Minimally Invasive Spine Surgery: Small Incisions, Advanced Care

     "Spine Surgery" sounds like a daunting prospect for many, often associated with old images of long surgical scars and the necessity of an Intensive Care Unit (ICU) stay under constant medical supervision. Today, the medical world has advanced far beyond that. I, Dr. Akarawit Asawasaksakul, would like to reshape your understanding of why modern spine surgery has become a much smaller issue—literally—with incision sizes so small they might surprise you.

‘Spine Surgery’ from Past to Present: Minimizing Side Effects

     In the past, spine surgery required a "large incision" to provide the surgeon with the clearest possible view of the surgical site. However, this came at the cost of significant blood loss and trauma to the surrounding muscles. Medical science has continuously developed technology to overcome these limitations. The use of a Microscope is a technology that magnifies the surgical field with high-performance precision, especially around critical areas like ‘nerves,’ allowing surgeons to operate accurately while minimizing injury to nearby tissues.

Microscope-assisted surgery serves as a foundation for other minimally invasive procedures, such as Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF), Oblique Lumbar Interbody Fusion (OLIF), and microdiscectomy for herniated discs.

Minimally Invasive Spine Surgery (MISS)

The evolution of endoscopic and microscopic technology has led to Minimally Invasive Spine Surgery, which can be categorized into these main groups:

• Microscope: Utilizes an external camera to magnify the surgical area, allowing for much smaller incisions compared to traditional surgery.
• Endoscopic Surgery: A tiny camera is inserted into the body through an incision only 1-1.5 cm wide. The surgeon operates through the scope, significantly reducing trauma to surrounding tissues.

Types of Endoscopic Surgery

Today, surgeons apply these techniques to treat various conditions, including cervical spine surgery, palliative surgery for spinal cancer, and spinal fusion. However, these methods require specialized surgical expertise.

• Full-Endoscopic Surgery: Performed through a single small incision.
• Bi-portal Endoscopic Surgery (UBE/BES): Uses two small points: one for the camera and one for the surgical instruments.

Who is it for?

• Herniated Nucleus Pulposus (Herniated Disc)
• Spinal Stenosis caused by age-related degeneration
• In cases of severe spinal deformity or multiple-level correction, open surgery may still be necessary for some patients.

Benefits of MISS: Less Pain, Faster Recovery

• Minimal Tissue Damage: Muscles surrounding the spine are barely touched.
• Less Blood Loss: No need to worry about blood transfusions or long recovery periods.
• Rapid Recovery: Typically, after endoscopic surgery, patients can walk almost immediately and return home the next day.
• Return to Daily Life: Within a few months, patients can start exercising, and by 6 months, they can often return to full activities with much lower surgical risk.

The Surgeon's Priority: Patient Quality of Life is Key

     The most important thing is not just an accurate diagnosis, but the improved quality of life following treatment. Correct diagnosis leads to targeted treatment. Our physicians begin with a detailed history and physical examination, followed by tools like MRI or CT Scans to pinpoint exactly where the pathology lies. We always follow the motto: "Always choose the method that offers the least pain and fastest recovery for the patient first."

Just as medicine must evolve to bypass the limitations of the past, we too can let go of the fear that ‘spine surgery will leave you unable to walk.’ Instead, you can return to walking with grace. Finally, I want to leave you with this: spinal diseases "can be cured," provided we meet before the nerves have been compressed for too long.