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.