Minimally Invasive Spine Surgery

With minimally invasive spine surgery (MIS), surgeons can effectively treat spine disorders without the muscle dissection and disruption of spine anatomy normally associated with traditional, open surgery. The technology is so advanced that MIS can be accomplished through 1-inch incisions, offering patients the possibility of reduced blood loss, less scar tissue formation, and a relatively quick return to normal activity.

During MIS, an endoscope is inserted through a small incision. An endoscope is a thin telescope-like instrument with a lighted tube and camera attachment. The surgeon operates by passing instruments through the endoscope to the operative field. The light illuminates the field and the camera transmits images to a monitor in the operating room.

Not every patient is a candidate for MIS, and there are certain disorders that still require open surgery. Treatment options depend largely on the surgeon’s judgment, as well as the patient’s diagnosis and overall state of health. Dr. Frazier performs both MIS and open surgery and will recommend the treatment best suited for each patient.

Minimally invasive spine surgery is appropriate for the treatment of degenerative disc disease, herniated disc, vertebral fracture, spinal stenosis, and some types of spinal deformity. In addition, tumors and infections can be treated with MIS.
Many MIS procedures are performed on an outpatient basis.


Advantages

Perhaps the greatest advantage is that procedures once requiring open surgery and a lengthy recovery can now be done with MIS. The outcomes associated with MIS are as good, if not better, than those obtained with open surgery.

  • Advantages of MIS include:
  • Reduced operative time
  • Less soft tissue damage, due to reduced muscle retraction
  • Reduced blood loss
  • Surgical incisions are less painful and heal faster
  • Recovery is faster with less postoperative pain
  • Shorter hospital stay
  • Less tissue scarring; incision-site scars more cosmetically pleasing


MIS at New York City Spine

Dr. Frazier has trained extensively and is considered an expert in the field. He routinely performs MIS, including, but not limited to, the following procedures:

  • Discectomy
  • Anterior Lumbar Interbody Fusion (ALIF)
  • Direct Lateral Interbody Fusion (DLIF)
  • Posterior Lumbar Interbody Fusion (PLIF)
  • Transforaminal Lumbar Interbody Fusion (TLIF)
  • Extreme Lateral Interbody Fusion (XLIF)
  • Vertebroplasty and Kyphoplasty

A recommendation for MIS may be made after non-surgical treatments are exhausted, certain symptoms progress, and/or pain is unrelenting. The MIS techniques Dr. Frazier performs are those scientifically proven to be safe and effective. Dr. Frazier considers your age, overall health, and the severity of your condition before making a recommendation for surgery. We welcome your questions about MIS and look forward to helping you overcome your spine disorder.


MIS Approaches

In contrast to traditional open back surgery, MIS procedures approach the spine from the front (anterior), back (posterior), side (lateral), or back and side (posterolateral). The following MIS fusion procedures can correct spinal instability caused by degenerative disc disease, spondylolisthesis, and/or disorders affecting normal curvature of the spine. The main difference between the procedures listed below is the area of the body through which the spine is accessed.

  • Anterior Lumbar Interbody Fusion (ALIF)
  • Direct Lateral Interbody Fusion (DLIF)
  • Posterior Lumbar Interbody Fusion (PLIF)
  • Transforaminal Lumbar Interbody Fusion (TLIF)
  • Extreme Lateral Interbody Fusion (XLIF)

The interbody device, such as a Titanium cage or PolyEtherEther Ketone (PEEK) spacer, is implanted into the disc space.  Bone graft is packed into and around the device to stimulate spinal fusion.  

ALIF requires that the surgeon access the spine and disc through the abdomen.  This procedure is often combined with posterior fusion and instrumentation for better spinal fixation.

DLIF provides access to the spine through the side of the body.  This procedure involves a transpsoas approach, which means the surgeon accesses the spine through the psoas muscle; a long muscle on both sides of the lumbar spine.   

PLIF is a technique in which the disc is accessed through the back (posterior) of the spine.  Besides implantation of the interbody device, posterior instrumentation such as screws and rods are included for stabilization.

TLIF is done to access to both sides of the disc through the intervertebral foramina, small passageways through which nerves exit the spinal canal.  An interbody device such as a cage or spacer is implanted into the disc space from one side of the spine.  Pedicle screws and rods, with additional bone graft, secure the back (posterior) section of the spine.  TLIF fuses the front and back sections of the spine.

XLIF is a lateral access surgery, which means that the spine is accessed through the patients side/flank via small incisions made between the ribs and hip.  This procedure treats L1 to L5 and is not effective for L5-S1.  Because XLIF does not disrupt supporting spinal structures such as the ligaments, posterior instrumentation may not be needed.


Risks and Complications

Although the risks and complications of MIS are similar to open surgery, MIS offers significant benefits to the patient.  Benefits include:

  • Reduced operative time
  • Less soft tissue damage, due to reduced muscle retraction
  • Reduced blood loss
  • Surgical incisions are less painful and heal faster
  • Recovery is faster with less postoperative pain
  • Shorter hospital stay
  • Less tissue scarring; incision-site scars more cosmetically pleasing

Of course, no patients are identical and the best approach, as well as the risk and complications, vary.  Dr. Frazier will explain the rationale behind the recommended approach, as well as discuss the possible risks and complications related to your particular MIS procedure.


When MIS is Recommended

Although the indications for surgery vary between adults, MIS may be recommended if:

  • Imaging tests demonstrate spinal instability, large curve, or curve progression
  • Pain and other symptoms worsen and are unresponsive to non-operative treatment
  • Neurologic problems develop, such as bowel or bladder dysfunction
  • Imaging tests, such as x-ray or MRI demonstrate spinal instability or curve progression