Microscopic Spine Surgery

What is Microscopic Spine Surgery?

Microscopic spine surgery is a minimally invasive surgical procedure performed using state-of-the-art technology to treat conditions pertaining to the spine. It involves the use of highly sensitive surgical microscopes, special surgical instruments, devices and advanced imaging techniques to visualize and perform the surgery through small incisions to repair and correct spinal deformities.

The technically advanced microscopic spine surgeries can be employed to perform various spine surgeries, such as:

• Anterior cervical discectomy and fusion (ACDF)
• Intradiscal electrothermal annuloplasty (IDET)
• Posterior cervical laminectomy and fusion
• Anterior lumbar interbody fusion (ALIF)
• Posterior lumbar interbody fusion(PLIF)
• Transforaminal lumbar interbody fusion(TLIF)
• Axial lumbar interbody fusion(AxiaLIF)
• Direct lateral lumbar interbody fusion (DLIF)
• Kyphoplasty

Benefits of Microscopic Spine Surgery

Microscopic spine surgery is aimed at minimizing damage to the muscles and surrounding structures and possesses numerous benefits over traditional spine surgery including:

• Smaller surgery scars
• Reduced risk of infections
• Less blood loss during the surgery
• Less post-operative pain
• Quicker recovery
• Shorter hospital stay
• Better cosmetic outcomes
• Quicker return to work and normal activities

Anatomy of the Spine

The spine, also called the backbone, plays a vital role in stability, smooth movement, and protection of the delicate spinal cord. It is made up of bony segments called vertebrae with fibrous tissue called intervertebral discs between them. The vertebrae and discs form the spinal column from the neck to the pelvis, giving symmetry and support to the body.

Indications for Microscopic Spine Surgery

Microscopic spine surgery can be indicated to treat several spinal conditions such as:

• Spinal stenosis
• Sciatic nerve pain
• Spondylosis
• Spondylolisthesis
• Nerve damage
• Scoliosis
• Kyphosis
• Degenerative disc disease
• Compression fractures in the spine
• Herniated discs
• Spinal tumors

Preparation for Microscopic Spine Surgery

Pre-procedure preparation for microscopic spine surgery will involve the following steps:

• A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• You should refrain from alcohol or tobacco at least a few days prior to the surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
• You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
• You should arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Microscopic Spine Surgery

The minimally invasive microscopic spine surgery will usually involve the following steps:

• You will lie face down on the operating table under the influence of general anesthesia.
• Under fluoroscopic (live X-ray) guidance, your surgeon passes a thin needle called a guidewire through the skin and muscles in your back to locate the diseased area.
• The needle is withdrawn and a small incision of about 1 inch is made over the area to be treated and dilators are inserted sequentially.
• A series of segmental dilators and tubular retractors are used to gradually separate the muscles and create a portal or tunnel through which the surgery can be performed.
• The dilators create a tunnel leading to the affected disc by splitting the back muscles instead of cutting them.
• Retractors are used to hold the tunnel open, and a microscope and special surgical instruments are inserted.
• Viewing through the microscope, your surgeon carries out the necessary correction such as trimming and removing the diseased disc (herniated disc) portion using special cutting instruments to decompress the spinal nerve root. Synovial cyst or bone spurs that may compress the nerve root are also removed.
• After confirming the correction, the microscope, dilators, retractors, and special instruments are withdrawn, and the muscle fibers are joined back together.
• A small strip of adhesive bandage is applied over the incision site at the completion of the procedure.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after microscopic spine surgery will involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. 
• You may need to stay in the hospital for a day or two before discharge to home.
• You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• Application of cold and heat therapy on the spine area is also recommended to reduce inflammation and pain.
• Walking and moving around in bed is strongly encouraged to prevent the risk of blood clots.
• Antibiotics are prescribed as needed to address the risk of surgery-related infection.
• Your diet is slowly advanced post surgery. You will start with clear liquids, then progress to having normal solid foods, as tolerated.
• Instructions on surgical site care and bathing will be provided.
• Eating a high-calcium and low-fat diet is strongly recommended to promote healing and a faster recovery.
• A high-fiber diet and drinking 8 to 10 glasses of water daily are recommended to keep stools soft. Laxatives or stool softeners may also be recommended as needed.
• Activity restrictions until the first follow-up visit include:
  • Avoid lifting, bending, or twisting your back
  • Do not lift anything heavier than 5 pounds
  • Refrain from any strenuous activities such as housework, yard work, or sex
• Refrain from smoking as it inhibits bone growth and delays healing.
• Walking is a good exercise and is strongly recommended to improve your endurance.
• A physical therapy protocol is recommended to help strengthen spinal muscles and optimize their function after the first follow-up visit.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• You will be able to resume your normal activities in 2 to 3 weeks but may have certain activity restrictions.
• Complete recovery and return to work vary from patient to patient as it is related to a patient’s overall health status and the type of work one does.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Microscopic spine surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Infection
• Blood loss
• Blood clots or deep vein thrombosis
• Anesthetic/allergic reactions
• Neurovascular injury
• Persistent pain
• Bowel or bladder problems