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Minimally Invasive Spine surgery – Myths busted

A doctor explains with a human spine model.
Published by Dr. Umesh Srikantha on May 24, 2020

What is Minimally Invasive spine surgery?

Minimally invasive spine surgery (MISS) is a new and improvised technique of doing spine surgery. Here surgery is done using either an endoscope or small tubes, which pass through the muscle. In conventional, microscopic or open surgery, the muscles often have to be divided and retracted from their attachments to access the area of spine where surgery is being performed. In MISS, the muscle attachments are preserved and surgery is accomplished by creating a tract through the muscle, rather than dividing and retracting it to access the area of surgery.

This minimizes injury to the muscle, preserves post-op function, fastens recovery and reduces blood loss during surgery. It has been proven that patients undergoing MISS have faster recovery times, lesser post-operative pain, better post-op muscle function and return to work early as compared to patients undergoing conventional, microscopic or open surgery.

Image depicting the procedures of a open spine surgery and minimally invasive spine surgery.

Myth #1 - MISS doesn’t treat the condition fully

When we think of surgery being done with a small tube, the first concern for patients is whether its adequate, and if the visualization served by the tube or endoscope is enough for doing what can be done in a conventional/ open surgery. MISS is just an innovative technique of doing spine surgery, which means to say that, the primary objective of surgery is not compromised and clinical results of MISS are comparable or superior to conventional/ open surgery. Also, with technological developments, the visualization offered by MISS or Endoscopes is sometimes superior to that of what conventional/ open surgery can offer. Patients can thus be assured that MISS can treat the condition fully, to the same extent as that of conventional/ open surgery.

Myth #2 - MISS has higher failure rates

Nothing can be farther from the truth. As much as the surgeon would wish all his/ her surgeries to be completely successful, failures are an inevitable part of a surgical procedure. However, it might be wrong to blame any technique for its expected and fair share of complications. Failures in MISS can happen to a similar extent as that of conventional/ open surgeries. However, incidence of certain complications like infection and wound healing problems are certainly less in MISS as compared to conventional/ open surgeries.

Myth #3 - MISS is applicable in very few spinal conditions

MISS is a relatively new subject that is still in its adoption stage among many spine surgeons. Many surgeons are still going through their learning curve for this technique, which has a relatively steep learning curve. However, surgeons who have been practicing MISS for several years now and have crossed their learning curve can apply this technique for majority of spinal surgeries. For eg. In our center, more than 80% of the surgeries are being done by MISS techniques. With increasing experience in MISS, more and more conditions can be effectively treated by MISS.

Myth #4 - MISS cannot treat complex conditions

As stated above, with increasing experience, MISS can treat more complex cases. For eg. Complex spinal tumors, severe degenerative deformities and conditions affecting the cervical spine are routinely treated by minimally invasive techniques at our center. The decision to treat complex cases by MISS should be left to the operating surgeon and a balanced decision should be made based on ones experience and the condition being treated. In cases of doubt, it is always better to treat the complex condition in a conventional manner rather than compromising on the primary objective by attempting a half skilled, half hearted job through minimally invasive technique.

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Dr. Umesh Srikantha

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