Minimally Invasive and Open Surgery Procedures
Minimally Invasive Spine Surgery: Part 1
Minimally Invasive Spine Surgery
The trend in spine surgery has moved toward minimally invasive procedures. More than 20 years ago a similar trend started with knee surgery. At that time if a patient had torn knee cartilage the surgical procedure required opening the knee. It took several weeks or months for the patient to recover. Now many knee surgeries are performed through small keyhole incisions using an arthroscopic tube. Similar advances continue to be made in spinal procedures. Devices are now available that use microscopic fiber optics that transmit anatomical images to a monitor similar to a television. The equipment is made with built-in magnification that enables the surgeon to view tiny structures through a portal.
Open Surgery versus Minimally Invasive
Spine surgical procedures are often referred to as an open procedure or minimally invasive. Open procedures require larger incisions, muscle stripping, more anesthesia, operating time, hospitalization and, the patient usually needs more time to recuperate. Minimally invasive surgical techniques utilize portals or tiny incisions made in the skin (percutaneous) through which small, specialized instruments are inserted. For example, an endoscope allows the surgeon to see an illuminated and magnified view of the operating field through a tiny incision.
Today many different types of spine surgery can be performed utilizing minimally invasive techniques. Some types of minimally invasive spine surgery use laser technology. Lasers may be used to separate or eliminate tissue. New instruments for use in minimally invasive spine surgery have been developed and continue to be refined.
Discectomy and Microdiscectomy are terms that mean the surgical removal of part or an entire intervertebral disc. The difference between these terms is that microdiscectomy uses microscopic magnification. These procedures are performed to remove a herniated or ruptured disc. The advantage to microdiscectomy is that the procedure is minimally invasive. The incision and instruments are small, which enables the patient to recover quickly.
Interbody Cage Fusion is a newer spinal implant designed to be filled with bone graft and inserted into the empty space created by a discectomy (disc removal). A cage is similar to a tiny birdcage. Bone graft is packed around the cage following implantation. Like instrumentation and fusion, the bone graft grows into and around the cage and creates a stable construct.
Laminotomy and Laminectomy
An easy way to learn the difference between these terms is to remember 'ectomy" means to remove. For example, an appendectomy is the removal of the appendix. Laminotomy and laminectomy are surgical procedures involving the lamina; a thin bony layer covering the spinal canal. The lamina may obstruct the surgeon's view of an intervertebral disc. Laminotomy is the partial removal of the lamina. Laminectomy is the complete removal of the lamina.
Laminotomy: Lamina Partially Removed
Laminectomy: Lamina Entirely Removed
If an intervertebral disc has herniated the surgeon may need to remove pieces of the disc compressing nerve roots. With part or all of the lamina removed, the surgeon has a better view of the disc. These procedures also provide greater access to the spinal canal and other parts of the spinal anatomy.
This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.