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Mir H. Ali, MD, PhD
Orthopedic Spine Surgery
Patient Educational Series

Minimally Invasive Surgery

One of the most common terms in surgery in recent years has become 'minimally invasive surgery '. While minimally invasive surgery has been very successfully performed in many areas of medicine, it has more recently begun being explored in the area of spine surgery. It is with great excitement that spinal procedures that were performed with a traditional 'open' technique approximately 10 to 15 years ago or more often now done in a minimally invasive way with a smaller incisions, less blood loss, and shorter recovery time. While the minimally invasive spine surgery techniques cannot be applied to all people and all problems, they are being used much more commonly and most patients are able to take advantage of these technological advancements.

For example, many people benefit from minimally invasive microscopic lumbar discectomy for the treatment of a herniated disc. While in a typical patient of average size, the incision from a traditional surgery is about 1 inch and the incision from the minimally invasive surgery is half an inch; in this case, the benefits of minimally invasive surgery may be negligible. However, the benefits are more obvious in a larger patient, where the traditional incision can be up to 2 inches in length and the minimally invasive incision only half of an inch. The recovery time is very similar for a microscopic lumbar discectomy performed via the traditional open technique and the minimally invasive technique in most patients but may be shorter in a larger patient with the minimally invasive surgery. Thus, it is surgeon selection - based mainly on the patient size and the location of the disc herniation - whether or not a patient might benefit from the minimally invasive microscopic lumbar discectomy.

For older patients with spinal stenosis, minimally invasive surgery may be used to minimize the length of the surgical incision and possible bleeding. With elderly patients, the length of surgery is actually more important to their health and outcome than the length of the incision. Thus, it is individual surgeon preference - based on comfort, experience, and training - whether he selects to use a traditional 'open' technique or a minimally invasive technique to perform the patient's lumbar decompression.

The area of lumbar fusion surgery is also gaining momentum in the area of minimally invasive spine surgery. A lumbar fusion surgery is a major surgery which traditionally requires a large incision, significant blood loss and a 3 to 5 day hospitalization when performed via the 'open' technique. Through a minimally invasive approach, the length of incision, the blood loss, and the hospital stay can be significantly reduced. There are some disadvantages to the minimally invasive technique in that the decompression requires extra training and skill to be performed adequately and the bone fusion is limited to one surface typically rather than the traditional three surfaces. As a result of this, there are some complications or increased rate of non-union - also known as pseudarthrosis - where the bones do not heal to one another in a fusion operation. This can lead to ongoing pain, migration/breakage of the rods and screws, and possible neurological consequences. Thus, the surgeon must decide in each patient if the benefits of minimally invasive fusion surgery outweigh the potential risks.

Please discuss your surgical condition and if minimally invasive spine surgery may be an option for you with a fellowship-trained orthopedic spine surgeon.

Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine

Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for general situations and a particular situation requires evaluation before specific treatment recommendations can be made.