Minimally invasive procedures can result in more comfort and less downtime
Minimally invasive surgery is used to describe procedures that are performed using a small incision while still giving a surgeon complete access to the area needing treatment.
In spinal surgery, it allows surgeons to free compressed nerves and even insert implants through one to two cm incisions. Almost all aspects of spinal pathology can be treated minimally invasively with a few exceptions. These include big spinal tumours and major corrections of spinal alignment.
“A good surgeon will always try conservative methods to provide relief before resorting to surgery. These options include medications, physiotherapy, spinal exercises, injections into the spine and the damaged discs, and so forth,” said Dr James Tan, a consultant neurosurgeon at Gleneagles Singapore.
“Some patients do respond to these treatments and do not need spinal surgery.”
However, if this initial treatment fails to successfully treat the condition, a patient can be considered for minimally invasive spinal surgery, especially those for whom nerve decompression is needed due to spinal stenosis.
The technique, for instance, was very effective in treating one of Dr Tan’s patients who had been complaining of leg pain. It turned out she had severe spinal compression in her lower back, with the nerves squeezed tight due to bone spurs and a degenerated disc.
“This condition was ideal for spinal decompression using minimally invasive surgery as it allows both decompression and the insertion of screws without dissecting and damaging the muscles,” recalled Dr Tan, adding that the patient was encouraged to sit up straight after surgery and attempt to walk within 24 hours.
"She stayed in hospital for a total of three days and was discharged without needing a walking aid. If she had undergone open spinal fusion, she would have needed prolonged bedrest of at least four to five days before getting up to walk.”
Other common minimally invasive procedures include ones used to remove herniated or prolapsed discs, and spinal fusions from the back or the sides.
To allow a surgeon to work through a small opening, intra-operative x-rays, computer navigation and even intra-operative CT scans are used to provide guidance and enable the procedure to accurately target the correct area.
Not only do they lead to less scarring than open surgery, minimally invasive procedures also result in less inflammation so the patient can recover more comfortably and faster.
Open surgery is still required, however, for intradural tumours, or where tumour resection is required over extensive areas and where a surgical site has undergone previous surgery.
Minimally invasive surgery still comes with some risks, such as a possibility of infection from the incisions if the patient doesn’t keep them clean. There will also be bleeding, though this occurs on a smaller scale as the tissue will have suffered less damage.
The likelihood of nerve or spinal cord injuries is still present and it is still possible to have lasting injuries through minimally invasive surgery. As visibility of the spinal structures can be limited, an inexperienced surgeon might damage vital nerve structures and blood vessels. As a result, specialists who perform minimally invasive surgeries are first required to undergo specific training before they perform them under supervision.
Dr James Tan is a neurosurgeon practising at Gleneagles Hospital in Singapore. He subspecialises in the surgical treatment of degenerative spinal disorders.
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