Minimally invasive spine surgery was developed from the desire to effectively treat disorders of the spinal discs with minimal muscle-related injury and with rapid recovery. Minimally invasive techniques offer several advantages including tiny scars instead of one large scar, minimal muscle-related injury, a shorter hospital stay (two to three days versus five to six), reduced post-operative pain, a shorter recovery period and the ability to return to work and daily activities much sooner.

Orthopedic surgeons (surgeons specializing in the surgical treatment of bone and joint disorders) often perform minimally invasive spine procedures. The orthopedic surgeons at The George Washington University Hospital perform the following minimally invasive spine procedures:

Disc Surgery
Radiculopathy, or sciatica, causes a stabbing pain that shoots from the back or buttocks into the leg. It can also cause numbness or weakness in the leg and foot. The most frequent cause of this condition is a herniated/ruptured disc in the back, also known as lumbar disc disease. When a disc is herniated, it can create pressure against one or more of the spinal nerves, leading to severe pain, numbness or weakness in the lower back, legs and/or feet.

With minimally invasive disc surgery, a ½-inch incision is made in the back so the procedure can be performed through a small hollow tube. A tiny camera is placed into the tube that provides an excellent view of the nerve and its relationship to the herniated disc. This enables the surgeon to effectively remove the herniated disc.

Not all herniated disc patients are eligible for minimally invasive spine surgery. The ideal candidate has a well-maintained disc height, preferably with 30 percent or less disc collapse, and no evidence of severe spinal stenosis (build-up of bone in the spinal cavity). The numerous benefits to this approach include reduced time in the hospital and a faster recovery.

Spinal Stenosis Surgery
Lumbar spinal stenosis (LSS) occurs as a result of aging and everyday wear and tear on the spine. Symptoms can include persistent, progressive lower back pain (with or without radiation), numbness or weakness in the buttocks and legs and symptoms that improve with resting, lying down or bending forward. Stenosis of the spine can also occur in the cervical (upper spine and neck) or thoracic (middle spine) region of the body.

An exciting new treatment option for patients who are candidates for spinal stenosis surgery is micro-endoscopic laminotomy (MEL). MEL accomplishes the same goal as an open laminectomy but is minimally invasive.

With fluoroscopic (X-ray) guidance, a thin needle is placed under the skin on one side of the midline spine. A small, up to 1-inch incision is made around this needle. A set of tapered metal dilators are passed over the guiding needle, then the tissue and muscles are gently spread off of the underlying bone.

Next, a hollow metal cylinder is passed down to the area of the stenosis and is secured. A rigid surgical micro-endoscopic camera is placed through this working channel to provide the surgeon with a close-up, magnified view of the pathology. With this close-up operative view, the surgeon can micro-surgically remove the bone compressing the nerve roots. The numerous benefits to this approach include reduced time in the hospital and a faster recovery.

Spinal Fusion for the Lumbar Spine
Patients with degenerative spinal disease may require spinal fusion surgery to stabilize the vertebrae and to alleviate severe, chronic back pain. Spinal fusion involves correcting an unstable part of the spine by joining two or more vertebrae. Traditionally, spinal fusion is performed as open surgery, and while it has been associated with a low complication rate and pain relief for 90% of patients, many patients report experiencing back pain and fatigue as a result of muscle loss that can occur following surgery.

Laparoscopic spinal fusion is a minimally invasive alternative. The lower spinal vertebrae are repaired through an incision directly over the spine (posterior lumbar approach.) The upper spinal vertebrae are repaired through an incision in the back or side of the neck (cervical spine). The middle spinal vertebrae are repaired through an incision made in the chest and abdomen (anterior thoracic spine). The abnormal or injured vertebrae are repaired and stabilized with bone grafts, metal rods or both. The numerous benefits to this approach include reduced time in the hospital and a faster recovery.

Microscopic Lumbar Discectomy
Each year, approximately 1% of adults in the United States experience lumbar disc herniation that causes sciatica, pain that radiates from the lower back through the leg.

Microscopic lumbar discectomy is a procedure that can be performed as outpatient surgery or as inpatient surgery with a one-night stay in the hospital. The minimally invasive procedure involves making a 1" incision so the surgeon can remove the disc fragment that is causing the pain. A smaller incision leads to less blood loss, decreased post-operative pain and a quicker recovery.

Scoliosis and Kyphosis Surgery
Scoliosis is the condition of lateral, or side-to-side, spinal curves. On an X-ray, the spine of an individual with scoliosis looks more like an "S" or a "C" than a straight line. A normal spine curves gently backward (kyphosis) in the upper back and gently inward in the lower back (lordosis.) Some of the bones in a scoliotic spine may also be slightly rotated, causing a difference in the person's shoulder height when standing, a prominence in one part of the back of the chest (thorax) or a prominence in the lower back when standing or bent over. The degree of scoliosis may range from mild to severe.

Recent advances in surgery have allowed surgeons to use minimally invasive techniques to perform scoliosis surgery. Video-assisted thoracoscopic surgery (VATS), involves the use of a thoracoscope in combination with a tiny video camera. The camera is introduced into the body though small incisions of 1–4" or less and enables the surgeon to perform spinal fusion from the front of the spine. Since traditional scoliosis surgery involves making a 6–8" incision, VATS results in less blood loss, post-operative discomfort and scarring.

Insurance
Although insurance plans vary, the minimally invasive spine surgery is usually covered by insurance in the same manner that traditional spine surgery is covered. Review your insurance plan in advance to be sure.