A doctor explains with a human spine model.

Published Dr. Umesh Srikantha on April 12, 2020

Minimally invasive spine surgery offers several benefits to the patient. Because of the basic concept of preserving muscle attachments and reducing damage to the posterior midline bone-ligament complex, it ensures better post-operative spinal stability and better post-operative extensor muscle strength as compared to people who have undergone conventional open surgeries.

The major benefits of MISS revolve around its basic concept of causing reduced trauma to the supporting structures of the spine (Posterior tension band, lamina and Paraspinal muscles). These afore mentioned structures are usually not involved in the pathologic process and more often they are innocent bystanders that are traumatized while gaining access to the site of actual pathology. Though, from a patients’ perspective, smaller and cosmetic incisions are the most attractive benefits, the actual advantages are much more, in terms of biomechanical (Table. 2) or clinical factors. (Table. 1)

Table 1. Clinical benefits of MISS (Direct benefits to the patient)

Clinical benefits of MISS

Reduced peri-operative blood loss

Less post-op pain

Less post-op analgesic requirement

Less hospital stay duration

Early return to work and normal activity

Less incidence of post-operative wound infections (Superficial and deep)

Improved clinical outcomes (ODI scores)

Smaller incisions (cosmetically better)

ODI – Oswestry Disability Index

Table 2. Biomechanical benefits of MISS (Indirect benefits to the patient)

Biomechanical benefits of MISS	Remarks
Preserved muscle attachments	Serial dilatation to create a trans-muscular or inter-muscular tract to the area of pathology preserves muscle attachments
Reduced retraction induced damage	Reduced intramuscular pressure in adjacent muscles
Intact post-operative segmental motion	Avoids segmental hyperflexibility – a common side effect of injury to posterior tension band in conventional surgeries
Improved post-operative extensor muscle function	Extensor muscle cross-sectional area and strength better preserved after MISS
Reduced post-operative inflammatory response	Elevations in CPK, CRP, peripheral IL-6 and NKCA significantly lower after MISS as compared to conventional open procedure.
Improved short-term and long-term radiological parameters	Reduced immediate post-op T2W signal changes within multifidus and better long-term muscle cross-sectional area after MISS

CPK – Creatine Phosphokinase; CRP – C-reactive protein; IL-6 – Interleukin-6; NKCA – Natural Killer cell activity; T2W – T2 weighted MRI sequence

References:

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