What Does Minimally Invasive Spine Surgery (MISS) Mean? Part 2

What is Minimally Invasive Spine Surgery for?

To clarify that that “minimally invasive” can refer to fusion surgery

Warning: Fusions are now called Minimally Invasive Spine Surgery

The term “minimally invasive spine surgery” now means that you might be getting a fusion. A fusion can be performed with minimally invasive surgical techniques, but a fusion is hardly a minimally invasive procedure.

Q – Is a spine fusion a minimally invasive surgery?

A – Not in my opinion

“Minimally Invasive Spine Surgery (MISS)” suggests that everything is minimal. The incision is small since the surgery can be performed through a tubular retractor (or maybe by a robot). Everything seems minimal, but is it really? It’s not minimal if a fusion is being performed! The confusion arises from the fact that a fusion can be described as “minimally invasive” if the incisions required for the surgery are relatively small.

This is a huge problem in my opinion. People assume that since the incisions are small, that it is a small procedure. In fact, nothing could be further from the truth.

Fusions are permanent and irreversible. If you don’t like your fusion, there is very little recourse. If you really don’t like it, you can opt to revise the fusion to something larger or resort to pain management procedures like a pump or a stimulator.

Robotic surgery is taking the world by storm. In the spine world, robots promise the most minimally invasive surgery of the spine, but is robotic spine surgery really that minimal? The answer is a resounding – NO.

The reason that it is not that minimal is because the robot is helping the surgeon position the hardware for your fusion. The fusion requires removal of the disc which is replaced with an implant and/or bone graft. The implant or bone graft eliminates the motion where the disc was.

At this point in time, a cat scanner acts as the “eyes” for the robot. Once the surgeon is oriented, the robotic arms are used to cut bone and place implants, like screws, in the correct position. This is hardly minimal surgery; the incisions might be small, but the surgery is not minimal, it is a fusion.

What’s the most common long-term problem resulting from a fusion?

The answer is adjacent disc disease (ADD).

ADD occurs at a rate of 5% per year after a lumbar fusion (2.5% per year after a cervical fusion). So 10 years after a lumbar fusion, there will be evidence of adjacent disc disease in 50% of the patients.

What is adjacent disc disease (ADD)?

Adjacent disc disease refers to the premature wear of the discs that remain at the ends of a fusion. When a level is fused, the remaining mobile segments will have to “move a little more and work a little harder” to compensate for the loss of motion from the fused segment(s). The additional motion can wear out the disc at that level out sooner and may require additional surgery.

No matter how minimally invasive the surgical technique is to perform a fusion, the long-term effects of adjacent disc disease are still the same. Adjacent disc disease is what happens at the ends of the fusion.