Minimally invasive lumbar surgery is an alternative to open lumbar surgery that allows the surgeon to access the spine through smaller incisions. Special techniques and instruments, used in this approach, minimize muscle and soft tissue damage and also offer several advantages over the traditional open approach which include smaller scars, less blood loss, lower postoperative pain, faster recovery and shorter hospital stay. Thus, after a minimally invasive surgery, patients return to their normal activities sooner when compared to that after an open surgery.
The minimally invasive approach is available for lumbar discectomy, lumbar fusion and lumbar laminectomy. With advancements in technology and spinal instrumentation, more spinal surgeries are possible through a minimally invasive approach. However, certain conditions may still require an open approach for direct visualization and better access to the spine. Thus, the best approach for a patient depends on both the patient’s condition and the surgeon’s preference and is decided only after an evaluation of the patient’s condition and a discussion between the patient and the surgeon.
Minimally invasive lumbar surgery is performed through a few small incisions on the back rather than one large incision. To allow for better visualization with the smaller incisions, the whole procedure is conducted under a C-arm; a device for intra-operative fluoroscopy. The C-arm provides real time X-ray images of the patient’s spinal anatomy to guide the surgeon during the procedure. To reach the patient’s spine, the back muscles are not cut but are instead split or retracted using special surgical instruments such as retraction blades and tubes resulting in less muscle damage and blood loss, reducing the need for blood transfusion. To facilitate surgery through the small incisions, special spinal instruments are used. For example, Sextant spinal system for spine fusions has been especially designed for spinal fusion surgeries through the minimally invasive approach. It allows the surgeon to attach the screws and rod to the vertebrae through small skin incisions with minimal damage to the muscles. The soft tissue and the muscles are then put back in their normal position and the incision is closed with glue rather than staples or sutures. The recovery is much faster than open approach and the patient is discharged within a few days of the surgery.
The incisions should be kept clean and dry till they heal completely. Lifting, bending and twisting of the back should be avoided for a few weeks as advised by the surgeon.
With minimally invasive approach the same procedure is performed as in open approach, thus the risks associated with minimally invasive procedure are similar to that with open surgery and may include bleeding, infection and nerve injury.
