Minimally Invasive Discectomy vs Micro/Open Discectomy

Minimally Invasive Discectomy vs Micro/Open Discectomy

Minimally Invasive Discectomy vs Micro/Open Discectomy

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We’ve all heard of “Minimally Invasive Discectomy” as it is used as a marketing ploy almost everywhere. Everyone has a different description of what minimally invasive actually is.

Some consider MIS as surgery being done through small incisions, with less dissection, and therefore less pain, and faster recovery.   With that criteria, many of the spine surgeries being done today are MIS, when compared to the techniques of the past.  Not too long ago, patients were admitted to the hospital for many days, with large incisions to the back, for simple operations such as lumbar discectomy.  Now, it is fairly standard for the surgery to be performed on an outpatient basis, with less than two inch incisions, and rapid return to activities

Others consider the term more important when concerning lumbar fusions.  The multifidus muscle is thought to be a very important stabilizer of the spine.  If the multifidus muscle is preserved, some would consider that the definition of MIS lumbar Spinal Fusion Surgery.   By that criterion, the open bilateral Wiltse approach would qualify as MIS surgery, yet there will be standard incisions being used for the surgical approach.

In the end the term Minimally Invasive Surgery is an attempt to define a better, more precise, less painful way to do surgery.  Unfortunately, there are also associated risks and learning curve issues with the MIS approaches.  The goal for the surgeon is to have visualization of the surgical site.  In the learning curve of MIS surgery, sometimes, the visual field may be obscured, and in the attempt to continue the surgery, outcomes may be compromised.  In some MIS procedures, the real term should be percutaneous.

In the percutaneous techniques, needles are placed into the body, and surgery is conducted via the needles, with x-ray guidance.  The surgeon never sees the actual field of surgery, but makes assumptions by the location of the needle on the X-ray/fluoroscopic image.   While these techniques can be effective, the surgeon must make assumptions that the x-ray image is correctly identifying the location of the problem, as the Surgeon will never directly be able to see if the problem has been addressed.

In the end, MIS or any surgery must consider the advantages, and the risks.  MIS sounds high tech, sexy, and state of the art.  In my opinion, there are advantages to MIS for certain situations.  But in the end, it comes down to results.  That ultimately will depend on the problem, the patient, and the skill of the surgeon.  With or without MIS, if the goals of the surgery has been met, there will likely be a good outcome.

Citations

  • McClelland S 3rd, Goldstein JA. Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us? J Neurosci Rural Pract. 2017 Apr-Jun;8(2):194-198. PubMed PMID: 28479791
  • Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014 Sep 4;(9):CD010328. PubMed PMID: 25184502
  • Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S281-6. PubMed PMID: 21160391

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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