Minimally Invasive Spine Surgery (MISS)

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Your Questions

Please Note: These questions do not replace the advice of a physician. It is important that you ask us all the questions you have about minimally invasive spine surgery.

• When should I consider surgery?
• Am I a candidate for minimally invasive spine surgery?
• Why do I need to get an MRI, CAT Scan and an XRay before I have surgery? 
• How long will I be in the hospital? 
• When can I go back to work after minimally invasive back surgery?
• How long is the recovery?
• After surgery, how long will my pain last?
• Will I have to take pain medication after my surgery? Will I become dependant?
• Do I have to wear a brace?
• Will I need physical therapy after I get minially invasive spine surgery?
• Do you use lasers for minimally invasive back surgery?
• What are the disadvantages of MISS compared to traditional, open surgery?
• Which type of surgery has a greater success rate?
• Is minimally invasive spine surgery experimental?
• Why aren’t more hospitals and surgeons performing MIS surgeries?
• Are there any challenges with insurance coverage, due to this being a newer technique?
  
  
• When should I consider surgery?
  Surgery should always be the last resort when it comes to treating spinal conditions in the neck and back.  However, if various non-operative treatments have been attempted without improvement or worsening over a 6-12 month period, then surgical treatment seems reasonable for certain specific conditions such as spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis.  The decision for surgery should be individualized to the patient and the patient’s symptoms, along with their level of function. Return to top.
  
  
• Am I a candidate for minimally invasive spine surgery?
  The field of minimally invasive spine surgery continues to grow.  Most surgeries today can be treated with some aspect of minimally invasive surgery.  However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumors and some infections. 
  
  The best options should be individualized to the patient’s diagnosis and overall patient condition.  At UCSD we perform both minimally invasive spine surgery, as well as open-surgery, and choose the type of treatment that is best suited for the individual patient. Return to top.
  
  
• Why do I need to get an MRI, CAT Scan and an XRay before I have surgery?
  The integration of our newest technolgies that assist in MISS surgery often require that radiologic procedures be tailored to fit each operation and will often require a new scan. Return to top.
  
  
• How long will I be in the hospital?
  In general, minimally invasive spine surgery decreases the hospital stay by one-half.  In a typical endoscopic discectomy, the surgeries are performed in the same day, and the patients go home shortly after surgery on the same day. 
  
  For various types of lumbar fusion surgery, the patient typically goes home in 2-3 days, where previously they stayed in the hospital 5-7 days.  Furthermore, the immediate post-operative period is marked by much less pain when using minimally invasive techniques. Return to top.
  
  
• When can I go back to work after minimally invasive back surgery?
  The decision to return to work should be individualized to the patient, as well as the patient’s occupation.  For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks.  For a larger surgery such as a fusion, this may take 4-6 weeks.  Again, return to work is much faster using minimally invasive surgery vs. standard open surgery but this decision is individualized to special needs of each patient. Return to top.
  
  
• How long is the recovery?
  Most patients are able to get up out of bed and start walking shortly after surgery, usually on the same or following day.  For the first 6 weeks, the activity level is limited to walking and normal daily activities. 
  
  Most patients are encouraged to avoid heavy lifting, frequent bending, twisting or turning or climbing during the first 6 week period.  After 6 weeks, patients begin a physical therapy and exercise program to achieve rapid recovery and strength.  By 3 months a gradual increase in normal activities as well as the institution of low impact sporting activities can be started. At 6 weeks, all activities are begun, including sports. Return to top.
  
  
• After surgery, how long will my pain last?
  On average, patients who have had minimally invasive spine surgery are discharged in half the time of traditional surgery and the pain usually follows this rule. Each procedure will have a differnent rate of recovery. Return to top.
  
  
• Will I have to take pain medication after my surgery? Will I become dependant?
  There is no evidence that post-operation pain treatment leads to addiction. Return to top.
  
  
• Do I have to wear a brace?
  Although most patients are provided a brace, this is for comfort only.  The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as an internal brace, allows one to avoid having to wear a brace.  Most patients find that the brace improves their pain for about 1-2 weeks, and thereafter it is only worn occasionally. Return to top.
  
  
• Will I need physical therapy after I get minially invasive spine surgery?
  Physical therapy is an important component of a rapid recovery.  This is individualized to the patient, but in most cases, physical therapy started 2-6 weeks after surgery, depending on the surgery performed and the patient’s overall condition. Return to top.
  
  
• Do you use lasers for minimally invasive back surgery?
  Minimally invasive spine surgery utilizes a wide variety of advanced techniques, including lasers, endoscopes, operating microscopes, as well as computer-assisted navigation systems, so that procedures typically done with a large, open decision can be done through small openings. 
  
  By necessity, advanced technologies are needed to accomplish the same task that we would otherwise do with an open procedure using more basic equipment.  The decision to use one or other types of advanced technologies depends on the individual condition and the surgery performed. Return to top.
  
  
• What are the disadvantages of MISS compared to traditional, open surgery?
  Minimally invasive spine surgery holds significant promise, in terms of less pain and more rapid recovery.  However, it is important to keep in mind that this is relatively new technology, and all new techniques are associated with some degree of uncertainty. 
  
  Furthermore, certain minimally invasive techniques are highly technical and require significant training, and in cases where there is a lack of training, complications may occur.  Such complications can include inadequate decompression, nerve injury, infection or persistent pain. 
  
  However, these are all risks that are associated with open surgery as well.  Occasionally, due to the complexity and technical challenges of minimally invasive surgery, the surgeries may take a longer period of time to complete. Return to top.
  
  
• Which type of surgery has a greater success rate?
  At present, the long-term results of minimally invasive surgery are not well studied.  These assessments are ongoing.  The short term success of minimally invasive spine surgery is well established.  It is clear that minimally invasive surgery allows more rapid recovery and return to work/sports.  There is less post-operative pain and shorter hospital stay. Return to top.
  
  
• Is minimally invasive spine surgery experimental?
  No. MISS has been used sucessfully for many years. However, the scope, complexity and procedures available continue to evolve at a rapid rate. Return to top.
  
  
• Why aren’t more hospitals and surgeons performing MIS surgeries?
  Minimally invasive surgery is highly technical.  This requires significant training of the surgeon as well as the OR staff.  Furthermore, the equipment needed to perform these procedures safely and effectively can be very expensive.  As the only University hospital in San Diego, we are committed to the efficacious advancement of new technologies that promises to improve patient health and well being. Return to top.
  
  
• Are there any challenges with insurance coverage, due to this being a newer technique?
  The minimally invasive techniques performed at UCSD are accepted by nearly all insurance carriers. Return to top.