Minimally invasive spinal stabilization

Spinal instability may develop due to various causes, and various conservative treatments can be used for it, but in some cases, improvement may only be achieved by surgery. This involves the surgical implantation of metal fixation devices by our physicians, which contribute to the stability of the spine, and the reduction of the symptoms. The surgery can be performed by conventional methods when the area is explored from the back, and by minimally invasive techniques too, out of which the applicable one will be selected by the physician.

What does a spine fixation surgery with minimally invasive technique mean?

The condition of a subset of patients with spinal disorders can be improved with a spinal stabilization surgery. During the spinal stabilization/fusion surgery performed with the conventional technique, the muscles located right next to the spine need to be detached from the bony spine to safely place the implant. This means that more significant blood loss should be expected in the operation room, and the rehabilitation after the surgery is prolonged due to muscle recovery (which is at least 6 weeks).

However, in some specific cases, there is the opportunity to perform the fixation or even fusion surgeries with a so called minimally invasive technique. In these cases, instead of performing the surgical exploration from the back with this muscle detachment technique in the midline, the spinal implants (screws and a rod) are placed through a few cm large incision made on the skin (percutaneously). The rehabilitation period gets shorter after the surgery in the long term because the muscles were not involved but increased wound pain should be expected compared to the conventional technique, although this still could be alleviated with pharmacological treatment.

When can be a minimally invasive spine surgery performed?

In the majority of the cases, a minimally invasive spine surgery can be technically performed, but just like every method, it has its advantages and disadvantages too. The biggest advantage of the surgery is the reduced tissue damage, but it has numerous disadvantages as well compared to the conventional spine surgeries. More routine is needed to perform minimally invasive techniques, because during a substantial part of the surgery, the surgical site is covered by skin, which the operating surgeon does not see with their eyes, but only with an X ray image intensifier in 2 dimensions. Another disadvantage is that the surfaces can only be created at the locations of the discs between the vertebrae, while during a conventional open technique, fusion can be also created between the back surfaces of the vertebrae, and that may lead to a more secure fixation in the long term. For all the above mentioned reasons, minimally invasive techniques are mainly used in older patients, where a reduced surgical load is recommended because of the general condition, and in those cases, when the fusion surfaces do not play a great role in the treatment (e.g., young patients with vertebral fractures due to accidents).

The spine surgeon makes the decision in every case based on the professional principles whether which minimally invasive or conventional surgical procedure should be selected; the decision making includes the consideration of the patient’s surgical load, and the importance of the fusion surfaces.