Minimally Invasive Spine Surgery (MISS)
Minimally Invasive Spine Surgery (MISS) is a set of surgical procedures designed to address spinal disorders through smaller incisions than open surgery. The underlying philosophy of MISS is to perform the same operations as open surgery – for example, stabilizing the spine, decompressing nerves, or tumor removal – but with minimal disturbance to surrounding muscles and soft tissues.
Here's a breakdown of key aspects of MISS:
How it's Performed:
- Smaller Cuts: One or more tiny cuts which are usually smaller than an inch, are made by surgeons.
- Tubular Retractors: One of the most typical approaches is to pass a stiff, tube-like instrument called a tubular retractor through the tiny cut down to the spine. It establishes a tunnel to the surgical area and opens up the muscles without cutting them.
- Specialized Equipment: Long and slender instruments that can be used with the tubular retractor or through small cuts.
- Visualization: Surgeons use the following to visualize the operating site like:
- Microscope: A magnified view is given by a surgical microscope.
- Endoscope: A slim tube containing a camera and light source that enables the surgeon to look inside the body on a TV screen.
- Fluoroscopy (Real-time X-rays): For guiding instrument and implant placement.
- Computer-Assisted Navigation and Robotics: Can be employed in a few instances to improve accuracy.
With these instruments, the surgeon removes degenerated tissues, decompresses nerves or stabilizes the spine while maintaining as much of the normal anatomy as possible.
Common MISS Techniques
A. Microdiscectomy
- Purpose: Used for herniated disc removal, relieving pressure on spinal nerves.
- How it Works: The surgeon removes the damaged portion of the disc pressing against the nerve, reducing pain and numbness.
- Advantage: Faster recovery as compared to open discectomy.
B. Laminectomy/Spinal Decompression
- Purpose: Treats spinal stenosis (narrowing of the spinal canal).
- How it Works: A small part of the lamina (vertebral bone) and thickened ligaments is removed to create more space for the nerves.
- Advantage: Reduces pain, numbness, and weakness in the legs.
C. Spinal Fusion (For Stabilization)
- Purpose: Treats spinal instability, spondylolisthesis, and degenerative disc disease.
- Types of MISS Fusion Techniques:
- Transforaminal Lumbar Interbody Fusion (TLIF): Accesses the spine from the back at an angle to minimize muscle damage.
- Extreme Lateral Interbody Fusion (XLIF) / Direct Lateral Interbody Fusion (DLIF): Accesses the spine from the side, avoiding back muscles altogether.
- Percutaneous Screw Fixation: Uses small skin incisions to place screws and rods for spinal stability.
- Advantage: Faster recovery compared to open spinal fusion.
D. Vertebroplasty/Kyphoplasty (For Spinal Fractures)
- Purpose: Used to treat vertebral compression fractures, often caused by osteoporosis or trauma.
- How it Works: Bone cement is injected into the fractured vertebra to stabilize it and reduce pain.
- Advantage: Provides immediate pain relief in many cases.
E. Endoscopic Spine Surgery
- Purpose: Used for disc herniations, spinal stenosis, and nerve decompression.
- How it Works: A tiny endoscope (1 cm or less) is inserted with saline irrigation to improve visibility.
- Advantage: Minimally invasive, often performed under local anesthesia with faster recovery.
Conditions Treated with MISS
MISS is suitable for various spinal conditions, including:
- Herniated discs (bulging disc pressing on nerves)
- Spinal stenosis (narrowing of the spinal canal)
- Degenerative disc disease (age-related disc wear and tear)
- Spondylolisthesis (a vertebra slipping forward)
- Spinal deformities (such as scoliosis or kyphosis)
- Spinal tumors (removal of abnormal growths with minimal damage)
- Vertebral compression fractures (due to osteoporosis)
- Spinal infections
Benefits of MISS
In comparison to conventional open spine surgery, MISS has the following benefits:
- Smaller Scars: Produces one or more small scars rather than one long incision that results in improved cosmetic results.
- Less Pain After Surgery: Fewer muscle and tissue damages usually mean less postoperative discomfort.
- Faster Recovery: Patients may have a faster recovery to everyday activities like in some cases within weeks rather than months.
- Shorter Hospital Stay: Many MISS procedures can be done on an outpatient basis or require a shorter hospital stay ,1-2 days compared to 3-5 days for traditional surgery.
- Reduced Blood Loss: Smaller incisions and less tissue disruption result in decreased bleeding during surgery.
- Lower Risk of Infection: Smaller incisions decrease the possibility of points for the entry for bacteria.
- Reduced Muscle Damage: Steering clear of cutting or considerable retraction of muscles may result in reduced weakness and quicker recovery to usual strength.
- Reduced Dependence on Pain Medication: As a result of less postoperative pain.
- Increased Potential Lower Risk of Painkiller Dependency: Because of lower dependence on long-term pain control.
- Improved Surgical Experience for Some Patients: Could be especially useful for obese, older patients, or patients with chronic pain because of reduced incisions and less physiological stress.
Risks of MISS
Although MISS has numerous advantages, it is still a surgical procedure and thus has potential risks which are explained below:
- Infection: Either at the site of the incision or in the surgical wound.
- Excessive Bleeding: While usually less than open surgery.
- Nerve Damage: May result in numbness, weakness or other neurological symptoms. The risk is usually lower than with open surgery but it still exists.
- Blood Clots: Development of blood clots in the legs or lungs.
- Inadequate Decompression or Fusion: The less invasive technique may not always meet the desired extent of nerve decompression or proper bone fusion (non-union or pseudarthrosis). This complication can be increased in smokers and diabetic patients.
- Screw Malposition: Where screws are applied for fusion, there is a risk of the screws being mispositioned.
- Dural Tear: A tear in the dura mater, the membrane that envelops the spinal cord, and can result in cerebrospinal fluid leakage.
- Need for More Surgery: In case the first surgery fails or complications develop.
- Persistent Pain: There is a possibility that the surgery might not be able to remove the initial pain or may introduce another kind of pain.
- Reduced Spinal Flexibility: Fusion, whether it’s open or minimally invasive, can be responsible for loss of some degree of flexibility at the fused area.
- Surgeons’ Learning Curve: MISS can be technically demanding and takes specialist training and expertise.
Important Considerations
- Not all patients are suitable for MISS. The suitability of MISS on a patient will vary with the spinal condition, its severity, the patient’s general health status and the level of the surgeon’s expertise.
- Surgeon experience is very important. Success of MISS is greatly reliant on the surgeon’s experience and training with such methods as these are very complex surgery and require precision.
- Comprehensive assessment is necessary. Patients must have a thorough assessment, such as imaging studies and symptom discussion with an experienced spine surgeon, prior to MISS consideration.
Who is a Good Candidate for MISS?
- Patients with moderate spinal conditions who haven’t responded to non-surgical treatments (e.g., physical therapy, medications).
- People looking for quicker recovery and minimal scarring.
- Patients with severe spinal deformities or large tumors may still require traditional open surgery.
Expert Care in MISS
We Are Spine & Leading Surgeons
When opting for Minimally Invasive Spine Surgery, selecting a highly experienced and skilled spine surgeon is essential for optimal results. We Are Spine is a premier team of spine experts committed to providing state-of-the-art spine care, such as MISS procedures that promote quick recovery and reduced post-operative discomfort.
At We Are Spine, various world-class spine surgeons are experts in MISS and have received extensive training in the latest techniques
Expert Care in MISS
Top Doctors Specializing in MISS at We Are Spine
Dr. Shekhar Bhojraj: One of India’s leading and most renowned spine surgeons with years of experience. He has deep knowledge of complicated spinal surgeries. His leadership has made a big impact on MISS and in spine care development.
Dr. Abhay Nene: With over 28 years of experience, Dr. Nene has a special interest in minimally invasive spine surgery that focuses on procedures that involve smaller incisions, less blood loss and faster patient recovery times.
Dr. Sheetal Mohite: Dr. Mohite was got exposure to minimally invasive spine surgery while training at Rush Medical Center, Chicago, USA. He has expertise in multiple spinal disorders and is renowned for disc replacements, deformity correction, spinal fractures and minimally invasive spine surgeries.
Dr. Premik Nagad: Dr. Nagad earned an advanced fellowship in minimally invasive spinal surgery at Rush University Medical Center in Chicago, Illinois. He has an extensive background in this work and has published many articles on spinal cases of tuberculosis.
Dr. Priyank Patel: Dr. Patel has extensive global training in advanced surgical techniques, including minimally invasive spinal surgery. He is committed to the treatment of spine and spinal cord conditions with advanced methods.
Dr. Aaditya Kashikar: Dr. Kashikar underwent an international fellowship in minimally invasive spine surgery at Rush University and Medical Centre, Chicago, USA. He has more than 14 years of experience and provides solutions for many spine-related problems.
These surgeons use this cutting-edge technology to give patients the best possible treatment, which leads to a faster recovery, less pain and a better quality of life.
In conclusion, Minimally Invasive Spine Surgery provides a less invasive option for variety of spinal conditions that would otherwise require an open surgery. It helps to achieve quicker recovery with less pain and smaller scars. But it is important to recognize the risks involved with this surgery and talk with an experienced spine specialist about the most effective treatment.
If you are thinking of Minimally Invasive Spine Surgery, meeting with the experts at We Are Spine will help you to determine the course of treatment for your problem. With a team of internationally educated and highly qualified surgeons, you can get world-class treatment and the most advanced surgical techniques available today.