Introduction:
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 three to six months or longer to resume their day-to-day activities. Hence, keyhole spine surgery was introduced.
About 80 % of the world's population will have low back pain at some point in their lives. Hence, anticipating this problem and to reduce postoperative pain and improve recovery times, 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.
What Is Keyhole Spine Surgery?
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 high expertise and cutting-edge technology. Currently, there are only a few centers worldwide that have the expertise to perform this procedure.
What Is the Mechanism Behind Keyhole Spine Surgery?
Due to the deep location of the spinal cord and intervertebral nerve, accessing the spinal area for treatment requires moving muscle tissue aside. This is achieved through small incisions, allowing the insertion of directional instruments and tiny video cameras. These minimally invasive techniques enable precise access to the spinal zone. The incision, resembling a keyhole, is approximately one inch in length, hence termed a Keyhole procedure.
What Are the Diseases That Can Be Treated with Keyhole Spine Surgery?
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Lumbar radiculopathy is commonly known as a slipped disc, disc herniation, back pain, or sciatica.
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Spinal stenosis or degenerative spinal diseases, neurogenic claudication.
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Cervical radiculopathy, that is, neck pain with sharp arm pain.
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Spondylolisthesis.
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Spinal instrumentation such as percutaneous screws and rods.
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Osteoporotic fracture vertebra in vertebroplasty and kyphoplasty.
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Specific types of thoracolumbar spinal injuries.
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Spinal infections.
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Certain types of spinal tumors (epidural and intradural extramedullary).
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Tethered cord, is a type of birth defect affecting the spine.
How to Prepare for Keyhole Spine Surgery?
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 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.
How Is Keyhole Spine Surgery Done?
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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.
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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.
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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.
What Is the Recovery Time Following Keyhole Spinal Surgery?
Minimally invasive spinal surgery allows for faster recovery than traditional open surgery, with smaller incisions and less muscle damage. Surgeons monitor progress, ensuring recovery in weeks.
Minimal Pain Medication Is Necessary Following Keyhole Spinal Surgery:
Due to minimal incisions and protection of the lumbar muscle during keyhole spinal surgery, the need for opioid pain medication is reduced, facilitating a quicker return to an active lifestyle. Physiotherapy aids in mobility and prevents future back issues.
Resuming Work Following Keyhole Spinal Surgery:
Returning to work after keyhole spinal surgery depends on job requirements like lifting or sitting, with the potential for return within weeks due to minimal incision and muscle involvement.
Recovery Periods Following Keyhole Spine Surgery:
After keyhole spine procedures, discharge typically occurs within two to three days. Returning to a sedentary job can take about a week or two, while multiple operations may prolong recovery.
What Are the Advantages of Keyhole Spine Surgery?
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There will be less tissue trauma and blood loss.
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Minimal tissue scarring and less postoperative pain will only be present.
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It requires a shorter hospital stay (discharge on the same day of surgery is possible in selected cases).
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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.
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The smaller surgical incision may be as small as two centimeters.
What Are the Risks of Keyhole Spine Surgery?
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:
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Blood clots.
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Bleeding.
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Return of symptoms.
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Nerve damage.
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Infection.
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Failed fusion (pseudarthrosis or non-union).
Who Can Undergo a Keyhole Spine Surgery?
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 three to six 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. Discuss the various considerations with the doctor before making surgical decisions to treat back or neck pain.
