Minimally Invasive Spinal Surgery

During minimally invasive spine surgery, surgeons make small incisions and use small cameras or imaging devices to obtain detailed views of inside a patient's body. The detailed internal views are shown on television monitors in the operating room. Minimally invasive techniques may provide several benefits over traditional surgery, including:

• Smaller scars instead of one large scar
• Minimal muscle-related injury
• Shorter hospital stays (usually two to three days instead of five to six days)
• Reduced postoperative pain
• Shorter recovery periods
• Ability to return to work and daily activities much sooner

Types of Surgery

Neurosurgeons and orthopedic surgeons at Inland Valley Hospital perform the following minimally invasive spine procedures:

Disc Surgery

Radiculopathy may occur in the neck (cervical) or low back (lumbar). Most patients respond to nonsurgical treatment. However, when symptoms are severe enough to interfere with the enjoyment of daily activities, surgery is needed. Symptoms can include weakness in the arm or leg, and burning pain in the arm or leg (sciatica).

Cervical (Neck)

Surgeons at Inland Valley Hospital offer minimally invasive treatment for both cervical and lumbar radiculopathy. For patients with cervical radiculopathy without arthritis of the joints in the neck, a small incision can be made in the neck. A microscope decompresses the spinal nerves to relieve pain. Many patients go home the same or next day following the procedure.

For patients who have pre-existing arthritis of the neck, the best option for treatment may be anterior discectomy and either fusion or disc replacement. Anterior discectomy for decompression of the nerve roots is a minimally invasive procedure with very high success rates. The procedure involves a small incision on the neck. Once the decompression is performed, either a fusion or disc replacement may be performed. With either procedure, most patients are able to go home from the hospital the same or next day.

Lumbar (Low Back)

Lumbar radiculopathy, or sciatica, causes a stabbing pain that shoots from the back or buttocks into the leg. It can also cause numbness or weakness in the leg and foot. The most frequent cause of this condition is a herniated/ruptured disc in the back, also known as lumbar disc disease. When a disc is herniated, it can create pressure against one or more of the spinal nerves, leading to severe pain, numbness or weakness in the lower back, legs and/or feet.

With minimally invasive disc surgery, a one-half inch incision is made in the back so the procedure can be performed through a small hollow tube. A tiny camera is placed into the tube, allowing a clear view of the nerve and its relationship to the herniated disc.

This allows the surgeon to remove the herniated disc. Not all herniated disc patients are eligible for minimally invasive spine surgery. The ideal candidate has a well-maintained disc height, preferably with 30 percent or less disc collapse, and no evidence of severe spinal stenosis (build-up of bone in the spinal cavity). Benefits of this approach can include reduced time in the hospital and a faster recovery.

Spinal Stenosis Surgery

Lumbar spinal stenosis (LSS) occurs as a result of aging and everyday wear and tear on the spine. Symptoms can include persistent, progressive lower back pain (with or without radiation), numbness or weakness in the buttocks and legs and symptoms that improve with resting, lying down or bending forward. Stenosis of the spine can also occur in the cervical (upper spine and neck) or thoracic (middle spine) region of the body.

Micro-endoscopic laminotomy (MEL) is an exciting new treatment option for patients who are candidates for spinal stenosis surgery. MEL accomplishes the same goal of an open laminectomy, but is minimally invasive.

With fluoroscopic (X-ray) guidance, a thin needle is placed under the skin on one side of the midline spine. A small (up to one-inch) incision is made around this needle. A set of tapered metal dilators are passed over the guiding needle, and the tissue and muscles are then gently spread off of the underlying bone.

Next, a hollow metal cylinder is passed down to the area of the stenosis and secured. A rigid surgical micro-endoscopic camera placed through this working channel provides the surgeon with a close-up, magnified view. With this close-up operative view, the surgeon can micro-surgically remove the bone compressing the nerve roots. Benefits of this approach include reduced time in the hospital and a faster recovery.

Spinal Fusion for the Lumbar Spine

Patients who have degenerative spinal disease may require spinal fusion surgery to stabilize the vertebrae and alleviate severe, chronic back pain. Spinal fusion involves correcting an unstable part of the spine by joining two or more vertebrae. Traditional open-surgery spinal fusion has been associated with a low complication rate and pain relief for 90 percent of patients; however, many patients report back pain and fatigue as a result of muscle loss that can occur following surgery.

Laparoscopic spinal fusion is a minimally invasive alternative. The lower spinal vertebrae are repaired through an incision directly over the spine. The upper spinal vertebrae are repaired through an incision in the back or side of the neck. The middle spinal vertebrae are repaired through an incision made in the chest and abdomen. The abnormal or injured vertebrae are repaired and stabilized with bone grafts, metal rods or both. Benefits of this approach can include reduced time in the hospital and a faster recovery.