Minimally Invasive Spine Surgery

Necessary Equipment and Technical Training

In the field of spine surgery, countless advancements have been made in the last 20-30 years alone. Many operations that 30 years ago seemed "prohibitive" due to their invasiveness and risk to the patient are now routine procedures for a growing number of surgeons specializing in this type of surgery.

This evolution is due not only to the increasingly adequate training of young surgeons, who benefit from the experience of their professors, but also to improvements in surgical techniques. Techniques have become less and less invasive over time, and today we have reached a point where it is probably difficult to imagine further reducing the invasiveness of most common spine surgeries.

Over the years, a number of innovative surgical techniques and equipment have been introduced, developed, and refined, allowing for effective intervention through both radical and minimally invasive surgical procedures, depending on the case and pathology to be treated. In spine surgery, minimally invasive or endoscopic spine surgery requires specific skills from the orthopedic surgeon. Now, one of the criteria for choosing the best spine surgeon is their specialization in minimally invasive surgery. Therefore, the best spine surgeon in France will be one of the best back surgeons who has pursued their studies in the field of minimally invasive surgery. Search the internet for the best spine surgeon in Lyon or the best spine surgeon in Paris, for example, and you will see that the results given will all be orthopedic physicians who perfectly master the minimally invasive surgical techniques of the spine.

How is an Endoscopic Spine Surgery Performed?

Musculoskeletal pain in the spine is very often linked to degenerative disc disease and is initially treated with pharmacological and rehabilitation treatments.

However, when pain persists significantly and neurological deficits are present despite conservative treatments, surgical treatment may be necessary.

Unlike traditional surgery, minimally invasive surgical procedures have the advantage of leaving barely visible scars and minimizing the surgical trauma to paravertebral soft tissues. This results in faster patient recovery and fewer side effects compared to traditional surgery.

Minimally invasive spine surgery can be performed under general, spinal, or local anesthesia, depending on the type of operation. To perform this type of surgery, the surgeon uses state-of-the-art instrumentation and a highly specialized surgical team.

Compared to traditional surgery, in addition to being less aggressive, the advantages for the patient are numerous:

• Minimal surgical incision (2-3 cm);
• Hospital stay of one or two days;
• Recovery time for work and physical and sporting activity of one to two weeks;

Endoscopic Spine Surgery Step by Step

Endoscopic spine surgery can treat various pathologies. In the surgical approach, the procedure varies depending on the type of spine pathology to be treated. However, regardless of the pathology to be treated, minimally invasive spine surgery is always based on the same principle.

Let's take the example of vertebral stabilization. Vertebral stabilization concerns cases of instability, scoliosis, spondylolisthesis, degenerative spondylosis, stenosis, severe disc arthrosis in which the intervertebral disc degenerates, causing contact between adjacent vertebrae. It can also be performed in cases of complex vertebral fractures that cannot be treated otherwise than by kyphoplasty or vertebroplasty. The incidence of early instability is 5-6% in men and 2-3% in women. It increases with early practice (before the age of seven) of sports such as weightlifting, wrestling and combat sports, gymnastics and judo. Degenerative instability, on the other hand, is present from the age of 50 and is linked to morphostructural alterations resulting from aging.

Endoscopic spine surgery is based on total respect for all the body's structures. Thus, the use of very sophisticated instruments allows the placement of transpedicular screws and stabilizing rods with only a one-centimeter incision in the skin. Thanks to a special technique, once the screws are inserted, a stabilizing bar is introduced in connection with the screws, which allows complete correction of the spinal alteration. Endoscopy also allows absolute control of what is being done.

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Limitations of Minimally Invasive Spine Surgery

Surgical risks remain the same as those of conventional "open" surgery. It must always be kept in mind that minimally invasive techniques are a means, not an end. The goal is the treatment of the disease according to criteria defined by scientific studies and experience. If these results can be obtained by damaging less tissue, with smaller incisions, with optical means, with the robot, with augmented reality, then it is real progress. But every day, orthopedic surgeons encounter situations in which the minimally invasive technique has not achieved the desired result. It is necessary that the patient to whom minimally invasive surgery using the most modern techniques is proposed, discusses in detail with the surgeon the advantages and disadvantages of the proposed technique, particularly with a view to treating the disease. This is all the more true as we enter the field of pathologies such as tumors for which years of experience have validated, with long-term results, the need to follow precise treatment protocols. It is pleasant and desirable to apply the same criteria with minimally invasive techniques and with the help of robotics and virtual reality.

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