This information is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. Always consult your doctor about your medical conditions or back problem. The Society for Minimally Invasive Spine Surgery (SMISS) does not provide medical advice, diagnosis or treatment.
Surgery should always be the last resort when it comes to treating spinal conditions in the neck and back. However, if non-operative treatments have been attempted without improvement or worsening over a 6-12 month period, then surgical treatment seems reasonable for certain specific conditions such as spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis. The decision for surgery should be individualized to the patient and the patient’s symptoms, along with their level of function.
The field of minimally invasive spine surgery continues to grow. Most surgeries today can be treated with some aspect of minimally invasive surgery. However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumors and some infections. The best options should be individualized to the patient’s diagnosis and overall patient condition.
The integration of the newest technologies that assist in MISS surgery often require that radiologic procedures be tailored to fit each operation and will often require a new scan.
In general, minimally invasive spine surgery decreases the hospital stay. In a typical endoscopic discectomy, the surgeries are performed in the same day, and the patients go home shortly after surgery on the same day.
For various types of lumbar fusion surgery, the patient typically goes home in 2-3 days, where previously they stayed in the hospital 5-7 days. Furthermore, the immediate post-operative period is marked by much less pain when using minimally invasive techniques.
The decision to return to work should be individualized to the patient, as well as the patient’s occupation. For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks. For a larger surgery such as a fusion, this may take 4-6 weeks. Again, return to work is much faster using minimally invasive surgery vs. standard open surgery but this decision is individualized to special needs of each patient.
Recovery from each surgery is different. Some patients return to full activity in 6 weeks while other patients require more time. We encourage all patients to participate in a physical therapy program to safely begin the process of returning to all normal activities.
On average, patients who have had a minimally invasive spine surgery are discharged in half the time of traditional surgery and the pain usually follows this rule. Each procedure will have a different rate of recovery.
There is no evidence that post-operative pain treatment leads to addiction.
Although most patient are provided a brace, this is for comfort only. The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as an internal brace, allows one to avoid having to wear a brace. Most patients find that the brace improves their pain for 1-2 weeks, and thereafter it is only worn occasionally.
Physical therapy is an important component of a rapid recovery. This is individualized to the patient, but in most cases, physical therapy starts 2-6 weeks after surgery, depending on the surgery performed and the patient’s overall condition.
Minimally invasive spine surgery utilizes a wide variety of advanced techniques, including lasers, endoscopes, operating microscopes, as well as computer-assisted navigation systems, so that procedures typically done with a large open incision can be done through small openings.
The decision to use one or the other types of advanced technologies depends on the individual condition and the surgery performed.
Minimally invasive spine surgery holds significant promise, in terms of less pain and more rapid recovery. However, it is important to keep in mind that this is relatively new technology, and all new technologies are associated with some degree of uncertainty.
Furthermore, certain minimally invasive techniques are highly technical and require significant training, and in cases where there is a lack of training, complications may occur. Such complications can include inadequate decompression, nerve injury, infection or persistent pain.
However, these are all risks that are associated with open surgery as well. Occasionally, due to the complexity and technical challenges of minimally invasive spine surgery, the surgeries may take a longer period of time to complete.
At present, the long-term results of minimally invasive surgery are not well studied. These assessments are ongoing. The short-term success of minimally invasive spine surgery is well established. It is clear that minimally invasive surgery allows more rapid recovery and return to work/sports. There is less post-operative pain and shorter hospital stay.
No. MISS has been used successfully for many years. However, the scope, complexity and procedures available continue to evolve at a rapid pace.
Minimally invasive surgery is highly technical. This requires significant training of the surgeon as well as the OR staff. Additionally, the equipment needed to perform these procedures safely and effectively can be very expensive.
Coverage varies greatly depending upon the insurance provider. It is best to contact your insurance company with questions and to inform your surgeon of any concerns.