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New trends in spinal surgery point toward performing surgeries through smaller incisions, causing lower soft tissue damage. Such procedures are called closed or minimally invasive approaches. Following are minimally invasive techniques used for various indications:
I.Degenerative Spinal Disorders
Microdiscectomy and Endoscopic Discectomy
The gold standard surgery technique in lumbar disk hernia is open discectomy surgery. Nowadays, the lumbar disk hernia surgeries are frequently done using microscope (microdiscectomy). Another minimally invasive technique in which cameras are used is endoscopic discectomy. With the help of minimally invasive interventions, it is possible to discharge patients the same day of the surgery or the following day. The recovery rate is faster than traditional surgeries since muscle injuries are lower. No difference was observed when comparing minimally invasive discectomies.
Dynamic Instrumentation
This is performed to treat degenerated disc disease, when back pain cannot be managed by conservative treatment and the cause of pain is strongly associated with the degenerated disc. The theoretical advantage is that the dynamic instrumentation shares the loads affecting the disc and the pain decreases. Further disc degeneration is prevented. This instrumentation restricts movement to some extent. Yet, there are ongoing debates on the efficacy of the dynamic instrumentation system since few practical proofs exist for the abovementioned theoretical benefits. However, for a select group of patients, we believe that system is very beneficial.
Spinal Stenosis- Microscobic decompression with single-sided intervention
This technique is used for the spinal stenosis patients who do not need instrumentation or the instrumentation cannot be performed due to particular circumstances. This technique provides relief in both sides of the vertebrae by performing laminectomy to only one side of the spine using a microscope. Since a small incision and a small bone window is used, there may be no need for instrumentation.
II.Adult Scoliosis
Minimally Invasive Deformity Correction:
For correction of the lumbar scoliosis in adult patients, minimally invasive anterior surgery and fusion and posterior percutaneous screw fixation technique can be performed.
III.Spinal Fractures
Vertebroplasty
Closed (Percutaneous) screw fixation technique
This is a commonly used technique in the single or multiple spinal fractures after high-energy traumas (traffic accidents, fall from heights, etc.) To stabilize the fracture, small incisions are made, and screws and rods are placed without opening muscle tissue or making long incisions. The advantage is the fast recovery rate. Additionally, the amount of bleeding and the risk of infection is lower.