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What is Minimally Invasive Spine Surgery?

By James M. Leipzig, M.D., F.A.C.S. on

While surgery for any condition can seem daunting, spinal surgery may bring its own share of concerns for patients. However, thanks to technical and technological advancements, spinal surgery is continuously more sophisticated, with new techniques leading to higher success rates and fewer postoperative complications. One such development is minimally invasive spine surgery (MISS), which involves less invasive incisions, advanced instruments, and surgical training.

In “open surgery,” or the traditional option for spine surgery, surgeons make a long incision to access the diseased area of the spine. Between five to six inches, the incision pulls the muscles to the side, risking damage to the soft tissue and impacting other anatomy, potentially prolonging healing. MISS offers an alternative for most back and neck procedures.

What is minimally invasive spine surgery?
MISS, which has been developing in both use and technological sophistication since the 1990s, uses several smaller incisions, sometimes as short as two centimeters. This can lead to less bleeding, a lowered risk of complications, better cosmetic results, and a shorter recovery time.

Rather than pulling aside the muscles to examine the spine, surgeons often use a tubular retractor to tunnel through the skin and soft tissues to the spine. It keeps the muscles immobile while fluoroscopy typically provides real-time X-ray images to guide the surgeon. Operating microscopes are also used along with the retractor. Other options include a mini-open, which is similar to an open procedure but still uses considerably smaller incisions.

During surgery, intraoperative imaging aids the surgeon in placing rods, screws, plates, or other devices required to stabilize the spine.

MISS patients typically have a significantly shorter hospital stay and can often have their surgery performed on an outpatient basis. Though each experience is unique to the patient, pain time from MISS is usually half of what it is for open surgery. Depending on the type of surgery and the activity level required at a patient’s job, recovery times can be between one to two weeks, although larger procedures, such as fusions, can take between four to six weeks.

As with other surgeries, physical therapy is often vital in helping a patient regain strength and return to his or her normal routine faster.

What conditions can minimally invasive spine surgery treat?
As MISS is a constantly evolving and expanding field, it can now be used to address many spinal conditions, including degenerative disc disease, herniated discs, spinal deformities and infections, and lumbar spinal stenosis. However, certain tumors, infections, and high-degree scoliosis still require traditional open surgery.

Who practices minimally invasive spine surgery?
MISS is practiced by only about 10% of spinal surgeons in the country. It’s a highly technical procedure, requiring extensive training on both the part of the doctor and the operating room team, as well as expensive equipment not carried at every hospital. Given the intensity of this training, it is critical to find a surgeon that possesses the necessary knowledge and expertise.

Dr. Leipzig, a Virginia spine surgeon with over 20 years of experience, is trained in MISS and can recommend the best treatment option for you. Contact Virginia Spine Care today at (540) 725-9711.


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"I enjoy interacting with patients and helping them understand their condition and treatment options. Spine problems and spinal surgery can be stressful. It’s an honor to be able to treat patients and guide them toward recovery."
James Leipzig, M.D., F.A.C.S.