosis occurs when spinal nerve roots and/or the spinal cord become compressed. The nerve roots branch off the spinal cord and exit the spinal canal through passageways called neuroforamen. Nerve and/or spinal cord compression can cause symptoms such as pain, weakness, tingling sensations, and numbness. Sometimes, pain and symptoms travel into the arms or legs.
Risks of Minimally Invasive Spine Surgery
Any type of spine surgery offers potential benefits and risks—complications can occur. Listed below are several possible complications which are although very rare but they may occur during and/or after spine surgery—both open and minimally invasive spine surgical procedures.
Bleeding
Blood clots
Nerve damage
Return of symptoms
Failed fusion (known as pseudarthrosis or non-union)
Infection
Are You a Candidate for Minimally Invasive Spine Surgery?
Minimally invasive spine surgery offers many benefits: smaller incisions, less pain, fewer risks, and quicker recovery times. However, MISS is still a surgical procedure. Keep in mind that less than 10% of people with back or neck pain need spine surgery— and, surgery should be the last resort for treating pain caused by a spinal disorder.
If non-surgical treatments, such as medications, physical therapy, and/or spinal injections do not effectively reduce symptoms in 1-3 months, then you may be a candidate for spine surgery. Of course, certain types of spinal disorders warrant urgent or immediate surgical intervention. Talk openly with your doctor or spine specialist about your pain and symptoms, along with the results of different therapies you’ve tried. There are many considerations you and your doctor need to discuss before making a surgical decision to treat back or neck pain—and if minimally invasive spine surgery may be an option for you.
Advantages of Minimally Invasive Spine Surgery
If you are considering spine surgery, you may want to find out if minimally invasive spine surgery (MISS) is a good option for you. Compared to traditional open spine surgery, MISS offers several advantages. However, it's important to keep in mind that not everyone is a good candidate for MISS.
Here are some advantages of minimally invasive spine surgery compared to open traditional spine surgery:
Faster recovery after surgery
Less time spent in the hospital (Depending on the procedure, the average hospital stay for MISS is typically less than 2 days.)
Can be performed at an outpatient surgery center (You can go home within hours after surgery.)
Less anesthesia
Less post-operative pain
Smaller incisions (rather than one large incision)
Less scarring
Less soft tissue and muscle damage
Reduced blood loss during surgery
Reduced risk of infection (especially because incisions are significantly smaller in MISS)
Minimally invasive spine surgery seems like an attractive option, but that doesn't mean that everyone is a good candidate for MISS.
For example, if you have a certain type of spinal tumor or infection, minimally invasive spine surgery may not be an option for you. However, MISS may be a good choice for older patients or other patients who are considered poor candidates for traditional open spine surgery.
As always, talk to your doctor about any questions or concerns you may have regarding minimally invasive spine surgery and be sure to weigh the advantages and disadvantages of MISS.