Medicine has always aimed at this goal: woundless healing, causing no harm
Minimally invasive spine surgery: the evolution of spinal surgery
M inimizing trauma. This is the core concept that underpins the approach to minimally invasive care and surgery: a very simple, understandable and positive intent. After all, the idea is present in the word itself. The adjective "minimally invasive" is self-explanatory: it refers to a medical approach, whether diagnostic or surgical, that treats the patient's body with the least possible interference and leaves minimum trauma. It is clear that this is where the future of medicine is headed: woundless healing, causing no damage or side effects.
Since the dawn of medical science, this goal has been pursued, stemming from the attempt to observe or access the internal structures of the body by cutting through minimal openings. The development of these methods gained momentum in recent decades, thanks to the increased precision and gradual miniaturisation of optical (endoscopic) instruments, which have now reached exceptional heights. This miniaturisation goes hand in hand with that of surgical instruments, culminating in microsurgery.
Seeing 'inside' without cutting the patient open
The inception of minimally invasive surgery was initially linked to development of techniques allowing physicians to see inside a body without the need for large incisions that would expose the surgical site. The technological leap from the first rigid cystoscopes of the early 1900s to today's thin, flexible, disposable cystoscopes is immense. An even greater leap forward was made in laparoscopic techniques, employing small probes with powerful lights and high-definition cameras. Inserted through small incisions, they are capable of capturing detailed images, and displaying them on large monitors. All are aimed at increasing precision and reducing damage, both on a diagnostic and an operational and therapeutic level.
The benefits of minimally invasive surgery
Being able to look inside the human body without causing harm is crucial not only for properly assessing the presence and severity of a condition, allowing for an accurate diagnosis, but also to perform surgery. In fact, the minimally invasive approach has become the preferred surgical approach in recent decades, and there are numerous benefits.
- Reduced trauma. Smaller incisions result in less bleeding and help preserve muscle tissues, which are either minimally cut, or simply moved aside to accommodate the miniaturised instruments during the procedure.
- Reduced duration of surgery. Lower dosages of anaesthetic are required, and in certain cases local anaesthesia alone can be used. It reduces overall stress on the patient's body, which involves relying less on medication.
- Reduced post-operation risk. Trauma is less severe, the wounds are smaller, and the risks of post-operative complications, such as bleeding and infections, are reduced.
- Reduced post-operative pain. Yet another advantage derived from all of the above.
- Reduced healing time and functional recovery. Smaller wounds heal faster, functionality is restored in less time.
- Reduced hospitalisation time. An clear benefit for the patient, but also indirectly for the hospital, potentially leading to an increase in the number of patients treated and surgeries performed.
- Reduced size of scars. A significant benefit, not only for aesthetic reasons.
Another consideration not to be underestimated is the different emotional impact on the patient, who approaches the surgery with the reassurance that it will be much less taxing and that they will swiftly regain their functionality. In robot-assisted spine surgery, essentially the most advanced form of minimally invasive surgery, on top of the benefits already mentioned, radiation exposure is reduced as well.
Minimally invasive spine surgery: specific features
In line with trends seen in various medical specialties, percutaneous minimally invasive methods have been embraced by spine surgeons in recent decades, leading to a notable shift in their approach.
The development of this perspective, dating back to the mid-20th century, started off with the study of paths that lead to the backbone without cutting any muscles. Alternative back procedures to PLIF (Posterior Lumbar Interbody Fusion) were then explored, like ALIF (Anterior Lumbar Interbody Fusion) and XLIF (Extreme Lumbar Interbody Fusion): two methods of accessing the thoracic and lumbar spine, from the front and from one side respectively, to perform arthrodesis, i.e. the fusion of adjacent vertebral bodies by placing implants.
The new frontier in minimally invasive surgery is undoubtedly robot-assisted surgery. The significant benefits it offers, particularly when new technologies can be applied, make it the preferred approach over all others.
Conditions treated through minimally invasive approach
The minimally invasive approach can be used for awide range of spinal conditions: in general, for all direct or indirect decompression of the spinal canal. It is often performed using minimally invasive techniques in cases of herniated discs (cervical and lumbar), in spondyloarthrosis and in spondylolisthesis, in cervical and dorsal myelopathies, and in corrections of deformities (such as degenerative scoliosis). Some of these disorders are also treatable by robot-assisted surgery.
Can your condition be treated with minimally invasive spinal surgery?
The minimally invasive surgical approach is applicable to a wide range of conditions and is always indicated where possible. A consultation with a specialist can define whether minimally invasive spinal surgery may be the most suitable treatment for your specific case. Likewise, if you have already been diagnosed with a back condition and prescribed a treatment plan that includes a back surgery, but would like to seek a second opinion, minimally invasive surgery or robot-assisted surgery may still be considered as alternatives.
To find out more, request a consultation with Dr Giuseppe J. Sciarrone. The doctor is available for outpatient consultations and performs surgeries at the Humanitas San Pio X Hospital in Milan, where he is co-director of the Centre for Spinal Surgery and Robotics. Dr Sciarrone is also available at Casa di Cura Rizzola in San Donà di Piave (VE) and Casa di Cura Pierangeli in Pescara, two of the best centres of excellence for neurosurgery and spinal surgery in Italy.
