Minimally Invasive Spine Surgery
 
Minimally invasive spine surgery is the performance of surgery through tiny incisions, usually with the aid of microscopes or endoscopic visualization (very small devices or cameras designed for viewing internal portions of the body). 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.

These techniques offer several advantages including a few tiny scars instead of one large scar, minimal muscle-related injury, a shorter hospital stay (just 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.

Neurosurgeons (surgeons who specialize in the treatment of diseases and disorders of the brain, spinal cord, peripheral nervous system and sympathetic nervous system) often perform minimally invasive spine procedures. The neurosurgeons at The George Washington University Hospital perform the following minimally invasive spine procedures:
 
Lumbar and Cervical Microdiscectomy
 
Designed for patients with uncomplicated, herniated discs accompanied by the following:

• Leg and low back pain.
• Pain that has not responded to conventional treatments such as rest, analgesics, physical therapy, chiropractic treatment and medications.
• Herniated lumbar discs confirmed by X-ray studies.

The lumbar and cervical microdiscectomy is not designed for patients with symptoms from arthritis of the spinal joints or very large bone spurs that may cause a similar type of pain. Smaller bone spurs can be treated.

During the microdiscectomy procedure, surgeons remove herniated discs that are pushing on nerves in the lower back and neck. With the patient under anesthesia, surgeons make a small incision with X-ray guidance over the disc. They insert a series of progressively bigger tubes over the disc until they have adequate portals to visualize the disc material, using either an endoscope or microscope, and then remove the disc. The same procedure is used for both the lumbar and cervical spine.

The patient may feel relief from pain immediately following this outpatient procedure. Walking and exercising is usually encouraged on the same day. Some patients experience muscle spasms in the lower back that can be relieved with relaxants and analgesics. Pain in the area of the surgical site is minimal so post-operative medication is generally unnecessary. Daily exercise is recommended from the date of discharge and a re-evaluation will take place several days later. Normal activities can often be resumed at the doctor’s discretion within one to six weeks.

The primary advantage of this procedure is that there is no interference with the muscles, bones, joints or manipulation of the nerves in the lower back area. Since insertion of the instruments through the muscle is the only wound, there is no scarring in or around the nerves post-operatively. Approximately 90 percent of patients experience pain relief after this procedure.
 
Lumbar Spinal Decompression and Fusion
 
Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves. In this type of back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment. Surgeons perform a minimally invasive spinal cord decompression and fusion with or without rods and screws to hold the spine in place. They make an incision at the correct level and insert tubes that allow them to see the disc and remove bone and ligament to relieve pressure on the spinal sac and nerves. In some cases, the whole disc is removed and a plug of bone is put in to improve the normal balance of the spine.

This procedure is typically recommended for patients who have experienced leg pain for at least six weeks and have not found sufficient pain relief with conservative treatment (such as oral steroids, NSAID’s, and physical therapy). If the leg pain does not improve with conservative treatments, microdiscectomy surgery is a reasonable option to relieve pressure on the nerve root and speed the healing. Surgery will be advised for individuals who develop progressive leg weakness, bowel or bladder problems.

Sometimes in spinal stenosis, the vertebrae shift or slip in relation to each other. Abnormal motion may then occur between the vertebrae. In such cases, spinal fusion surgery may be required in addition to decompression in order to stabilize the involved vertebrae. Spinal fusion is the correction of an unstable part of the spine by joining two or more vertebrae.

Post-operatively, patients may return to a normal level of daily activity quickly. Some spine surgeons restrict a patient from bending, lifting or twisting for the first six weeks following surgery. However, since the patient's back is mechanically the same, it is also reasonable to return to a normal level of functioning immediately following spine surgery. Patients are allowed to return to most activities within weeks and post-operative rehabilitation may be advised to assist in the return to normal activities.