Minimally Invasive Spine Surgery (MISS)
Minimally Invasive Spine Surgery (MISS) is also known as minimal access spine surgery or keyhole spinal surgery. This spine surgery is minimally invasive because MISS spinal surgery is performed through one or more small incisions or punctures through which tubular retractors are inserted. MISS surgeries range from decompressions and discectomies, right through to multi level instrumented fusions and corrective deformity reconstruction.
Minimally Invasive Spinal Surgery (MISS) benefits include:
Less post-operative pain
Reduced hospital stay
Faster mobilization and return to work
Reduced risk of infection and blood loss
Improves back muscle function and physical form
Tubular progressive dilating retractors spare cutting through muscles and soft tissues and minimize damage. Tubular retractors gently and progressively dilate and separate muscles and soft tissues in the operative field. A final working tube or adjustable retractor is then secured in place. Using specialized bayoneted instruments and microscopic visualization, surgery is performed through the tube, which can be moved at will depending on the exposure needed.
Dr Pope performs MISS techniques for his Thoraco-lumbar Microdiscectomies and Laminectomies and cervical foraminotomiesin about 90-95% of cases.
For the vast majority of Dr Pope's MISS lumbar Microdiscectomies and/or laminectomies for 1 or 2 levels, the surgery is performed as DAY ONLY. This means you would be admitted to the hospital on the day of surgery and will go home the same day about 4-6 hours after the procedure. You would be reviewed in Dr Pope's Rooms in 2-4 weeks and a Spine Physiotherapy course will be recommended. Patient's can be back at work from 2-6 weeks post-op, but strict adherence to Dr Pope's advice should be done to optimize your individual requirements.
Minimally Invasive Lumbar Microdecompression (Old Link - Needs Video)
Microendoscopic Discectomy (Old Link - Needs Video)
Please read the transcript from the April 2010 ABC Radio National Health Report on “Spinal Surgery: a minimally invasive operation”, or click on the icon for the Audio link to the Radio interview which gives in Dr Pope’s opinion a balanced perspective of Minimally Invasive Spine Surgery.
There is first an interview with a patient who has experienced the procedure after 2 previous “traditional” procedures, then an interview with Associate Professor Donald Hilton an American Neurosurgeon and pioneer of Minimally Invasive Spine Surgery from the University of Texas, San Antonio explaining his experience, and finally an interview with an experienced Australian Spine Surgeon who is an ex-president of the Australian Spine Society (Premiere Society in Australia for Spine Surgeons) explains his personal experience and the Australian experience with MISS
The above Nine National News segment (aired Sunday October 10 EST) demonstrates one of Dr Pope’s patient's experiences of a MISS procedure for a lumbar disc herniation (bulge/slip)”.
For Thoraco-Lumbar Fusions (1-2 levels), Dr Pope performs MISS techniques in about 65-75% of cases.
In these MISS cases, patients can expect to be mobilizing on the day of the surgery, and the average hospital stay is 1-3 nights compared to 7-10 nights for traditional "open" techniques.
Dr Pope will see you in 2-4 weeks with new x-rays and prescribe a full Spine Physiotherapy course.
Patient's can potentially be back at work from 6 weeks post-op but strict adherence to Dr Pope's advice should be done to optimize your individual requirements.
Dr Pope will discuss the issues pertinent to your individual needs and MISS may not be the most optimal option in some patients.
In comparison, traditional open spine surgery requires a longer incision and stripping muscles (including the entheses) from the underlying bones which involve also cutting through muscles. This causes soft tissue damage and swelling and equates to increased pain and a longer post-op recovery, and longer time to return to daily functioning and to work.
Indications for MISS:
Still the majority of spine surgery is performed as an Open Procedure. Advances in education, training seminars and networking, surgical instruments, techniques, stereotactic neuro-navigation surgery, biotechnology (i.e. bone graft), and interbody implantable devices have made MISS safer and more optimal in surgical spine treatment.
The learning curve is an obstacle for some surgeons who are comfortable in the Open Procedures and they do not want to “go backwards” learning a new technique that will slow them down and potentially increase complications in the process. In general, once a certain number of MISS cases have been completed, the learning curve diminishes rapidly and surgical times are often faster than the Open Procedure. Results are comparable to the Open Technique and redo surgery rates are also favourable in comparison, although some surgeons do not give an appropriate length of time before making an informed decision to either continue or relinquish the MISS approach. The following indications are recognised as suitable for MISS technique:
Cervical and lumbar spinal stenosis and lateral recess stenosis
Spondylolisthesis There are other indications for MISS technology include infection, trauma such as fractures, and tumours of the spinal column (usually extradural metastases) and also including spinal cord Tumours. MISS allow surgeons to perform a decompression, stabilize utilising instrumented fusion, and/or correct deformity.
Benefits of MISS:
Patients with high expectations to return to work and active play find minimally invasive spine surgery offers many benefits. On the other end of the spectrum, patients with major co-morbidities such as the elderly, obese, or those with a major spinal problem, such as degenerative deformity or multi level trauma, may also benefit from MISS surgery.
Avoid stripping of muscles and soft tissues and impeding function
Therefore patients experience less postoperative pain
Less postoperative pain medication
Reduced Blood loss
Shorter Post-operative stay
Many decompressive procedures can be performed as outpatient (day of surgery)
Cosmetically appealing small incisions (especially for young women)
Faster recovery to mobilisation
Faster return to regular activities of daily living
Postoperative infection rate is decreased
Quicker return to work
Verdict:
MISS procedures and techniques are safe and effective for treating a variety of spinal conditions. These procedures although very technical, are accomplished safely and efficiently by well trained surgeons in specific training and experience in MISS techniques. The benefits can outweigh the risks considerably in the right hands and you should discuss MISS options carefully with your Spine Surgeon. Dr Pope is comprehensively trained in MISS techniques and will be happy to explain if MISS may be suitable for you.
Please click on the following links to access further information about MISS.
View Medtronic’s Longitude MISS system for percutaneous pedicle screw insertion. (Videos are .wmv on website)