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Also referred to as “MIS spine surgery” or MISS, this term has been used a lot recently, and not always appropriately. Some surgeons refer to any surgery in which they make a smaller than traditional incision as MIS surgery. However, I believe that the true distinction between traditional and MIS spine surgery is the amount of muscle dissection and muscle damage that the surgeon makes during the surgery. This philosophy I attribute to my mentor Dr. Anand, a pioneer in MIS spine surgery.
Many of the operations that I perform as a spine surgeon must be performed while keeping a few major goals in mind to make you, the patient, feel better:
If I can achieve these goals with the surgery, you will feel better. Now let’s talk about how exactly we can achieve these surgical goals together. Depending on what spinal disorder you have, we can most likely achieve these goals using a variety of different surgical approaches or techniques. This is where the true art of spinal surgery comes into place – the learned techniques and preferences that I as a surgeon bring to the table.
For example, let’s say you have a cervical disk herniation at two levels. These disk herniations are
Once we have exhausted all non-surgical treatments such as physical therapy and anti-inflammatory medications and we decide together that spine surgery is your best option, we can discuss various surgical techniques to treat your symptomatic disk herniations. We could decide to try a posterior cervical foraminotomy, which is technically an MIS surgery, to relieve pressure on the pinched nerves. Or we could perform a two-level anterior cervical diskectomy and fusion (ACDF). Or we could choose to perform a two-level artificial disk replacement. Technically, the foraminotomy might be considered to be more of an “MIS” procedure than an ACDF or disk replacement. However, the foraminotomy requires disrupting the neck musculature to obtain access. A two-level disk replacement might not sound like a minimally-invasive procedure, but we can do it through a small incision in the front of the neck that does not damage any of the neck muscles.
This philosophy can be applied to various surgical treatments of the spine, such as posterior spinal fusion using percutaneous MIS techniques or lateral interbody fusions, etc.
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