Introduction
Traditionally, spinal fusion surgery involved extensive incisions, muscle detachment, and prolonged recovery times. However, advancements in surgical instruments and techniques have greatly enhanced the experience for patients needing spine surgery. Minimally invasive lateral access spine surgery, also known as the lateral transpsoas approach, employs small incisions and a muscle-sparing technique, leading to hospital stays of just one or two days. Many patients are able to walk just a few hours after their procedure.
Anatomy
The spine is made up of a series of bones called vertebrae, divided into different regions based on curvature and function. The cervical spine consists of seven small vertebrae in the neck, while the thoracic spine contains twelve vertebrae in the chest area. The lumbar spine, located at and below the waist, consists of five larger vertebrae. The lower vertebrae are often fused or structured differently to connect with the hip and pelvis bones.
Each vertebra has a back part that arches to form the lamina, creating a roof-like structure over the spinal canal, which houses the spinal cord, nerves, and arteries. The spinal cord and nerves facilitate communication between the body and the brain.
Intervertebral discs, situated between the cervical, thoracic, and lumbar vertebrae, are composed of strong connective tissue. Each disc has a tough outer layer called the annulus fibrosus and a gel-like center known as the nucleus pulposus, which retains about 80% water. These discs, along with two small spinal facet joints, connect adjacent vertebrae, allowing for movement, stability, and acting as shock absorbers to protect the vertebrae.
Causes
Minimally invasive lateral access spine surgery may be a suitable alternative to traditional spinal fusion for select patients suffering from conditions such as degenerative disc disease, recurrent disc herniation, spinal instability, spondylolisthesis, failed fusion, osteomyelitis (bone infection), discitis (disc infection), tumors, scoliosis, and post-laminectomy syndrome. Candidates typically experience significant back pain, with or without accompanying leg pain, and have not found relief through medications, steroid injections, or physical therapy.
Symptoms
Individuals experiencing low back pain, or pain radiating to the legs, may be potential candidates for the minimally invasive lateral technique for spinal fusion.
Treatment
Minimally invasive lateral technique spinal fusion surgery is performed as an inpatient procedure, usually requiring a one- or two-day hospital stay. This technique accesses the spine from the side rather than the traditional front or back approaches. During the procedure, surgeons utilize real-time nerve localization, monitoring technology, and X-ray guidance.
The process begins with a small incision in the side flank. Dilators equipped with electromyographic (EMG) data help guide the surgeon to the spine, while retractors gently spread the surrounding muscles for access.
Once the target area is reached, the necessary surgical interventions are conducted. Afterward, retractors are removed, and the incisions are sutured closed.
Recovery
Due to the small incision and preservation of muscle tissue, recovery from minimally invasive lateral technique spine surgery is significantly quicker and less painful compared to traditional surgical methods. Patients can often walk within hours post-surgery, and only a brief hospital stay is required.
