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Minimally Invasive Spine Surgery viewed from two perspectives: Dr John C. Chiu of the California Spine Institute manipulating the micro probes and graspers, and footage from inside the disc of the instruments in action (including close-ups), cutting away a portion of the bulging disc, .
Back and neck pain is the price human beings pay for poor posture, prolonged sitting, lifting, repeated bending, obesity, and injury from accidents. It is providing the United States with a massive economic headache.
Approximately 85% of inhabitants of the Western world are afflicted with some degree of back or neck pain at some point in their lives. About 25% of our population has been incapacitated for two weeks or more and possibly 8 to 10 million people have a permanent disability from chronic back pain.
In most cases, simple treatments such as bed rest, exercise, physiotherapy, and pain medication bring relief. Many sufferers are not so fortunate. If one or more of their vertebral discs ruptures and presses on nerve roots, the pain that radiates from the back or neck and down the limbs can be incapacitating and severe.
Until recently, the only treatment was surgical removal of part of the ruptured disc, a major operation that required general anaesthesia, the dissection of muscle, removal of bone, manipulation of nerve roots, and, at times, bone fusion.
In an effort to overcome the disadvantages of traditional surgical techniques, the scientific medical community began exploring the use of endoscopy (arthroscopy). An endoscope (arthroscope) provides clear visualization and magnification of deep structures. This technology, first used in knee surgery, has been astonishingly successful in relieving pain.
Now, because of advanced scientific technology and miniaturization, including fiber optics, video imaging technology, and experience gained through minimally invasive spinal surgery, there is a less traumatic discectomy procedure for some patients with disc problems. It is Microdecompressive Endoscopic Spinal Discectomy, a form of Minimally Invasive Spinal Surgery. For simplicity, and because the term Microdecompressive Endoscopic Spinal Discectomy, doesn't mean much to the average person, we call it simply, Minimally Invasive Spinal Surgery or MISS.
MISS verses Conventional Open Back Surgery
MISS is a procedure for decompressing nerve roots damaged by spinal disc protrusions. The term minimally invasive, of course, speaks volumes. It defines a category of procedures designed to do as little damage—to be as non-invasive and non-intrusive—as possible. Minimally invasive surgery, then, refers to surgical procedures designed to do as little collateral or malingering damage as possible.
In other words, we get in, do the job, and get out with minimal disruption to:
• The offending disc itself
• The entry point and access path
• The immediate area surrounding the disc
• The patient's overall health
MISS is performed with micro instruments, fiber optics, lasers and digital imaging, as opposed to conventional highly invasive knives, bone saws and other equally intrusive devices. Compared to conventional open back surgery, which usually entails huge incisions, displacing muscle tissue and nerve roots, and sometimes the removal bone, MISS is without question much less traumatic. It doesn't destabilize the spine, unlike many conventional back surgeries. It can also be performed on multiple discs, even at widely spaced levels, during the same surgical session. Working on multiple discs with open back surgery often requires additional destructive entry wounds—far too much damage for patients to endure or recover from.
Herniated discs, one of the more common disc problems, place pressure on the nerves in your spine, causing severe pain. Conventional back surgery attempts to solve this and other disc problems with extreme measures—such as removing a spinal disc or fusing parts of the spine together, so that they no longer move independent of one another, significantly decreasing the spine's mobility, or ability to move freely. Too often, considering the risks and sustained trauma, these solutions fail to relieve the patient's pain or make it and the overall spine condition worse.
It hurts just thinking about that. As you can imagine, major alterations like this to your spine (not to mention the huge access wound) take a long time to heal, several weeks or months. Full recovery, or returning to 100 percent original functionality, occurs infrequently. Also, this kind of surgery can require lengthy hospital stays, entails significant blood loss, and renders the patient vulnerable to several possible complications.
MISS, on the other hand, is performed with very small "micro" instruments and tiny cameras inserted through a small tube. We also use x-ray, and other types of visualization technology to help guide the instruments, allowing us "see" what we're doing without cutting and clearing obstructing vital tissues and structures. Instead of huge, traumatic access wounds, we reach the offending disc through a very small incision. Damage to tissues and other vital structures in the immediate vicinity are, in nearly all instances, so minuscule that within a very short time—usually a few days—the access point is completely healed, with little to no impact on the patient's body and overall health.
Who Should Consider This Operation?
Our MISS (Microdecompressive Spinal Discectomy) procedure is specifically designed for patients with uncomplicated herniated discs accompanied by the following:
Pain of the low- or mid-back, neck or limbs, or intractable cervicogenic headache (caused by herniated cervical, or neck, disc.)
Pain that has not responded to conventional treatments including rest, physical therapy, chiropractic treatment, medication, exercise, and pain management
Positive corresponding neurological findings of reflex changes, muscular weakness, or decreased sensation
A positive CT scan, MRI scan, or myelogram for disc herniation
Positive provocative discogram
Multiple discs can be treated at one sitting
Post fusion junctional disc herniation syndrome (complications from prior conventional fusion surgery)
This Procedure is not Designed for:
Patients with symptoms from advanced arthritis of the spinal joints, or large bone spurs that may cause a similar type of pain
Evidence of neurological or vascular pathologies mimicking a herniated disc
Fractures, tumors, or active infections
Procedure is performed only on patients with clinical symptoms confirmed by physical examination, X-ray, MRI, or CT scans
The MISS Procedure /with Laser Probe Video
Depending on the type of surgery indicated the procedure is done with the patient under either a local anaesthesia or in some situations, a brief general anaesthesia (sometimes for cervical procedures).
Using fluoroscopic x-rays, the endoscope and video image for guidance, a hollow tube is inserted into the disc space. A variety of surgical instruments could be used through the hollow tube, including mini-forceps, curettes, trephines, rasps, burrs, cutters, and other types of probes. A discectome, a hollow probe, is used to suction and remove small pieces of disc material. Enough disc is removed for decompression of the nerve root. A laser is used to shrink and tighten the disc and remove portions of the disc. The supporting structure of the disc is not affected. Upon completion, a small Band-aid is applied to the incision. The procedure takes about 30 minutes per disc, on the average. X-ray exposure is minimal.
(Note: This procedure is used for bony decompression and soon could be attempted even for bone fusion and internal fixation/stabilization.)
The patient may feel relief from pain immediately following this outpatient procedure. Some patients experience mild muscle spasms that can generally be relieved with muscle relaxants and analgesics.
Pain at the site of the operation is usually minimal and requires no medication. Walking and light exercising are usually encouraged on the day after discharge, and a daily exercise program is also recommended. Re-evaluation is done several days later. Little, if any, postoperative medication is required for most patients and normal activities can usually be resumed at the doctor's discretion within a couple weeks.
There are numerous advantages to MISS compared to open spinal surgery*.
(Note: Patients with large free fragments of disc in the spinal canal, as determined by the x-ray, cannot benefit from the endoscopic procedure, but might benefit from the arthroscopic procedure. However, the laser can shrink the bulging disc further for disc decompression.)
Some advantages are:
•Much less tissue trauma when compared to an open surgical procedure
•Hospitalization is not required, MISS is an outpatient procedure
•Faster recovery, since MISS is an outpatient procedure
•Minimal to no scarring in and around the nerves post operatively
•Earlier return to work and to daily activities
•Patients can begin an exercise program the day after surgery •
•We estimate the cost of endoscopic surgery is 40% less than conventional spine surgery
MISS requires no hospitalization , allows for earlier return to work and return to daily activities, when compared to conventional spine surgery.
Please feel free to discuss any questions you might have concerning these procedures.
*Some patients experience mild muscle spasms and transient pain. A small percentage of patients do not get relief of symptoms. Patients who initially have obtained good results appear to remain pain free.
**Endoscopy (pronounced en-doe-scop-ey ) means looking inside and typically refers to looking inside the body for medical reasons using an endoscope (pronounced en-doe-scope), an instrument used to examine the interior regions of the body.
***Arthroscopy (pronounced are-throw-scop-ey) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope (pronounced are-throw-scope), a type of endoscope that is inserted into the joint through a small incision.
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