Spine surgery has come a long way in just 20 years. In clinic, I have seen scars on patients measuring 6 inches for the same surgery I can do through an incision less than an inch (Fig 1.). This can hardly be considered the “same surgery” – so what’s the difference? In the 6-inch scar surgery, much more dissection through healthy muscle and other tissues was performed to reach the spine.

The scar on the left is for the same surgery as the larger one on the right. In miSS, however, the muscles are spread apart to deliver a working channel to the spine, rather than cutting through the muscle.

Why does this matter?

Anytime we operate on the body, scar tissue is formed. The bigger the trauma to the body, the higher the likelihood that more scar tissue will form. Think of it like the difference between driving a Mack Truck through a wall compared to a VW Golf. You can imagine which will cause more damage to the wall– it’s the same for minimally invasive spine surgery (the Volkswagen).

Besides scar tissue, however, cutting muscles have bigger repercussions at times, and can strip the muscle of blood supply, causing muscle death. This is referred to back fusion disease. In contrast, miSS preserves more native anatomy. In cases where I have gone back years after the original surgery, I am happy to find healthy muscle still alive in the body. In revising open surgeries, there is rarely healthy muscle present.

Besides preserving native anatomy and decreasing scar tissue, minimally invasive spine surgery proves to be beneficial in lots of different ways, including:

1. Less Blood Loss

Smaller windows to the body cause less blood loss, and miSS rarely requires blood transfusions.

2. Less Infections

Most bacteria causing infections lurk just below the skin, and because the incisions are smaller, miSS has significantly lower infection rates compared to traditional open surgeries, with studies quoting a 10 fold decrease at times.

3. Faster Recovery

Less is more in this case. Returning to work or what you enjoy is faster with miss – in fact, many miSS cases at miiSpine are Outpatient cases, meaning no hospital stays.

4. Less Risk of Destabilizing the Spine:

Minimally invasive spine surgery preserves the body’s natural stabilizers. By working through smaller windows, surgeons can spare important structures, which is important because a loose spine can result from too much bone removal, which then requires a fusion. For example, I call surgery to free up pinched nerves in spinal stenosis the Roto-Rooter procedure. In this miSS, an incision the size of a quarter(like in the photo) is all it takes to unclog the spinal nerve roots while preserving the important structures.

Why Don’t All Surgeons Offer Minimally Invasive Spine Surgery?

Not every surgeon has received training in these techniques, and even when they have, there is also a steep learning curve to minimally invasive spine surgery. Personally, I have honed my skills for over 15 years. In his book, Outliers, Malcolm Gladwell describes the keys to success in all fields. It has been proven that it takes 10,000 hours to master a skill - that’s10 years at 3 hours per day! Not every surgeon is willing to commit the time to learn these new techniques, especially if they are comfortable (and have already spent 10,000 hours) doing open surgery.

Minimally invasive spine surgery has been around for over 20years, and its benefits have been proven in numerous studies. In head-to-head comparisons with open surgery, miSS consistently shows less blood loss, faster recovery, less pain, and lower infection rates all while achieving the same long term goals of spine surgery.

So what would you rather have? The Mack truck or VW Golf of spine surgery?  Both will certainly get through the wall, but with different results. Minimally invasive spine surgery isn't about avoiding spine surgery altogether, it's about doing it in the safest, most non-invasive way possible.

If you are experiencing back or neck pain and are concerned about treatment options, you may benefit from finding an innovative spine physician. Dr. Venu Vemuri at miiSpine is an award-winning doctor focused on providing a comprehensive treatment approach towards all types of back conditions and pain. For additional information or to schedule an appointment, call the Louisville, Kentucky miiSpine office today at: (502) 242-6370.