Minimally Invasive Spine Surgery or MISS is a safe and effective technique used as an alternative to traditional open surgical procedures performed to treat patients suffering from spinal disorders. This type of surgery is performed to achieve high outcomes while stabilising the vertebral bones and spinal joints and/or relieve the pressure being applied to the spinal nerves. If not treated it may result in conditions such as spinal instability, bone spurs, herniated discs, scoliosis, or spinal tumours.

The major indicators that highlight the need for Spine Surgery are:

• Inability to perform daily activities
• Chronic pain in the back, legs, neck and shoulder
• Experiencing utter discomfort while lying down or sitting in the same position
• Loss of flexibility and movement
• Difficulty in walking (unable to walk more than 500 metre)
• Stiffness in the spine
• Visible deformity in the spine

Some of the major conditions treated under Spine Surgery are:

• Spondylolisthesis (Degenerative, Isthmic, Dysplastic)
• Spinal Stenosis (Central, lateral recess, forminal, extra forminal )
• Disc Herniation (Central, lateral recess, forminal, extra forminal )
• Osteoporotic Compression Fractures
• Deformity ( Scoliosis, Kyphosis)
• Acute Traumatic Spinal Cord Injury
• Spinal Cord and Spinal Column Tumours
• Craniovertebral Junction Anomalies
• Spondylodiscitis

Spine Surgery aims to help patients suffering from chronic spinal disorders that can lead to permanent deformity and prevent one from living a normal life. Spine surgeries can be of different types:

• Spinal Fusion: It is one of the most common spine surgeries that are used to join two or more vertebrae. The surgery involves the use of metallic wires, screws, pins, rods and plates. It includes different type of procedures such as open surgery, minimally-invasive surgery, endoscopic, laser surgery etc.
• Discectomy or Microdiscectomy: It is another common spinal surgery that is used to treat patients suffering from herniated intervertebral discs. It helps to relieve the pressure on the nerve.
  1. Microsurgical: In this type of surgery, surgeons use a microscope to remove the damaged portion of the disc. It requires small incision usually less than an inch over the spinal canal.
  2. Percutaneous Stitches: This type of surgery involves the removal of the disc portion using an endoscopic surgery by making a small incision at the back of the knee.
• Laser Surgery: The procedure involves the removal of a small bone from the spine through laser, in order to get rid of nerve root compression which can lead to chronic pain in the back or lower limbs.
• Spinal Decompression: It is the standard procedure of providing relief from compressed nerves by decompressing it using Minimally Invasive key-hole approach (microscopic or endoscopic).
• Vertebroplasty/kyphoplasty: These types of procedures are performed to relieve the patient from the chronic pain and other problems associated with compression fractures of the vertebrae. These procedures involve the injection of cement through a needle into the vertebrae. The goal is to reduce deformity by restoring height to the crumbled vertebra and provides immediate relief from pain.

The following steps are usually recommended for patients to prepare them for Spine Surgery:

• Inform the doctor about the current medication and past medical history so that one can prepare for any complication beforehand
• Undergo the entire tests including pre-anaesthetic check-up for evaluation of  current health condition, before the surgery.
• Ask a family member to accompany  the patient on the day of surgery
• Arrange for  crutches or a wheelchair as one might need them after the surgery
• Be both physically as well as mentally prepared for the surgery

Minimally Invasive Spine Surgery (MISS) also called as less invasive spine surgery is a surgical process that requires a small incision for performing the surgery.

Pre-operative Details

Before proceeding with the surgery the doctors have to make sure that the patient is fit for the procedure. This is done by performing a series of tests and screening process. The patient might be prescribed certain medications, a week, or two before the surgery, to avoid any sort of infection during or after the surgery.

A patient will receive general anaesthesia before moving to the operation theatre and will sleep through the surgical procedure.

Operative Details

• Step 1: The doctor will make  few small incisions at the affected site
• Step 2: A thin telescope-like instrument, called an endoscope is inserted through small incisions in the body. It has a tiny video camera – smaller than a dime attached to its top, which projects the inside view of the patient’s body on a monitor. These images help the doctor to perform complex operations easily
• Step 3: The doctor then passes small surgical instruments or robotic arms (during robotic-assisted surgery) through these incisions to perform the surgery by using the best X-ray views of the anatomy of the spine.
• Step 4: The doctor closes the incisions with sutures and covers them with surgical tape

Post-operative details

After the operation, the patient has to stay in the hospital for a day or two for monitoring purposes. A doctor might prescribe a patient to take physiotherapy sessions in order to have a fast recovery.

The important precautionary measures one must consider before and after the surgery are:

Before the surgery:

• Lose extra body weight as this can hinder the healing procedure
• Avoid eating heavy meals a day before the surgery, as it can lead to nausea and vomiting
• Abstain from smoking and drinking
• Take all the prescribed medications religiously

After the surgery:

• Avoid sitting in the same position for longer durations (more than half an hour)
• Avoid heavy weight lifting
• Maintain  proper posture while sitting and sleeping
• Do not perform rigorous exercises
• Take all the medications prescribed by the doctors
• Start physical therapy as soon as possible
• Do not indulge in sexual activities
• Avoid forward bending
•  Use western toilet system