Minimally Invasive Spinal Fusion: Stabilizing the Spine with Less Disruption

Dr. Manny Emenike
Authors:Dr. Manny Emenike | Brian Takita
Posted on:March 22, 2024

Spinal fusion is a surgical procedure to join two or more vertebrae. This eliminates painful motion from an unstable spinal segment caused by conditions like:

  • degenerative disc disease
  • spondylolisthesis
  • some fractures

Minimally invasive spinal fusion (MIS fusion) aims to achieve the same goal as traditional open fusion. With smaller incisions & less disruption to surrounding tissues.

Minimally Invasive Spinal Fusion: Stabilizing the Spine with Less Disruption

Spinal fusion surgery aims to alleviate chronic back pain. Minimally invasive techniques reduce recovery time & complications.

Minimally Invasive Spinal Fusion?

Minimally invasive spinal fusion joins two or more vertebrae. This limits movement & reduces pain. Small incisions & specialized instruments aid the procedure.

Evolution of MIS Fusion

Minimally invasive spinal fusion techniques address the drawbacks of open spine surgery. These techniques involve:

  • smaller skin incisions
  • less tissue damage
  • quicker recovery

While achieving clinical outcomes comparable to open surgery[1][2]. The development of MISF began with lumbar discectomy under a microscope. Since expanding to include a variety of procedures for decompression & fusion[1].

Key Principles of MIS Fusion

Specialized Instruments

MIS fusion utilizes unique surgical instruments & retractors designed to work through smaller openings.

Image Guidance

Real-time X-ray or advanced imaging often aids in accurate implant placement. While minimizing incisions.

Muscle Sparing Techniques

Surgeons employ approaches that avoid cutting through large muscles. Instead of working between them to reach the spine.

MIS Fusion Techniques

Several minimally invasive approaches exist. With your surgeon choosing the best option based on your specific condition. Common types include:

Transforaminal Lumbar Interbody Fusion (TLIF)

TLIF accesses the spine through the side of the back. It is good for lower back issues. This method reduces damage to spinal muscles.

Posterior Lumbar Interbody Fusion (PLIF)

PLIF also involves a rear approach. It treats discs that are badly degenerated or herniated.

Anterior Lumbar Interbody Fusion (ALIF)

ALIF accesses the spine from the front of the body (abdomen). It provides a clear path to the spine & avoids major back muscles.

Extreme Lateral Interbody Fusion (XLIF or DLIF)

XLIF (or DLIF) uses a side approach. It minimizes muscle disruption & is ideal for the mid to lower spine. Often used when multiple spinal levels need fusion.

Techniques & Technologies in MISF

MISF employs specialized instruments, such as tubular retractors & endoscopes. To access the spine through small incisions. Using an operating microscope or endoscope equipped with a camera. Allows surgeons to visualize the surgical site. Without the need for large incisions[1][3][4]. Using advanced imaging techniques, such as fluoroscopy or computer-assisted navigation. To guide the accurate placement of hardware. Such as screws & rods, to stabilize the spine[5][6].

Indications for MIS Fusion

MISF is recommended for various spinal conditions. When nonsurgical treatments fail to provide adequate relief. Indications include[6][7][8]:

  • herniated discs
  • spinal stenosis
  • spondylolisthesis
  • degenerative spinal disease
  • spine deformities like scoliosis

The specific approach & technique used in MISF depend on the location & nature of the spinal pathology.

Benefits of MIS Fusion

The benefits of MISF over traditional open surgery are numerous:

Reduced Tissue Trauma

Smaller incisions & less muscle dissection lead to reduced blood loss & tissue damage[1].

Faster Recovery

Patients typically experience a shorter hospital stay & quicker return to daily activities.

Less Postoperative Pain

Reduced tissue trauma often results in less pain after surgery. Minimizing the need for pain medication.

Lower Infection Risk

Smaller incisions decrease the potential for surgical site infections.

Improved Cosmetic Outcomes

Smaller incisions result in minimal scarring.

MIS Fusion Procedures

Transforaminal Lumbar Interbody Fusion (TLIF)

This procedure involves unilateral access to the disc space. To remove a degenerative disc & place a fusion device[6].

Lateral Lumbar Interbody Fusion (LLIF)

The LLIF approach allows access to the spine from the side. Minimizing disruption to the back muscles.

Percutaneous Pedicle Screw Fixation

Screws & rods placed through small skin incisions to stabilize the spine. Guided by X-ray or navigation systems[6].

Recovery & Outcomes

Recovery from MISF varies depending on the individual patient & the extent of the surgery. Most patients can expect to return home within a few days post-surgery, with a total recovery time averaging around six weeks. Physical therapy is often prescribed to strengthen the muscles around the spine & aid in recovery.

Candidates for MIS Fusion

While appealing, MIS fusion is not right for everyone. Factors influencing suitability include:

Severity of Condition

Severe spinal deformities or extensive instability may necessitate more traditional open approaches.

Patient's Anatomy

Individual anatomy can make some people better candidates for MIS techniques.

Surgeon's Expertise

The experience of the surgeon in performing specific MIS procedures is crucial for optimal outcomes.

Considerations

It's Still Surgery

Even minimally invasive techniques carry risks like infection, nerve injury, or implant complications.

Thorough Evaluation

Before considering surgery of any kind. A comprehensive assessment with a spine surgeon is essential.

Realistic Expectations

MIS fusion offers benefits. But it's not always guaranteed to be less painful or have faster recovery for everyone.

Conclusion

Minimally invasive spinal fusion minimizes surgical morbidity & preserves normal anatomy. MISF offers patients an effective alternative to traditional open surgery. With the potential for a faster recovery & improved quality of life. MISF is likely to continue being preferred over open spinal surgeries to treat spinal disorders.

[1]:

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

[2]:

Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

[3]:

Minimally Invasive Spinal Fusion: Thoracic And Lumbar

[4]:

Minimally Invasive Spinal Fusion (hopkinsmedicine)

[5]:

Minimally Invasive Spine Surgery (clevelandclinic)

[6]:

Minimally Invasive Spine Surgery (virginia.edu)

[7]:

Minimally Invasive Spine Surgery (clevelandclinic)

[8]:

Minimally Invasive Spine Surgery (aaos)