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Minimally Invasive Lateral Access Spine Surgery

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Introduction

In the past, spinal fusion surgery meant large incisions, muscle detachment and lengthy recoveries.  Innovations in spine surgery instruments and surgical techniques provide a much more pleasant experience for patients requiring spine surgery.  Minimally invasive lateral access spine surgery (lateral transpsoas approach) uses small incisions, a muscle sparing approach, and requires only a one or two day hospital stay.  In fact, people that have minimally invasive lateral access spine surgery can walk within a few hours of their surgery.
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Anatomy

The spine is composed of a series of bones called vertebrae.  There are different areas of the spine, defined by their curvature and function.  The seven small vertebrae in the neck make up the cervical spine.  The chest area contains the thoracic spine, with 12 vertebrae.  The lumbar spine is located at and below your waist.  The lumbar spine contains five large vertebrae.  The remainder of the lower vertebrae in the spine are fused or shaped differently in formation with the hip and pelvis bones.

The back part of each vertebra arches to form the lamina.  The lamina creates a roof-like cover over the back opening in each vertebra.  The opening in the center of each vertebra forms the spinal canal.  The spinal cord, nerves, and arteries travel through the protective spinal canal.  The spinal cord and nerves send messages between your body and brain.

Intervertebral discs are located between the cervical, thoracic, and lumbar vertebrae.  Strong connective tissue forms the discs.  Their tough outer layer is the annulus fibrosus.  Their gel-like center is the nucleus pulposus.  A healthy disc contains about 80% water.
 
The discs and two small spinal facet joints connect one vertebra to the next.  The discs and joints allow movement and provide stability.  The discs also act as a shock-absorbing cushion to protect the vertebrae.
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Causes

Minimally invasive lateral access spine surgery can be an alternative to traditional spinal fusion for select people with degenerative disc disease, recurrent disc herniation, spinal instability, spondylolisthesis, failed fusion, osteomyelitis (bone infection), discitis (disc infection), tumors, scoliosis, and post-laminectomy syndrome.  Surgical candidates have experienced significant back pain with or without leg pain, and have not had pain relief with medications, steroid injections, or physical therapy.
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Symptoms

People with low back pain or back pain that spreads to the legs may be candidates for minimally invasive lateral technique for spinal fusion.
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Treatment

Minimally invasive lateral technique spinal fusion surgery is an inpatient hospital procedure that typically requires a one or two day hospital stay.  The surgical approach is from the side of the person, rather than from the more traditional front or back approaches.  The surgeon uses real-time nerve localizing and monitoring technology, as well as X-ray guidance during the procedure. 

First, the surgeon makes a small incision on the side flank.  Dilators that provide electromyographic (EMG) data navigate the surgeon towards the spine.  Retractors gently spread the muscles to access the spine.

Once the appropriate area of the spine is reached, the required surgery can be performed.  Finally, the retractors are removed, and the incisions are closed.

Recovery
 
Because only a small incision is required and muscles are spared, recovery from minimally invasive lateral technique spine surgery is much faster and less painful than with traditional spinal surgery methods.  Patients are able to walk within hours of spine surgery, and only a short hospital stay is needed. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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