May 10, 2023 Author : Maia Gonçalves In spine surgery, a classical approach was traditionally used. This means making a long incision so that the surgeon can correctly visualize the anatomical structures and thus perform the procedures safely. However, technological advances in recent years have enabled the development and use of minimally invasive surgical techniques in various spinal diseases . These techniques are often referred to as MISS , the acronym for minimally invasive spine surgery. Minimally invasive techniques aim to obtain the same surgical results and with the same safety as the classic approach, but they add value related to the preservation of tissues surrounding the spine . Effectively, as they do not use a long incision, they do not cause significant damage to the surrounding muscles. In the short term, tissue preservation is reflected in less postoperative pain and faster recovery. In the medium and long term, it is possible to delay spinal degenerative processes, which are often precipitated by spine surgery. In spine surgery, the indications for a minimally invasive approach are the same as for the classic or traditional open approach. Spine surgery is usually only recommended : After a period of non-surgical treatment – with medication and physiotherapy – that did not result in painful symptoms relief; When neurological deficits are present; When it is possible to identify the exact source of pain with a high degree of probability, such as a herniated disc or lumbar canal stenosis. Developments in the area of minimally invasive spine surgery have included techniques, working instruments and the use of methods for viewing the area to be operated on by microscope and endoscope which, together, now allow the approach and treatment of a greater variety of pathologies of the cervical and lumbar spine with MISS techniques. Surgical technique MISS fusion and decompression procedures , for example discectomy and laminectomy, can be performed using different approaches. The most common technique involves the use of a tubular retractor. During the procedure, a small incision is made in the skin through which the tubular retractor is inserted, which then passes through the soft tissues until reaching the spine. In this way, a tunnel is created to the small area where the nerve compression is located and where the decompression is to be performed. The t ubular retractor separates the muscles (which thus are not cut) and allows a correct approach and visualization of the vertebral structure that needs intervention, with maximum preservation of the muscles and supporting tissues of the spine. In MISS surgery, it is fundamental to use a microscope (preferably) or magnifying glasses to visualize the neurological structures through the working channel of the tubular retractor (18-22mm). Likewise, a large part of the procedure is performed with the support of radiology (X-rays) to determine the positioning of the anatomical structures. At the end of the procedure, the tubular retractor is removed, and the muscles return to their original position. Thus, muscle damage, common in open surgeries, was limited. Endoscopic surgery is another possibility . It uses an endoscope with a working channel, and a monitor where the transmitted image is displayed. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
