It may be called “mini” but minimally invasive spine-fusion surgery offers patients maximum benefits by reducing infection risk, blood loss, and postoperative complications, including trauma to muscles, ligaments, and other soft tissue, according to endoscopic spine surgery expert Dr. Kaixuan Liu.
“Patients undergoing a mini-spine fusion are up walking almost immediately after surgery, usually leaving the hospital the same day, and returning to normal activity within six weeks or less,” says Dr. Kaixuan Liu, founder of Atlantic Spine Center. “Those patients requiring the more traditional, open spinal fusions must undergo several days recuperation before walking and wait six months or more before resuming regular activities.”
Scientists concur with Dr. Liu’s comments. A study authored by a Loyola University Medical Center physician and published in Neurosurgical Focus underscores the successful outcomes and advantages of minimally invasive spinal fusion performed in the lower (lumbar) region of the back. In later research, published in the Iowa Orthopedic Journal (PMC4492142), investigators write, “MIS TLIF (minimally invasive transforaminal lumber interbody fusion, a mini-spine-fusion technique) provides…less intraoperative blood loss and subsequently a lower transfusion rate compared to open techniques …MIS TLIF is at least as safe as open techniques with respect to dural tear, wound infection, and screw placement.”
Dr. Liu also cites a study, appearing in Spine (10.1097/BRS.0000000000001470), that indicates mini-fusion techniques can preserve the lumbar spine’s natural curvature in patients with degenerative spinal disease, despite some surgeons’ “perception that minimally invasive lumbar interbody fusion procedures are unable to affect segmental and regional lordosis.” Lordosis refers to the natural “S” shape of the spine.
When more conservative treatment measures fail, mini-spine-fusion surgery is an option for patients experiencing the pain of degenerative disc disease and instability in the lower spine due to aging and disorders like osteoarthritis.
“The procedure involves permanently fusing two affected vertebrae together through a small incision, thereby allowing them to become a single bone and preventing them from moving and painfully rubbing against each other,” says Dr. Liu.
Other spinal conditions for which minimally invasive spine-fusion can prove corrective are:
- Spinal fractures.
- Moderate cases of lumbar spondylolisthesis, a displacement of one of the vertebrae.
- Recurrent herniation of one or more lumbar discs, those rubbery elliptical pads that are located between the spine’s vertebrae and serve as natural shock absorbers to protect the spine from stressors and give it flexibility.
- Foraminal spinal stenosis, a narrowing of the small openings (foramen) between the bones in the spine, causing compression of the nerves that pass through those openings and resulting in debilitating pain, including sciatica – pain, numbness, and tingling that radiates through arms or legs.
Mini spinal fusion is not a recommended approach for treating certain spinal deformities or for “high-grade spondylolisthesis,” when one vertebra has slipped more than 50 percent beyond the adjacent lower vertebra, Dr. Liu says.
A mini-fusion procedure is performed through a tiny cut created near the source of the problem.
“The incision is made either on the backside (posterior) or in the patient’s side (lateral) depending on the best approach to a particular spinal problem,” Dr. Liu explains. “Under guidance of X-rays, the surgeon inserts a needle, guiding wire, dilator, and small tube into the incision and carefully removes the damaged spinal disc through the tube, avoiding any harm or irritation to the nerves and preserving the muscles and ligaments surrounding the spine. Then bone graft and a cage with bone-graft material are inserted in place of the damaged disc to maintain proper height between vertebrae. The cage and bone graft will eventually allow the two involved vertebrae to fuse.”
In some cases, the surgeon may add implants, such as plates or rods, to provide additional support for the vertebrae, Dr. Liu states.
Experts contend that the number of spine-fusion procedures performed in the United States has significantly increased as surgical techniques, tools, materials, and knowledge have improved.
As evidence of that, Dr. Liu refers to a study published in a March 2021 issue of The International Journal of Molecular Sciences. In it, authors suggest that ongoing developments in “visualizing and guiding techniques” and surgical materials are “continuously improving the safety and efficacy” of minimally invasive spine-fusion procedures and enhancing “the learning curve” of surgeons.”
This same study indicates that, in the future, mini-spine-fusion procedures could be paired with other advancements in techniques and materials, including ceramics as bone-grafting materials, repair cell therapies, concentrated platelets-mediated bone grafting and regeneration, and even 3-D printing.
“The possibilities are almost limitless,” says Dr. Liu, although he quickly adds that preservation of spinal health is more effective than any surgical approach or treatment protocol. He offers these tips:
- Exercise the body’s core (trunk) muscles, which provide support to the spine.
- Maintaining a height- and age-appropriate weight.
- Practice good posture when standing or sitting.
- Eat nutritiously to promote healthy bones.
- Follow recommended lifting techniques that take pressure off the spine and back.