Minimally Invasive Surgery (MIS)
What is Minimally Invasive Surgery?
To appreciate the benefits of Minimally Invasive Surgery one must first
understand
the limitations and drawbacks of traditional surgery particularly as it
pertains to the
spine. The spine is a unique structure in the human body. It has an extremely
complicated shape with significant variation from one patient to another.
It is
situated in the very center of the body surrounded by delicate structures
such as
blood vessels, intestines, and other organs. The spine serves as a protective
barrier for the nervous system which runs from the brain down to the tail
bone.
The mechanics of the spine is a sophisticated balance of ligaments and
discs
that allow us to walk upright while maintaining the ability to twist,
bend, tilt, etc.
The challenge of spine surgery is to access this centrally located
structure
without disrupting the delicate balance of form and function.
Anyone who has
tried to cut down a tree knows that the larger the tree, the larger the
size of the cut.
This is equally true of conventional surgery. In addition to larger skin
incisions,
the muscles are disrupted to allow access to the deeper spine. This can
lead to
muscle atrophy and scarring. This in turn can result in up to 40% loss
in muscle
strength as a direct consequence of the surgical exposure. To access the
spinal
canal, a procedure is used called a laminectomy. This involves removing
the back
wall of the spine including the spinous processes and interspinous ligaments.
These ligaments help to support the spine when bending forward. The mechanism
is the same as on a large crane which has a system of cables running down
the
back of the boom attaching to the main housing. When the boom is extended
the
cables help to keep the boom in position while supporting the heavy weight
at the
end of the boom. Removing these structures results in loss of stability
which in
turn can cause a return of symptoms or worsening of the condition.
Minimally Invasive Surgery addresses these issues by utilizing small
incisions
and avoiding disruption of the muscles and spinal elements while allowing
access to the problem. The challenge for the surgeon is to be constantly
learning new procedures and new technology. The benefit to the patient
is the ability
to recover from the operation more quickly with less pain. The recent
advancement in
radiographic navigation has allowed minimally invasive surgery to reach
a new level
of precision.
Navigating Spine Surgery with the O-arm
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