Minimally invasive discectomy

A minimally invasive discectomy (surgery on a disc in your spine) uses a much smaller incision, generally about an inch in length. This type of surgery creates a small tunnel through the muscles in the back down to the area where the herniated disc is located. In comparison, an open discectomy involves a much larger incision and also involves stripping the muscles away from the spinal column so that the surgeon can see the area where the herniated disc is located. The actual surgical procedure, removing the fragments of the herniated disc, is very similar with both techniques.

How big is the actual incision for a minimally invasive discectomy?
The tubular retractor that is used to create a tunnel down to the spinal column where the herniated disc is located measures ¾ of an inch. The actual skin incision is a little bit longer than this, but is generally about an inch in length. This type of surgery uses a "muscle splitting" approach, so that the tubular retractor is passed through a tunnel in the muscles of the back, rather than stripping them away from the spine, as in an open discectomy.  When the tube is removed, your muscles come back to their normal alignment.  In essence, the main advantage of the minimally invasive approach besides a smaller cosmetically pleasing incision would be its ability to preserve your normal spinal attachments and natural spinal biomechanics.  It would be similar to splitting your hair to get to your scalp rather than shaving your whole head off to achieve the same objective.

How long will I have to stay in the hospital?
For the most part, this is now an outpatient surgery. The surgery takes anywhere from 30 min to an hour to perform. Patients are kept in recovery for several hours for post anesthetic monitoring and would be ambulatory to be discharged the same day. 

What are the results of minimally invasive discectomy?
Patients who have had this type of surgery report very high levels of satisfaction and pain relief that are equivalent or better than traditional open discectomy. There are numerous articles supporting equivalent or better outcomes with the minimally invasive procedure over traditional open discectomy.  

How dangerous is a minimally invasive discectomy?
While all surgery involves risk, neurosurgeons who have advanced spine training take steps to minimize those risks. The minimally invasive surgery is supplemented with an operating microscope which is familiar in use to most surgeons. It gives us 3-D visualization of the operative field as well as control of magnification and illumination.  Minimally invasive discectomy risks of CSF leaks, infection, and recurrent disc herniaitons at our institution are comparable or less than that reported in the literature for the open procedure.

Can a minimally invasive fusion be performed through the tube system?
Absolutely. Our fellowship trained spinal surgeon is the only surgeon in the local area offering the minimally invasive posterior interbody fusion through the tube supplemented with percutaneous screws.  The advantages of preserving natural spinal mechanics and muscle attachments are even greater with the minimally invasive fusion compared to the open fusion surgery.  In most cases patients have gone home the same or following day after surgery.

Are there any other aspects of the minimally invasive surgery?
Over the last several years, the minimally invasive approach has also been used to treat spinal stenosis.  It has replaced the need to do a formal laminectomy – which can have consequences of creating instability and chronic back pain via changing the natural biomechanics of spinal motion.  Rather than stripping all muscles and removing all of the lamina, the minimally invasive spinal stenosis decompression surgery preserves all natural attachments.  It has the ability to decompress both sides of the spinal canal from a unilateral approach and removes only the bone that is compressing the nerves. The part of the bone that preserves natural spinal biomechanics as well as the muscle attachments are left intact. Reported outcome data and institutional experience have been excellent.

How will I know if a minimally invasive procedure is right for me?
As surgeons, we discuss the advantages and disadvantages of this type of surgical procedure with you. We determine if the cause of your back pain is likely to get better with or without surgery, and what type of surgery is the most reliable method for decreasing your pain and relieving the symptoms of a herniated disc.

Dr. Le is a neurosurgeon with Rebound Neurosurgery. His office is located in the Physicians Pavilion of the PeaceHealth Southwest Medical Center campus. He can be reached at 360.254.6161.

You can link to all the medical specialists who partner with PeaceHealth Southwest on our Find a Doctor area.

Published April 2008.

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