When you think of spinal cord surgery, you likely envision a large incision that will leave an unpleasant scar and a painful and lengthy recovery journey. Luckily, modern technology and medicine have availed less invasive solutions and procedures that mean a much shorter recovery period and barely-visible scars. These procedures represent a significant change in the treatment options that healthcare providers can recommend to patients suffering from various painful spine conditions. One of the procedures is minimally invasive spine surgery.

Minimally Invasive spine surgery is a safe procedure. However, the outcome can be unforeseeable when the surgeon's experience and skills are questionable. If you wish to try this surgical procedure to cure your spine problem and seek the services in LA, you require the service of an experienced laser spine surgeon. At Dr. Rappard's Practice, we offer professional treatment and guidance to each patient to achieve the best results from the surgical procedure. Do not hesitate to call us for help.

Overview of Minimally Invasive Spine Surgery Los Angeles

Minimally invasive spine surgery (MISS) is a form of surgery conducted on the spine bones (backbone) using minimally invasive methods. In open traditional spine surgery, the surgeon makes one lengthy cut (incision) through the skin using a scalpel. To help the surgeon view the surgical area clearly, they separate from bone or pull/spread out of the way a relatively significant amount of surrounding soft tissues and muscles. This can lead to more pain and muscle damage after the surgery.

In a minimally invasive spine procedure, the surgeon makes a single or several small incisions (approximately half an inch) through the skin. They will then place an endoscope or small metallic tube through the cut to enable them to work with smaller incisions. Working through a smaller operative field causes less soft tissue and muscle damage than working through one long incision.

Common Spine Surgeries Conducted Using the Minimally Invasive Technique

There are two common types of spinal cord surgeries performed using the minimally invasive technique:

Minimally Invasive Lumbar Discectomy

A herniated disc in your lower back that nips a nerve might result in severe pain in the leg, weakness, or numbness. A surgeon removes the disk in a procedure known as a discectomy.

The surgeon will position you face-down during this surgical procedure and then make a small cut over the herniated disc's location. They will then insert the tubular retractor and remove a small quantity of your lamina to better view the disk and spinal nerve. The surgeon will carefully retract the nerves and remove only the affected disc.

This technique could also apply to the neck-located herniated discs. The surgeon conducts the procedure via the back of your neck. The procedure is known as minimally invasive posterior cervical microdiscectomy/foraminotomy.

Minimally Invasive Lumbar Fusion

A surgeon may perform a standard open lumbar fusion from the side or the back via the abdomen. A minimally invasive lumbar fusion could be conducted in the same manner.

A common minimally invasive spine surgery fusion is the TLIF (transforaminal lumbar interbody fusion). Using this method, the surgeon accesses your spinal cord slightly from the side, reducing the amount of spinal nerve they must move.

In a minimally invasive lumbar interbody fusion, the surgeon will need you to lie facing down and then place one tubular retractor on each side of your spinal cord. This approach keeps the bone and midline ligaments from being disrupted. Using the tubular retractors, your surgeon removes the disk and the lamina, places the bone graft in the disc space, and places rods or screws to provide further support. At times the surgeon uses an extra bone graft apart from your bone to enhance the chances of healing.

When to Seek MISS

Most people with back pains will not require surgery. Your doctor may recommend surgery of your spinal cord if you are suffering from a back-related problem that has not improved with other treatments, for instance, physical therapy or medicine. If you are still experiencing much pain after undergoing any other type of treatment, spine surgery may correct the problem. However, spinal cord surgery cannot fix all back problems. Your doctor will only recommend a surgical procedure if you suffer from a condition that the procedure may help. These problems include cases like:

  • Herniated disc.
  • Spinal deformities such as kyphosis and scoliosis.
  • Spinal stenosis (spinal canal narrowing).
  • Spinal instability.
  • Fractured vertebra.
  • Spondylolysis (a default in a section of the lower vertebrae).
  • Spine infection.
  • Removal of a spine tumor.

If you consider spine surgery, consult your doctor if minimally invasive spine surgery is an option. Not all forms of spinal cord surgeries can be conducted with the minimally invasive technique. Also, not all surgery facilities, including hospitals, are equipped to perform MISS.

Candidates for MISS

Not all patients are candidates for MISS. There are particular indications for MISS—when it is effective and when patients should not go for it for safety reasons. Each surgery ought to be personalized for the technique and patient. But before you even consider MISS, the spine care team should determine, during your case evaluation, that other treatment methods exist, which you should try first before opting for surgery.

Preparing for The MISS

Do the following in preparation for the minimally invasive spine surgery:

  • Ensure your surgeon reviews any product you take shortly before your surgery date. You may have to quit using non-essential herbal remedies and medications as they might react badly with anesthetics and other medicines that may be administered.
  • Exercise regularly to keep your muscles and the entire body in shape. This will help shorten your recovery period.
  • Stop smoking if you smoke. Ask your doctor for assistance. Some programs and medications can assist you in quitting.

Your surgeon will need you to undergo an MRI or x-ray test for your spine. They may give you antibiotics after and before the surgery. Antibiotics assist in preventing infection. Your doctor will advise what you may drink or eat on the night following the surgery.

What You Should Expect During the MISS

Your surgeon will administer anesthesia, which could be regional or general. Regional anesthesia numbs the spine region, while general anesthesia makes you sleep throughout the surgical procedure.

As we have seen, there are various minimally invasive methods. These methods have one aspect in common: the surgeon will make a single or several tiny cuts through the skin instead of a single long incision. The incisions are made through the back, abdomen, or chest.

Your surgeon might use an endoscope or a fluoroscope to establish where to incise. An endoscope refers to thin, telescope-resembling equipment fixed to a small video camera, which projects your spine's internal view onto a television screen in the surgery room. A fluoroscope is a portable x-ray machine that provides the spine's real-time images during surgery. Small surgical equipment is passed via the endoscope or incisions via which the surgeon has placed tubular retractors.

Tubular retractors refer to hollow, thin tubes. They create tiny workspace tunnels from your skin opening to the target region on your spinal cord. The surgeon inserts equipment through a single or several retractors. Spinal tissue and bone extracted during the surgical procedure are also removed via these tubular retractors. The retractors help hold muscles from the surgery site, so they do not interfere with the operation. When the surgeon removes the retractors, your muscles will go back to their usual position.

After the surgical procedure, the surgeon will close the incisions with stitches (sutures), staples, or glue and cover them with small bandages or surgical tape.

MISS Benefits and Risks/Complications

All surgical procedures come with risks, including ones that use the minimally invasive approach. MISS risks resemble the risks for open surgery, but various studies indicate lower infection chances for minimally invasive spine surgery. Before surgery, your healthcare provider will inform you about all the risks and take measures to avoid them. General MISS risks and complications include:

  • Post-surgery pneumonia.
  • You may react badly to the administered anesthesia.
  • Blood loss during the surgical procedure may necessitate transfusion. Slight bleeding is anticipated, but it is not usually significant.
  • The surgery site may become infected. Your healthcare provider will administer antibiotics before and after the surgical procedure to reduce infection risk.
  • Deep vein thrombosis (blood clots in the legs) could go up to your lungs (pulmonary embolism).
  • Pain at the surgery site. Some patients will feel persevering pain around the surgery area.
  • Recurring symptoms. Patients' original symptoms may become recurring.

Specific spine surgery risks include:

  • Pain from the surgical procedure itself.
  • A spinal cord, blood vessel, or nerve injury may lead to pain or, in a worst-case scenario, paralysis.
  • Leaking of the spinal fluid.
  • Damage to the surrounding tissues.

Rarely a surgeon might not be capable of completing MISS as planned. A second surgical procedure may be needed, and the approach might have to be switched to open surgery from minimally invasive.

Benefits of MISS

MISS has several benefits over the open surgery technique, including:

  • Less loss of blood during the surgical procedure.
  • Less anesthesia.
  • Less soft tissue and muscle damage.
  • Reduced infection risk.
  • Less post-surgery pain.
  • Fewer pain medications use.
  • Quicker resume of day-to-day activities, work included.
  • Shorter recovery period (few months to a year).
  • Short stay at the hospital (a few days to about one week).
  • Better cosmetic results (a few small scars to one big scar).

What To Expect When Recovering After a MISS

Compared to open surgery, MISS leads to minor muscle damage, less pain, shorter stay at the hospital, quicker recovery, and faster resuming of daily activities and work.

Generally, hospital stays for patients that have undergone MISS is between three and five days. However, the total period to fully recover varies from one person to the next and is based on the specific spinal problem the patient has, how complex the procedure was, the surgical team's expertise, age, and overall health, among other factors. Recovering completely from the surgical procedure may take several months. Inquire from your surgical team about the expected whole recovery period for the surgical procedure you underwent.

Your healthcare provider may recommend physiotherapy to assist you in regaining strength while speeding your recovery.

Ensure you show up at all post-surgery appointments for checkups with your minimally invasive spine care team. The team will check how you are progressing and respond to any concerns or questions you might have.

Consult your healthcare provider immediately if:

  • Your post-surgery pain is worsening.
  • You are experiencing a fever (above 100.4 degrees Fahrenheit or 38 degrees Celsius).
  • The fluid amount leaking from the incision increases (a little fluid amount is expected).

Visit the ER or call 911 if you:

  • Have a splitting headache.
  • Have difficulty breathing.

Factors to Look at When Seeking Medical Assistance for Your Spinal Cord Problem

To obtain the best surgery results for your back or spine pain problem in Los Angeles, you want to research and decide on a Los Angeles spine surgery center that employs the team approach in their work. Surgeons must be highly skilled, knowledgeable, and experienced when using minimally invasive methods. However, they should not be the only members of the surgical team.

An excellent spine healthcare provider team includes rehabilitation physicians, physical medicine, interventionalists (addressing the physical and mental aspects of the spine condition), pain psychologists, general neurologists, and surgeons. Do not fear asking questions concerning a stepwise plan for your spine health. If you must undergo surgery, do not hesitate to inquire about how many surgeries the surgical team has conducted before and their results.

Find an Experienced Neurointerventional Surgeon Near Me

Before deciding to undergo MISS, you must thoroughly research the disadvantages and advantages of the available procedures and what procedure would be the most appropriate for your specific condition. A minimally invasive procedure is highly effective and suitable for most conditions, but there are others where using it may worsen your condition. If you are not sure what approach is ideal for you, consult a skilled spine surgeon first.

At Dr. Rappard's Practice, we offer first-class spine surgery services in Los Angeles, CA, including consultations. We do our best to obtain the best possible results for your spine condition. If you suffer from any spine-related condition, please contact us at 424-777-7463 for our help.