Low back pain is a very common health problem worldwide and a major cause of disability – affecting performance at work and general well-being. Though many causative factors have been identified which can lead to acute and chronic back pain, it still remains a challenge to accurately diagnose the condition.
The 2010 Global Burden of Disease Study estimated that low back pain is among the top ten diseases and injuries worldwide. Since chronic low back pain patients are advised to stay active, this can be achieved with physiotherapy. However, there is no strong evidence that exercise therapy is significantly different than the other nonsurgical therapies.
WHAT IS MINIMALLY INVASIVE SPINAL SURGERY?
Minimally Invasive Spinal Surgery (MISS) is a type of surgery which incorporates smaller incisions on the bones of the spine as compared to the standard spinal surgery. This leads to a faster recovery and a lesser degree of systemic symptoms in the patients like fever and pain. Minimal Invasive surgery might not be advised for all the individuals with low back pain but in conditions where it is indicated, the results have been significantly positive. The option to use minimally invasive techniques in spinal surgery has increased as improved patient outcomes and lower hospital costs have been observed. The advantage is mainly due to the fact that the trauma is minimum during the surgery.
CONDITIONS INDICATED FOR MISS-
Spine surgery as evidenced, cannot fix all types of back problems but an experienced healthcare provider will only advise the same only if it is required. The most common conditions in which Minimal Invasive Spinal Surgery is indicated are as follows:
- Herniated Disc
- Spinal stenosis (narrowing of the spinal canal)
- Spinal deformities (like scoliosis)
- Spinal instability
- Spondylolysis (a defect in part of a lower vertebrae)
- Fractured vertebra
- Removal of a tumor in the spine
- Infection in the spine
The primary objective of the Minimal Invasive Spinal Surgery is to stabilize the bone and vertebral joints which gets affected by the degenerative changes with subject to the various conditions cited above.
POST SURGERY SCENARIO
Some types of Minimal Invasive Surgery can be done as an outpatient procedure. The patient might have to stay for a couple of hours after the procedure so that the concerned healthcare provider can keep a vigilance for problems. The patient might have some pain after the surgery which can be managed with simple analgesics. Moreover, there are no dietary restrictions as well.
A small amount of fluid may leak from the incision which is considered normal. The patient should inform the healthcare provider as soon as possible if the amount of fluid increases, or if the systemic symptoms like fever and pain persists. This condition can also be managed efficiently provided the steps are taken at the earliest.
Some instructions will be given by the healthcare provider about how one can use the back efficiently, post-surgery. Heavy weight lifting and bending must be restricted. Some might need to wear a back brace for a time after the procedure. Physical therapy after the surgery is recommended which will help in strengthening muscles around the spine and leads to speedy recovery. Regular follow ups are required to make sure that there are no complications and to ensure that the surgery has proved to be beneficial for the patient.
ADVANTAGES OF MINIMAL INVASIVE SPINAL SURGERY
In comparison to the open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. Because of the reduced trauma to the muscles and soft tissues (compared to open procedures), the potential benefits are:
- The cosmetic results are definitely better from the smaller skin incisions which might be a matter of concern for the patient if he or she undergoes the open type of procedure.
- Blood loss, known as hemorrhage, is a major concern for the surgeon and the patient too during any surgical procedure. But with minimally invasive procedures, blood loss is reduced and the risk of the patient going into hypovolemic shock is minimized too.
- The obvious risk of the muscle damage due to less or no cutting of the muscle is also nullified.
- The post operative pains are reported to be of less intensity and hence the burden of infection or sepsis is lesser.
- The rate of the recovery of the patient is quick and the rehabilitation requirements are also not much when compared to the standard surgery.
- In addition, some MIS surgeries are performed as an outpatient procedure and utilize only local anesthesia, so there is a less risk for an adverse reaction to general anesthesia.
The patients also have less tissue inflammation and hence the level of biomarkers in the blood remains under manageable condition. Before any type of spinal surgery is undertaken other conservative options for treatment like weight loss, non- steroidal anti-inflammatory drugs, appropriate exercises should be explored. Eventually if none of them proves to be beneficial to the patient then the minimal invasive spinal surgery should be the next step as per the protocol. While the mass marketing of minimally invasive spine surgery may seem a relatively new phenomenon, the concept of the minimization of collateral morbidity through the surgeon’s own efforts is one that dates back to the times of the first physicians (primum non nocere—first, do no harm). Hence, the future of MISS remains bright.
What Are the Procedures?
Common minimally invasive back surgeries include:
- Discectomy: Trimming or removing bulging disks in your spine
- Laminectomy: Removing the covering that’s pressing down painfully on your spinal cord
- Spinal fusion: Pinning unstable joints to those around them to ease pain
COST EFFECTIVENESS OF MINIMAL INVASIVE SPINAL SURGERY
Preliminary findings analyzing various studies which has been undertaken shows that both cost savings and better outcomes have been reported in MISS as compared to an open approach.
MISS (Minimal Invasive Spinal Surgery) was the dominant strategy compared with open surgery. Cost savings were driven mainly by shorter length of hospital stay, reduced blood loss, and fewer complications such as surgical site infection.
- Small incision
- Less pain due to minimal muscle cutting
- Early recovery
- No muscle scarring, so no long term back pain due to surgical trauma.