Does a Small Incision Mean the Surgeon Can’t See My Spine?

In the traditional open spinal surgery, surgeons use a long incision to allow both visual and physical access into the anatomy of the patient. With the long incision, the surgeon is able to move or cut the surrounding structures enough so that the affected area of the spine can be seen and corrected.

This results in a long scar in patients, more blood loss and more pain after surgery as the surrounding structures such as the back muscles and ligaments are cut to allow the surgeon access into the spine. With more manipulation of the surrounding structures of the back, the patient will naturally feel more pain after surgery, and will need a longer hospitalization stay and also a longer recovery.

In today’s technology where minimally invasive keyhole spinal surgery is getting more and more popular, many question how the surgery is done as the small incisions would not allow the surgeon enough visual or physical access into the affected area. Minimally invasive spinal surgery is developed in order to help patients who require spinal surgery to recover faster, with less pain, less blood loss, shorter hospital duration, smaller scars and have an earlier return to their routines and activities of daily living,

So, how can the surgeon see the spinal anatomy of the patient through a small incision? This is due to the advancement of technology as more and more specialized instruments are developed to aid surgeon view the anatomy of the patient without having the need to have a large incision. In minimally invasive keyhole spinal surgery, multiple small incisions are made with small tubes inserted that can be manipulated to allow a nice view of the spine without damaging or cutting muscle tissue.

Endoscopes may be used, which are tubes with tiny cameras that once inserted, allow the surgeon to view the anatomy of the patient beneath the incision. There are multiple techniques used in minimally invasive keyhole spinal surgery. In the mini-open technique, it is most similar to open surgeries but small specializes instruments are used in place of the conventional traditional instruments so that it can fit through small incisions and still achieve the same goals as the traditional surgery. Specialized visualization tools are also used to view the spine through the smaller incisions.

The tubular technique allows the insertion of a tube and a series of bigger tubes are subsequently inserted to help push the surrounding structures such as muscles gently aside, so that they are minimally manipulated and there will be no need to cut them as compared to traditional methods of surgery. These series of tubes progressively dilate the area of the surgery and the surgery is done through the tube using specialized instruments.

Real time x-ray machines, known as fluoroscopy, may help with implant placement accuracy when direct visualization is not possible. This aids in minimally invasive keyhole surgery by reducing the need to open up tissues and reduces blood loss.

In conclusion, although minimally invasive keyhole techniques have smaller incisions, the advancement in technology still allows the surgeon visual access to the anatomy of the spine, if not better! Research has also found that minimally invasive keyhole surgery is superior, if not just as successful, as traditional open spinal surgeries.

Inspired Spine offers an innovative, minimally invasive keyhole spinal fusion technique that reduces recovery time, has less blood loss and offers excellent outcomes for relieving pain. Call us today to find out your options!

References:

• Highsmith JM. What is microforaminotomy. Spine universe. https://www.spineuniverse.com/treatments/surgery/minimally-invasive/what-microforaminotomy. Accessed 3/8/2017.
• FAQ’s on cervical laminoplasty. Inspired Spine. https://www.inspiredspine.com/conditions-treatments/treatments/minimally-invasive-spinal-surgeries/laminotomy. Accessed 3/8/2017.