Spine Surgery

SS1 Spine Surgery
Spine surgery also more commonly known as “open surgery,” meaning the area being operated on is opened with a long incision to allow the surgeon to view and access the anatomy. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique.

Because minimally invasive spine surgery does not involve a long incision, it avoids significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a faster recovery.

Spine surgery is typically recommended only when a period of nonsurgical treatment such as medications and physical therapy has not relieved the painful symptoms caused by your back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of your pain, such as a herniated disk or spinal stenosis.

History of Minimally Invasive Spine Surgery

SS2 Spine SurgeryMinimally invasive spine surgery is an endoscopic procedure that uses specialized video cameras and instruments that are passed through small incisions (less than 2 cm) in the back, chest or abdomen to access the spine and perform the needed surgery.
Endoscopic techniques have been used for several decades, but for diagnostic purposes only. In the late 1970s and early 1980s, endoscopic techniques were advanced so that both a diagnosis could be made and the disease could be treated. These same endoscopic techniques used in other surgical disciplines have now been advanced to the treatment of spine disorders.
Not every patient, however, is a candidate for a minimally invasive approach to spine surgery. To see if you are a candidate for this approach for spinal tumors, deformity, trauma, or degenerative disease you must be fully evaluated by a surgeon knowledgeable and experienced in these minimally invasive techniques. Dr Kevin Yip is renowned in this field and has been instrumental in advancing these techniques.
Who are suitable for this surgery?

In certain cases of degenerative discs, scoliosis, kyphosis, spinal column tumors, infection, fractures and herniated discs, minimally invasive techniques may speed recovery, minimize post-operative pain and improve the final outcome. Many types of minimally invasive spine surgery are performed at Singapore Sports And Orthopaedic Clinic including:

• Spinal fusion, which is often performed on degenerative disks
• Deformity corrections, such as for scoliosis
• Repair of herniated disks
• Decompression of spinal tumors
• Repair and stabilization of vertebral compression fractures

What are the benefits of minimally invasive spine surgery?

Minimally invasive spine surgery offers several advantages over open surgery, which typically requires large incisions, muscle stripping, more anesthesia, a long hospital stay, and a long recuperation period. The benefits of spine surgery include:

• A few tiny scars instead of one large scar
• Shorter hospital stay – a few days instead of a week
• Reduced postoperative pain
• Shorter recovery time – a few months instead of a year and quicker return to daily activities, including work
• Less blood loss during surgery
• Reduced risk of infection

What are the risks of spine surgery? Is the surgery safe?

SS3 Spine SurgeryAs with any surgical procedure, including minimally invasive spine surgery, there are general risks and procedure-specific risks. The more common general risks of spine surgery include the risk of adverse reactions to the anesthetic, post-operative pneumonia, blood clots in the legs (deep vein thrombosis) that may travel to the lungs (pulmonary embolus), infection at the site of surgery and blood loss during surgery requiring a transfusion. The specific risks of spine surgery include the risk of injury to the nerves or spinal cord resulting in pain or even paralysis, (the estimated risk of paralysis for major spinal reconstructions is somewhere around 1 in 10,000), the instrumentation, if used, breaking, dislodging or irritating the surrounding tissues, and pain from the surgery itself. On rare occasions, during a minimally invasive procedure, the planned surgery cannot be completed and requires either a second trip to the operating room or a conversion from the minimally invasive technique to a full open technique.

How do I prepare for spine surgery?

To prepare for spine surgery, quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have.
SS4 Spine SurgeryWhat happens during minimally invasive spine surgery?

Most types of minimally invasive surgery rely on a thin telescope-like instrument, called an endoscope, or on a portable X-ray machine, called a fluoroscope, to guide the surgeon while he or she is working. The endoscope is inserted through small incisions in the body. The endoscope is attached to a tiny video camera – smaller than a dime – which projects an internal view of the patient’s body onto television screens in the operating room. Small surgical instruments are passed through one or more half-inch incisions, which are later closed with sutures and covered with surgical tape. The fluoroscope is positioned around the patient to give the surgeon the best X-ray views from which to see the anatomy of the spine.

Complications
As with any operation, there are potential risks associated with MISS. Complications of MISS are similar to open spinal fusion surgeries, however, some studies show a reduced infection rate for MISS. It is important to discuss these risks with your surgeon before your procedure.

Infection. Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.
Bleeding. A certain amount of bleeding is expected, but this is not typically significant.
Pain at graft site. A small percentage of patients will experience persistent pain at the bone graft site.
Recurring symptoms. Some patients may experience a recurrence of their original symptoms.
Pseudarthrosis. Patients who smoke are more likely to develop a pseudarthrosis. This is a condition where there is not enough bone formation. If this occurs, a second surgery may needed in order to obtain a solid fusion.
Nerve damage. It is possible that the nerves or blood vessels may be injured during these operations. These complications are very rare.
Blood clots. Another uncommon complication is the formation of blood clots in the legs. These pose significant danger if they break off and travel to the lungs.

Recovery

SS5 Spine SurgeryMinimally invasive procedures can shorten hospital stays. The exact length of time needed in the hospital will vary with each patient and individual procedure, but generally, MISS patients go home in 2 to 3 days.
Because minimally invasive techniques do not disrupt muscles and soft tissues, it is believed that post-operative pain is less than pain after traditional, open procedures. You should still expect to feel some discomfort, however, advancements in pain control now make it easier for your doctor to manage and relieve pain.
To help you regain strength and speed your recovery, your doctor may recommend physical therapy. This will depend on the procedure you have had and your general physical condition. Specific exercises will help you become strong enough to return to work and daily activities.
If you have had a fusion procedure, it may be several months before the bone is solid, although your comfort level will often improve much faster. During this healing time, the fused spine must be kept in proper alignment. You will be taught how to move properly, reposition, sit, stand, and walk.
How long it will take to return to your daily activities after MISS depends upon your individual procedure and condition. Your doctor will evaluate you after your surgery to make sure that your recovery is progressing as expected.