Minimally Invasive Surgery

Minimally = as little as possible
Invasive = intrusive; involving the introduction of instruments into the body
Surgery = introduction of instruments into the body to treat a disorder, deformity, or injury

Minimally invasive surgery (MIS) is performed with specialized instruments and techniques that minimize disruption to the body’s tissues.

Compared to traditional, open surgical procedures, minimally invasive procedures generally:

• require less cutting of muscles or soft tissues
• use smaller incisions and leave smaller scars
• reduce a patient’s hospital stay post surgery
• require less recovery time
• allow a faster return to normal activities
• reduce the risk for infection
• may produce less pain and discomfort for the patient, necessitating fewer pain medications post surgery

At The Spine Hospital at the Neurological Institute of New York, our neurosurgeons perform minimally invasive surgery on adult and pediatric patients.

Minimally invasive procedures are typically carried out through incisions much smaller than those used in traditional procedures. In many MIS procedures, instruments called tubular dilators are inserted into incisions just a few centimeters in length. These dilators are tubes of expanding diameter that create channels through muscle and other tissue, down to the area of interest. Instead of cutting the muscles and tissues, the dilators move them aside. A final tube called a retractor fits over the dilators. Its function is to hold the tissues apart during surgery. Once the retractor is in place, the dilators can be removed.

The instruments used to perform MIS spinal procedures typically pass down through the retractors to reach the spine. Any material removed during surgery (for example, disc material or bone) is extracted up through the retractors.

Minimally invasive surgeries are performed through such small openings that the surgeon does not have the same view of the area as a surgeon performing an open procedure. To see inside the body during an MIS procedure, the surgeon may use any of the following tools and techniques:

• Endoscope: A thin, flexible tube with light and a camera at the end. The surgeon inserts the endoscope through the retractor, and the endoscope transmits video images to a large screen.
• Fluoroscopy: This technique produces X-ray images in real time–like a video X-ray. The images are projected onto a screen for the surgeon.
• Microscopy: A surgical microscope placed over the retractor can provide the surgeon with a highly magnified, brightly illuminated view of the surgical area.

Minimally invasive surgery procedures include:

• Cervical microdiscectomy– a procedure that uses a microscope and microsurgical tools to remove part of a spinal disc in the neck
• Extreme lateral interbody fusion (XLIF) – a procedure in which the surgeon accesses the spine from the side, removes a damaged disc (or discs), and places new bone in the available space.
• Image guided surgery– any procedure that uses special cameras to track instruments very precisely, like a GPS
• Kyphoplasty-  a procedure used to treat spinal fractures
• Lumbar Fusion – a procedure in which the surgeon removes certain portions of bone, and places new bone graft (bone transplant) that will fuse (grow together) with surrounding vertebrae
• Lumbar laminectomy– removing the lamina, a bone that makes up part of the vertebra, in the lumbar spine (low back)
• Lumbar microdiscectomy– a procedure in which a surgeon uses a microscope and microsurgical tools to remove part of a spinal disc in the lumbar spine
• Percutaneous pedicle fixation – the placement of metal rods and screws in sturdy sections of vertebrae called the pedicles
• Transforaminal interbody lumbar fusion (TLIF) –  a procedure in which the surgeon removes a damaged disc (or discs) and places new bone in the available space.

Not all neurosurgeons perform minimally invasive surgery; its cutting-edge tools and techniques require special training and expertise. Dr. Paul McCormick is highly trained and experienced with minimally invasive tools and techniques.

If you have any questions about surgical procedures for the spine, contact his office for information.