Minimally invasive spine surgery. Did you know all this?

Minimally invasive spine surgery represents the latest development direction of spine surgery and is sought after by patients. As minimally invasive spine techniques are developing very rapidly, it is not easy to correctly evaluate the various techniques, and only through continuous learning and practice can we make an objective evaluation. Choosing the right minimally invasive spine technique in the right patient can truly bring the advantages of minimally invasive surgery into play, and achieve faster recovery with less trauma, while at the same time the efficacy is no less than that of open surgery.

What are the common minimally invasive techniques in spine surgery?

There are three main categories of minimally invasive spine surgery, each of which has its own indications and needs to be chosen according to the patient's condition. There are of course some other categories of surgery that are performed less frequently due to their more significant drawbacks. The first category is the percutaneous puncture technique, which involves the use of a needle to go through the skin to perform some procedures. The two main types of percutaneous procedures include vertebroplasty and percutaneous pedicle screws. If there is an osteoporotic fracture, we can do a vertebroplasty, which is a procedure where a needle is inserted into the fractured bone to make some bone cement. This is a very minimally invasive procedure, and you can be discharged from the hospital in two days, and you can go down to the floor after the procedure. Percutaneous pedicle screws are screws. In the past, patients with fracture had to make a very long incision, but now they only need to make a small incision of two centimeters, and the screw is driven in through the muscle gap, so that the patient can get up earlier, and the wound is not so painful. There are other percutaneous puncture, which is a lancing technique, including nerve root blocks that are often done now. There are some herniated discs that can be given a little bit of medication next to the nerve root, and there are some cervical spondylosis that can be done that way as well. There are also some patients who may need a puncture biopsy, which can now be done more accurately with CT localization. These are all minimally invasive procedures with percutaneous puncture.

The second is access surgery. Some patients may have slipped lumbar discs, or severe spinal stenosis, and many of the bones taken out will be unstable, so some patients may need to go to the screws, and this type of surgery is not minimally invasive if you hit the screws, in fact, it is not. Minimally invasive surgery in spine surgery can be done under the channel. The so-called under the channel, originally to do a more than 10 centimeters of incision, the muscle to both sides to dial very strong. Now, if you make a small incision and do the surgery inside the muscle to muscle suture, you can also remove the disc, decompress the nerves, and then drive the screws in. So don't think it's necessarily a major surgery to put in screws, it's not like that. Recovery from this surgery is also very quick, the patient is down on the floor the next day and is discharged from the hospital after 3 to 4 days. The third is the use of endoscopy, the intervertebral foramenoscopy has a seven millimeter mirror, again a very small opening surgery, but it has a mirror to reach inside, through some equipment, can remove the protruding disc on the outside. Many surgeries are now done under a microscope, because there are very good microscope equipment, it can be magnified four or five times, so it's much clearer where the nerves are, where the discs are, and it's not as easy for damage to occur, so there are fewer complications.

Does minimally invasive spine surgery mean no incisions?

In fact, from a surgeon's point of view, the treatment of any disease can be divided into non-surgical (conservative) and surgical treatments. Therefore, no incision refers to conservative treatment, while minimally invasive spine surgery is a type of surgical treatment. Minimally invasive spine surgery is the opposite of open surgery, so is it correct to think of minimally invasive spine surgery as "minor surgery" and open surgery as "major surgery"? It's easy to understand, but only for the same disease. Currently, minimally invasive surgical techniques are available for many spinal disorders. To take a relatively extreme example, minimally invasive surgery for degenerative scoliosis is many times more traumatic than open discectomy, so the above statement must have a premise, that is, to be specific to a particular disease. By minimally invasive I don't mean a small incision is minimally invasive. There are times when a small incision can be massively invasive, and there are times when a large incision is not necessarily massively traumatic, so minimally invasive is based on the patient's injuries to evaluate the amount of trauma.

Is minimally invasive spine surgery an intervention?

The true essence of minimally invasive spine surgery is to achieve the same therapeutic goal, but with less damage associated with surgical access. For example, while open spine surgery requires stripping of muscles and damage to ligaments, minimally invasive spine surgery minimizes damage to muscles, ligaments, and other soft tissues by using percutaneous puncture techniques and transmuscular interspace access.

In fact, minimally invasive spine surgery includes all kinds of percutaneous surgery, microsurgery, channel surgery, and various combinations. Interventional therapies such as ozone therapy and radiofrequency ablation are only a part of percutaneous technology, and this type of technology often has narrower indications, so only by choosing the right cases can we achieve certain therapeutic effects.What diseases can minimally invasive spine surgery treat?Current minimally invasive spine techniques have many applications in lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis, spinal fracture, spinal tuberculosis, etc. In recent years, a lot of progress has been made in the minimally invasive treatment of cervical spine diseases and degenerative scoliosis.This can only be a specific analysis of specific diseases. Although the development of minimally invasive technology for lumbar disc herniation is relatively mature, not all patients with lumbar disc herniation can undergo minimally invasive surgery; and for some complex diseases such as degenerative scoliosis, some doctors try to minimally invasive traditional surgery, which on the one hand, has to choose the appropriate cases, and on the other hand, whether the long-term effect is better than traditional open surgery Further studies are still needed.A surgeon who has mastered both open spine surgery and minimally invasive spine surgery can best grasp the indications for minimally invasive spine surgery. Decision-making is more important than incisions, so choosing the right case is the key to the success of minimally invasive spine surgery.

What kind of spine disease patients are suitable for minimally invasive spine surgery?

Many patients come to the clinic and ask for minimally invasive spine surgery, "Doctor, I don't want to have an incision, I only want minimally invasive spine surgery."I just want minimally invasive surgery!Unfortunately, for some patients with severe spinal lesions and unrealistic demands, the only answer is "Whether you can have minimally invasive surgery or not is neither up to me nor up to you.You may have a chance to have minimally invasive surgery if you come to see me earlier for your disease."Any disease emphasizes early detection and early treatment. If you have high expectations for your health, you should start from the usual practice and prevention.Based on the current level of development of minimally invasive spine technology, realistically speaking, minimally invasive spine surgery is more suitable for early lesions.How soon can I get off the floor after minimally invasive spine surgery?

A type of day surgery of the spine is being performed.What is the concept of day surgery?It means that you are hospitalized today, then operated in the afternoon, and then you can be discharged the next day. This is a very big advancement in minimally invasive surgery, but it is not a misconception that patients are required to get out of bed immediately after surgery, or that they have to do functional exercises the next day.Although it is said that minimally invasive surgery is less traumatic than open surgery, both to the muscle tissue and the interstitial tissue, it does not mean that rehabilitation is not required after minimally invasive surgery.Nowadays, even though minimally invasive surgeries allow patients to move around on the floor after surgery, it is not recommended to return to business as usual right away, but to treat it as a surgery that requires proper rest.　 Normal minimally invasive surgery, generally will require patients to try to rest in bed on the day of surgery, then the next day you can get out of bed, that is, you can be discharged from the hospital, you can also carry out normal daytime activities, normal self-care is not a problem. However, it is not recommended to do exercise at this time.

How soon can I exercise after minimally invasive spine surgery?Between getting out of bed and 2-3 months after surgery, excessive weight bearing and functional body exercises are not recommended at this time. Generally, it is recommended to perform some body function exercises and strength training gradually 2-3 months after surgery.Specific to each patient, can be based on the recovery situation, under the advice of the doctor to exercise.