Keyhole spine surgery is an alternative to traditional open surgical procedures to treat different spinal disorders, like herniated disc, spinal stenosis, etc. Please read the article to know more.
Spinal diseases are the most common cause of disability worldwide and are measured using the disability-adjusted life year (DALY) parameter. Spinal diseases are the second most common reason for a medical consultation. Contrary to popular perception, the peak incidence of the spinal disorder is not seen in the elderly but rather in the age group of 35 to 55 years. With an increase in life expectancy, it is clear that spinal diseases may reach an alarming proportion.
Traditionally, spine surgeries have required a long incision, and often, unnecessary exposure of a large part of the normal spine leads to damaging the muscles and surrounding tissues that are important in maintaining spinal stability. Invariably these patients need a prolonged hospital stay and may take 3-6 months or longer to resume their day-to-day activities. Hence, keyhole spine surgery was introduced.
About 80% of the world population will have low back pain at some point in their lives. Hence, anticipating this problem and with a goal to reduce postoperative pain and to improve recovery times, the keyhole spine surgery was first introduced in 1997. It is currently the most popular and most commonly performed type of spine surgery in the developed world.
Keyhole spine surgery or minimally invasive spine surgery treats spine diseases without causing widespread injury to the surrounding tissues. It can be performed in various ways using tubular dilators, endoscopes, surgical microscopes, etc. And some of the surgical incisions can be covered with just a band-aid!
This minimally invasive spine surgery requires a high level of expertise and cutting-edge technology. Currently, there are only a few centers worldwide having the expertise to perform this procedure.
Lumbar radiculopathy, which is commonly known as a slipped disc or disc herniation or back pain or sciatica.
Spinal stenosis or degenerative spinal diseases, neurogenic claudication.
Cervical radiculopathy, that is, the neck pain with sharp arm pain.
Spinal instrumentation such as percutaneous screws and rods.
Osteoporotic fracture vertebra in vertebroplasty and kyphoplasty.
Specific types of thoracolumbar spinal injuries.
Certain types of spinal tumors (epidural and intradural extramedullary).
Tethered cord, a type of birth defect affecting the spine.
Talk to the healthcare provider about the ways to prepare yourself before the surgical procedure. Inform the healthcare provider about all the prescription, nonprescription and herbal medicines you are taking. This will also include over-the-counter medications. Before surgery, you will also be advised to stop taking some medicines for the mentioned period by the doctor, such as blood thinners. If you are a smoker, you need to stop it before the surgery, as smoking can delay the healing process.
Before the surgery, the doctor will ask for imaging tests. These include x-rays or CT scans or magnetic resonance imaging (MRI). Avoid eating or drinking after midnight before the night of surgery. Tell the healthcare provider about the recent changes in the health, such as fever, chills, etc.
As with any spinal disease, the correct diagnosis is reached based on the combination of patient symptoms, examination, and radiological tests like x-ray, MRI (magnetic resonance imaging), and CT (computed tomography) scan.
After proper patient selection, the procedure involves making a small incision over the spine and then using tubular dilators. The desired surgical procedure is performed through an endoscope or surgical microscope, without extensive dissection, cutting, or devitalizing muscles in contrast to traditional spine surgery.
The surgeon may also use sophisticated devices like computer-assisted neuronavigation, intraoperative C-arm, O-arm, and nerve monitoring (intraoperative electrophysiology), making this procedure extremely safe. Screws and rods can also be used if required.
Patients undergoing surgery for herniated discs and spinal stenosis are usually discharged the same day or the next day, whereas patients undergoing surgery for other reasons may take 3-5 days.
Physiotherapy with back and core strengthening exercises are usually started after 4-8 weeks.
A neurosurgical spine center has a multi-disciplinary team of neurosurgeons, neurointensivists, electrophysiologists, radiologists, physiotherapists, and rehabilitation specialists who manage the patients to ensure maximum benefit, recovery, and a better quality of life.
There will be less tissue trauma and blood loss.
Minimal tissue scarring and less postoperative pain will only be present.
It requires a shorter hospital stay (discharge on the same day of surgery is possible in selected cases).
Patients have a faster recovery and have the ability to resume day-to-day work in a shorter time. Patients can walk and move around the same evening of surgery.
The smaller surgical incision may be as small as 2 centimeters.
Any spine surgery that offers potential benefits also imposes some complications. The following are the possible complications that occur during or after spine surgery procedures. They are:
Return of symptoms.
Failed fusion (pseudarthrosis or non-union).
Keyhole spine surgery offers many benefits from less pain, smaller incisions, fewer risks, and quicker recovery. But keyhole spine surgery is still a surgical procedure. It is better to understand that people less than 5% with back or neck pain will need spine surgery and surgery should be the last option for treating pain due to spinal disorder.
When non-surgical treatments, such as physical therapy, medications, and spinal injections are not effective in reducing symptoms within 3 to 6 months, then you are the candidate for keyhole spine surgery.
Talk to the doctor about the pain and symptoms and also about the progression of different therapies you have tried. Before making surgical decisions to treat back or neck pain, discuss the various considerations with the doctor.
The minimally invasive spine surgery and traditional surgery follow different procedures, which are very effective. The success rate of minimally invasive spine surgery (MISS) is 90% when compared with traditional surgery.
Minimally invasive spine surgery is also called less invasive spine surgery. The patients under this surgery recover much faster when compared to open spine surgery. They usually return back to normal and perform all the regular activities within weeks. Minimally invasive surgery is less painful when compared to traditional surgery, and recovery occurs within four to six weeks.
The minimally invasive spine surgery is done by removing a small amount of lamina bone by a retractor. It provides the view of the spinal nerve and disk, and the surgeon undergoes surgery carefully by retracting the nerves, which gives a clear view of the damaged disk. This minimally invasive technique is also used in the neck for herniated disks.
Vitamin D is good for spine health, and lack of vitamin D results in lower back pain. Also, calcium and magnesium are the best ways to build strong spinal bones, preventing health-related problems such as a spinal fracture.
Sitting with improper posture for a long time makes overuse of the back muscles and gradually wears and tears the bones of the spine, causing the spine to weaken with age. So regular stretching helps to prevent the pain and also strengthens the muscles.
It will take six weeks to walk, and walking is the only best option that a patient can do after spinal surgery. It will take two to three weeks for improvement after the surgery, and the patient will not be able to do any work until eight to twelve weeks.
The spine's health can be improved by changing position during work, maintaining a proper posture while lifting heavy objects, maintaining an ideal weight, drinking plenty of water, quitting smoking, avoiding over-drinking alcohol, taking a healthy diet, and sleeping on a good mattress.
The time duration of the spine surgery depends on whether there is impingement of spinal nerves or scarring from prior surgeries and the number of vertebrae diseased. Normally if it is diseased little, it takes about two hours and occasionally even longer, more than 6 to 7 hours according to the extent of the disease.
We can lead a normal life after a spinal fusion as the results of spinal fusion are permanent, and 90% of people after spinal fusion return to work within a month. When the bones are fused, the natural mobility of the spine changes, affecting different parts of the body and the areas around the surgery.
The side effects of spine surgery are infections, dural tears, blood clots, nerve injury, leakage of cerebrospinal fluid, recurrent symptoms, paralysis, loss of vision, facial sores, and sometimes death.
Foods that prevent back pain are red wine, green tea, olive oil, nuts, carrots, salmon, sweet potatoes, tuna, spices, and seasonings.
People can strengthen and condition their spine by meditation, frequent massage, exposure to sunlight, deep breathing, awareness of posture, limited sitting time, appropriate nutrition, exercise to strengthen the abdomen and back muscles, and shoes that should support the spine.
It takes about three to four months for the bones to heal after surgery, and the healing process continues for at least a year. It is not so easy to return to regular activities quickly.
Last reviewed at:
15 Dec 2022 - 4 min read
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