Every now and again, I will see a patient in my office that had surgery for scoliosis in the 1970s and 1980s. As we talk about their spine, the conversation inevitably touches on their hospital course at the time of their surgery: several weeks in the hospital, a body cast, maybe some traction and months until they felt back to themselves. The stories are interesting because that hospital course is anachronistic today. What may be more interesting, however, is that advances in minimally invasive technology are increasingly making even the spine surgery experiences of a few years ago seem like the distant past.
Minimally invasive spine surgery refers to a series of techniques that have matured over the last 10-15 years. These techniques rely on the use of muscle-sparing approaches to the spine from a number of different positions: from the front of the spine (anterior), from the side or flank (lateral) or from the back (posterior). The exact approach is chosen by your surgeon by considering a number of important factors including your age, the alignment of your spine, the anatomy of your nerves and blood vessels and, of course, your symptoms.
In most cases, access to the spine is typically established by using a series of dilators that sequentially split the muscle to create a working portal. The exact size of this portal varies based on the surgeon and the pathology being addressed; however, it is now possible to perform surgeries through portals as small as 1.2cm (about a half an inch!). If the surgeon believes your spine needs to be instrumented (have screws and rods put in), this can also be performed through small stab incisions with the assistance of intra-operative x-rays, CT scans or robotic guidance.
When these advances in technology are paired with improvements in anesthesia and with multimodal pain medicine (non-opioid medicines to treat multiple pain pathways), they can dramatically reduce post-operative pain levels and enable patients to go home on the day of surgery in most cases. These techniques can address everything from relatively common problems (herniated discs and stenosis) to more complex pathology (scoliosis). Of course, as with all surgical techniques, there are important limitations to consider: your surgeon must ultimately make the decision about whether you would be an appropriate candidate for these techniques.