Minimally Invasive Spine Surgery

Hello everyone,

I am Dr. Nitin Jagdhane, consultant neurosurgeon and minimally invasive spine surgeon. Today we are going to talk about minimally invasive spine surgery. So basically everybody knows about the human spine, still to brief it, there are many vertebrae, right from the head up to the tailbone, which constitutes the spine and amongst these vertebraes between each vertebrae there are disc, which is the cushioning mechanism and there are such 7 vertebrae in the neck, around 12 vertebrae in the back and around 5 vertebrae in the lower back and then there are tailbone and its fine bones. So amongst these bones vertebrae or the disc their runs the nervous system that is a spinal cord and then its branches, we call it as nerves or roots. So as age advances and with many other factors, several times there are issues related to either the bones or maybe because of the disc or maybe sometimes inherent to the neural elements as well which lead to problems such as tingling or numbness in the limbs, weakness of the limbs, then paralysis of the limbs, sometimes urinary disturbances and main symptoms which they represent is the low back ache, backache or neck pain.

So these all conditions when they come at say after 40-50 years of age, they are mainly related to the degenerative pathology, so degenerative pathology means the age-related changes that reason that are causing wear and tear of the various vertebrae and its discs and the other elements of the spine because spine is something which holds entire body and it has the maximum wear and tear. So to know what are all other aspects or all other disease of the spine we will probably have another session on the various spine disorders. Today we are going to talk about what are the options when we get such spine problems? So traditionally spine surgery is known since ages and it has been done as an open procedure in which many vertebrae are exposed to reach the neural elements and then they are decompressed so that there is no pain, no tingling or there are no other symptoms which are because of the spine pathology.

Minimally invasive spine surgery is a relatively new advance and it can be done by various ways, but to know whether you are right candidate of minimally invasive spine surgery, you will have to get evaluated by a spine surgeon or by a neurospine surgeon or a neurosurgeon, who would be able to guide you whether you are the right candidate for the minimally invasive, some say endoscopic spine surgery, some say microscopic spine surgery etc. So basically minimally invasive spine surgery deals with the same approach for decompressing the neural elements which are compressed because of degenerative pathology in the bones or of the discs, other neural elementary itself by minimal invasive way that means in traditional spine surgery the muscles are cut and the tendons are cut and then we reach the vertebral bones and then after the surgery we approximate them by taking multiple sutures but whenever we do such extensive operations although we try to approximate these muscular structures, they do not actually come into the same place as they were before surgery, minimally invasive spine surgery techniques basically, they avoid cutting of these muscles and the incision is also not like a traditional midline incision, it is a little lateral and this is basically a muscle splitting approach so that muscles are not cut and basically tubes or endoscopes or there are multiple types of endoscopic instruments available these days, which are used to gain access to the vertebra and the neural structures and for the decompression.

So because the muscles are not cut, approximation is better as well as the incisions are very small because they are done through very small incision through which the tubes or endoscopes can enter and with various neuronavigation or other techniques, the exact location is guided to the surgeon and then the particular part of the spine is decompressed or is treated. Now as I said that whether you are a candidate for minimally invasive spine surgery is decided by spine surgeon and in general if there are multiple level problems in your spine, there are chances that you may not be a candidate but yes if you are having a problem at one or two levels or even three levels that can be managed with minimally invasive spine techniques and with the recent advances going on in the field of illumination as well as the endoscopes the field is quickly developing.

So in this procedure, there are three basic approaches. One is, a little lateral to the midline that is paraspinal approach or interlaminar approach, then there are other approaches which are called as transforaminal techniques, which are done with far lateral technique, which is used with the longer endoscope and then there are techniques which differ basically in the kind of endoscope that is used, so we will not go into much detail of these endoscopic instruments and equipment but the basic thing as I told you is that we take the minimally invasive approach to reach the pathology and we decompress it. Now the advantages of these techniques is that as there is a small incision, the healing time is faster, many cases can be done under local anaesthesia, which will traditionally be done under general anaesthesia in the traditional open spine surgery and this can be done even in cases in the elderly patients, who are not suitable candidates for general anaesthesia because of their comorbid conditions and this can be done as daycare procedure as well. Patient admitted in the morning, it is done under local anaesthesia and the patient can go home.

So these are in short the various techniques or as we can see in this image, basically this is a kind of tubular approach for tubular endoscopic system, which is used to decompress the neural elements. This is the endoscope to image the instruments and endoscope and nerves and the neural elements, which are getting compressed because of the disc and other pathologies are decompressed. So in traditional spine surgery as you can see in this image there is a bigger incision compare two minimally invasive spine surgery in which you can hardly see any incision and even after the surgery if you see the transection of that level in MRI, there are hardly any changes in the muscles and which shows very good recovery and good healing. I hope this was useful for all of you to at least know what are the basics regarding the minimally invasive spine surgery and what are the various techniques of it. Probably in the next video, we can discuss more the details of each surgery and the indications and right candidate for such kind of surgeries.

Thank you very much