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What is Minimally Invasive
Spinal Surgery (MISS)?

Minimally Invasive Spine Surgery viewed from two perspectives: Dr John C. Chiu of the California Spine Institute manipulating the micro probes and graspers, and footage from inside the disc of the instruments in action (including close-ups), cutting away a portion of the bulging disc, .

  • Introduction


    Back and neck pain is the price human beings pay for  poor posture, prolonged sitting, lifting, repeated bending, obesity, and injury  from accidents. It is providing the United States with a massive economic  headache.

     

    Approximately 85% of inhabitants of the Western world  are afflicted with some degree of back or neck pain at some point in their  lives. About 25% of our population has been incapacitated for two weeks or more  and possibly 8 to 10 million people have a permanent disability from chronic  back pain.

     

    In most cases, simple treatments such as bed rest,  exercise, physiotherapy, and pain medication bring relief. Many sufferers are  not so fortunate. If one or more of their vertebral discs ruptures and presses  on nerve roots, the pain that radiates from the back or neck and down the limbs  can be incapacitating and severe.

     

    Until recently, the only treatment was surgical  removal of part of the ruptured disc, a major operation that required general  anaesthesia, the dissection of muscle, removal of bone, manipulation of nerve  roots, and, at times, bone fusion.

     

    In an effort to overcome the disadvantages of  traditional surgical techniques, the scientific medical community began  exploring the use of endoscopy (arthroscopy). An endoscope (arthroscope)  provides clear visualization and magnification of deep structures. This  technology, first used in knee surgery, has been astonishingly successful in  relieving pain.

     

    Now, because of advanced scientific technology and  miniaturization, including fiber optics, video imaging technology, and  experience gained through minimally invasive spinal surgery, there is a less  traumatic discectomy procedure for some patients with disc problems. It is  Microdecompressive Endoscopic Spinal Discectomy, a form of Minimally Invasive Spinal Surgery. For simplicity, and because the term Microdecompressive  Endoscopic Spinal Discectomy, doesn't mean much to the average person, we  call it simply, Minimally Invasive Spinal Surgery or MISS.

  • MISS verses Conventional Open Back Surgery

     

    MISS is a procedure for  decompressing nerve roots damaged by spinal disc protrusions. The term minimally invasive, of course, speaks  volumes. It defines a category of procedures designed to do as little damage—to  be as non-invasive and non-intrusive—as possible. Minimally invasive surgery, then, refers to surgical procedures  designed to do as little collateral or malingering damage as possible.

     

    In other words, we get in, do the job, and get out  with minimal disruption to:

     

      • The offending disc itself

      • The entry point and access path

      • The immediate area surrounding the disc

      • The patient's overall health

     

    MISS is performed with micro instruments, fiber  optics, lasers and digital imaging, as opposed to conventional highly invasive  knives, bone saws and other equally intrusive devices. Compared to conventional open back surgery, which usually entails huge  incisions, displacing muscle tissue and nerve roots, and sometimes the removal  bone, MISS is without question much less traumatic. It doesn't destabilize the  spine, unlike many conventional back surgeries. It can also be performed on  multiple discs, even at widely spaced levels, during the same surgical session.  Working on multiple discs with open back surgery often requires additional destructive  entry wounds—far too much damage for patients to endure or recover from.

     

    Herniated discs, one of the more  common disc problems, place pressure on the nerves in your spine, causing  severe pain. Conventional back surgery attempts to solve this and other disc  problems with extreme measures—such as removing a spinal disc or fusing parts  of the spine together, so that they no longer move independent of one another,  significantly decreasing the spine's mobility, or ability to move freely. Too  often, considering the risks and sustained trauma, these solutions fail to  relieve the patient's pain or make it and the overall spine condition worse.

     

    It hurts just thinking about that. As you can  imagine, major alterations like this to your spine (not to mention the huge  access wound) take a long time to heal, several weeks or months. Full recovery,  or returning to 100 percent original functionality, occurs infrequently. Also,  this kind of surgery can require lengthy hospital stays, entails significant  blood loss, and renders the patient vulnerable to several possible  complications.

     

    MISS, on the other hand, is performed with very small  "micro" instruments and tiny cameras inserted through a small tube. We also use  x-ray, and other types of visualization technology to help guide the  instruments, allowing us "see" what we're doing without cutting and clearing  obstructing vital tissues and structures. Instead of huge, traumatic access  wounds, we reach the offending disc through a very small incision. Damage to  tissues and other vital structures in the immediate vicinity are, in nearly all  instances, so minuscule that within a very short time—usually a few days—the  access point is completely healed, with little to no impact on the patient's  body and overall health.

  • Who Should Consider This Operation?

    Our  MISS (Microdecompressive Spinal Discectomy) procedure is specifically designed  for patients with uncomplicated herniated discs accompanied by the following:

     

    Pain of  the low- or mid-back, neck or limbs, or intractable cervicogenic headache (caused by herniated cervical, or neck, disc.)

     

    Pain that has not responded to conventional treatments  including rest, physical therapy, chiropractic treatment, medication, exercise,  and pain management

     

    Positive corresponding neurological findings of reflex  changes, muscular weakness, or decreased sensation

     

    A positive CT  scan, MRI scan, or myelogram for disc herniation

     

    Positive provocative discogram

     

    Multiple discs can be treated at one sitting

     

    Post fusion junctional disc herniation syndrome  (complications from prior conventional fusion surgery)

  • This Procedure is not Designed for:

    Patients with symptoms from advanced arthritis of the spinal joints, or large bone spurs that may  cause a similar type of pain

     

    Evidence of neurological or vascular pathologies mimicking a herniated disc

     

    Fractures, tumors, or active infections

     

    Procedure is performed only on patients with clinical symptoms confirmed by physical examination, X-ray, MRI, or CT scans

     

  • The MISS Procedure /with Laser Probe Video

    Depending on the type of surgery indicated the  procedure is done with the patient under either a local anaesthesia or in some  situations, a brief general anaesthesia (sometimes for cervical procedures).

     

    Using fluoroscopic x-rays, the endoscope and video  image for guidance, a hollow tube is inserted into the disc space. A variety of  surgical instruments could be used through the hollow tube, including  mini-forceps, curettes, trephines, rasps, burrs, cutters, and other types of  probes. A discectome, a hollow probe, is used to suction and remove small  pieces of disc material. Enough disc is removed for decompression of the nerve  root. A laser is used to shrink and tighten the disc and remove portions of the  disc. The supporting structure of the disc is not affected. Upon completion, a  small Band-aid is applied to the incision. The procedure takes about 30 minutes  per disc, on the average. X-ray exposure is minimal.

     

    (Note: This procedure is used for bony decompression and soon  could be attempted even for bone fusion and internal fixation/stabilization.)

     

  • After Surgery

    The  patient may feel relief from pain immediately following this outpatient  procedure. Some patients experience mild muscle spasms that can generally be  relieved with muscle relaxants and analgesics.

     

    Pain at the site of the operation is usually minimal  and requires no medication. Walking and light exercising are usually encouraged  on the day after discharge, and a daily exercise program is also recommended.  Re-evaluation is done several days later. Little, if any, postoperative  medication is required for most patients and normal activities can usually be  resumed at the doctor's discretion within a couple weeks.

     

  • Advantages

    There  are numerous advantages to MISS compared to open spinal surgery*.

     

    (Note: Patients with large free fragments of disc in the spinal canal, as determined by the x-ray, cannot benefit  from the endoscopic procedure, but might benefit  from the arthroscopic  procedure. However,  the laser can shrink the bulging disc further for disc decompression.)

     

    Some  advantages are:

     

      •Much less tissue trauma when compared to an open  surgical procedure

      •Hospitalization is not required, MISS is an outpatient  procedure

      •Faster recovery, since MISS is an outpatient procedure

      •Minimal to no scarring in and around the nerves post  operatively

      •Earlier return to work and to daily activities

      •Patients can begin an exercise program the day after  surgery  •

      •We estimate the cost of endoscopic surgery is 40% less  than conventional spine surgery

     

  • Summary

    MISS requires no hospitalization , allows  for  earlier return to work and return to  daily activities, when compared to conventional spine surgery.

     

    Please feel free to discuss any questions you might  have concerning these procedures.

     

    *Some patients experience mild muscle  spasms and transient pain. A small percentage of patients do not get relief of  symptoms. Patients who initially have obtained good results appear to remain  pain free.

     

    **Endoscopy (pronounced   en-doe-scop-ey ) means looking  inside  and typically refers to looking inside the body for  medical reasons using an  endoscope (pronounced  en-doe-scope), an instrument used to  examine the interior regions of the body.

     

    ***Arthroscopy (pronounced  are-throw-scop-ey) is a minimally  invasive surgical procedure in  which an examination and sometimes treatment of damage of the interior of a joint is  performed using an arthroscope (pronounced are-throw-scope), a type of endoscope that  is inserted into the joint through a small incision.

     

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