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What is Minimally Invasive Spine Surgery, what role does it play and where can I get it?

Spinal disorders cause severe health sequelae and are often treated inadequately.

Given that spinal disorders with acute or chronic pain are a major cause of disability, reduced quality of life and major depression it is estimated that approximately 500 million people worldwide suffer from low back pain at any given time, and about 20% of people experience prolonged neck pain at some point in their lives.

Spinal disorders can lead to a variety of serious consequences with the most common being chronic pain. This pain can be localized to the affected area of the spine, or it can radiate to other parts of the body, such as the arms, legs, or torso.

Some of the common consequences of chronic back pain are reduced mobility due to difficulties for the affected persons to move around, which limit their ability to perform daily activities. Chronic back pain often disrupts a person's sleep, leading to insomnia or other sleep disorders, which can worsen their overall health.

Living with chronic back pain frequently causes emotional distress, leading to depression, anxiety, and other health issues like cardiovascular problems such as high blood pressure, heart disease, stroke, obesity, respiratory problems and reduced immune function.

In some cases, chronic back pain may lead to the use of opioid medications, which can result in dependence and addiction.

In a considerable number of affected people nerve damage will occur due to compression of nerves or the spinal cord that run through the spinal column. This can cause a range of symptoms, including numbness, tingling, weakness, paralysis and loss of bladder or bowel control.

Spinal disorders can affect balance and stability resulting in an increased risk of falls, particularly in the elderly.

Unfortunately, spinal disorders are often underrecognized, treated inadequately or treated in a delayed timely fashion which potentially leads to severe health sequelae due to immobilization, continuing pain, and malalignment of the spine. This often results in a more extensive, more risky, lengthy, and less effective treatment.

Minimally invasive spine surgeries (MISS) improve outcomes without the need for hospitalization

Minimally invasive spine surgery (MISS) is a term that summarizes all surgical techniques used to treat spinal disorders that minimize the size of the incision required and reduce the damage to the surrounding tissue. The goal of this approach is to reduce pain, speed up recovery time, and improve outcomes after spinal surgery. It has been shown that by employing MISS techniques, surgical complications can be reduced to an absolute minimum and even surgeries with a higher complexity can be done with only minute disruption of normal tissue. During MISS only very small skin incisions are required (usually less than 1 cm) through which specialized instruments are inserted to access the spinal column and to perform the necessary steps of the spinal repair, such as removing a herniated disc, stabilizing a fractured vertebra, or decompressing a pinched nerve.

One of the key benefits of MISS is that it can often be performed as an outpatient procedure, meaning the patient can go home the same day. Additionally, because the incision is smaller and there is less trauma to the surrounding tissues, there is typically only minor postoperative pain and a very short recovery time.

However, only a few spinal surgeons are specifically trained for MISS, have access to specialized tools needed to perform MISS, and are familiar with the specific microanatomy of the spine.

One of the most important MISS techniques is endoscopic surgery. This involves using a tiny camera (endoscope) and specialized instruments to perform the procedure through a small skin incision. The surgeon can then see inside the spine and perform, for example, a microdiscectomy where a portion of a herniated disc that is pressing on a nerve root is removed. In a similar fashion to spinal disc herniations spinal endoscopy can be used to decompress nerves in patients with spinal stenosis when the spaces within the spinal canal become narrower, putting pressure on the spinal cord and nerves.

At the Vienna Medical Center all kinds of endoscopic instruments are used for specific tasks during surgery together with the spinal endoscope: graspers or forceps for holding and manipulating tissues or structures, scissors or dissectors for cutting or separating tissues, curettes or rasps for removing bone or tissue, drills or burrs for shaping or removing bone, suction devices for removing fluid or debris, biopsy instruments for obtaining tissue samples, electrocautery devices for coagulating or cutting tissues using electric current and laser probes for cutting or vaporizing tissues using laser energy.

The specialists at the Vienna Medical Center employ all kinds of innovative technology for the following benefits for their patients:

Smaller incisions: This means less cutting and disruption of healthy tissue, which leads to less pain, less scarring, and a quicker recovery time.

Reduced risk of infection: Smaller incisions and less tissue disruption also mean a reduced risk of infection. This is because there is less exposure of the surgical site to bacteria and other microorganisms.

No hospitalization: Most MISS procedures can be performed as outpatient surgery, which means patients can go home the same day.

Quicker recovery: Because MISS procedures are less invasive, patients experience less pain and can recover more quickly. This means patients can return to your normal activities sooner than you would after traditional open surgery.

Reduced blood loss: Because there is less cutting and tissue disruption, MISS procedures typically result in only a very minor blood loss compared with traditional open surgery. This can be especially beneficial for patients who have conditions that affect their blood clotting ability or who are at risk for bleeding.

Better cosmetic results: MISS procedures leave smaller scars than traditional open surgery, which improves the cosmetic appearance of the surgical site.

Early diagnosis offers the best chance for a minimally invasive treatment

One of the key factors to success in spinal surgery is an early and correct diagnosis.

For example, in patients with osteoporosis, which is a progressive bone disease that leads to a loss of bone density and strength, making the bones prone to fractures. Fractures of the spinal vertebrae can occur which can be effectively treated with minimally invasive means like a technique called kyphoplasty, when diagnosed correctly and early.

During a kyphoplasty-procedure, a small incision is made in the back and a narrow tube is inserted into the affected vertebra under X-ray guidance. A small balloon is then inflated to create space in the collapsed vertebra, and the balloon is deflated and removed. Bone cement is then injected into the space to stabilize the fracture and restore the vertebral height. The cement hardens quickly, providing support to the vertebra and reducing pain immediately after the procedure. Kyphoplasty is typically performed under local anesthesia and sedation is usually done on an outpatient basis at the Vienna Medical Center.

Kyphoplasty is usually recommended for patients who experience severe pain that does not respond to conservative treatments such as bed rest, pain medication, and physical therapy.

If vertebral body fractures are not treated promptly, they can lead to several complications and long-term consequences like chronic pain, loss of height, reduced mobility, and kyphosis. Kyphosis is a deformity of the thoracic spine which occurs consequently after multiple vertebral fractures and leads to a forward hunched posture with breathing difficulties, digestive problems, and reduced overall quality of life. At this stage sometimes big, open surgeries are required to straighten the spine, but most often no effective treatment is available anymore.

So, it is important to seek prompt medical attention if you suspect a vertebral body fracture and consult specialists with plenty experience in the field of MISS.

Besides vertebral body fractures, MISS can be used to treat a wide range of spinal conditions, including:

Herniated spinal discs: A herniated disc occurs when the soft tissue between the vertebrae in the spine bulges out and presses on a nerve. This can cause pain, numbness, and weakness. MISS can be used to remove the portion of the disc that is pressing on the nerve, relieving the symptoms.

Spinal stenosis: Spinal stenosis is a condition in which the spinal canal narrows, putting pressure on the nerves in the spine. This can cause pain, numbness, and weakness. MISS can be used to remove the excess bone and tissue that is causing the narrowing, relieving the symptoms.

Degenerative disc disease: Degenerative disc disease is a condition in which the discs in the spine lose their cushioning and become less flexible. This can cause pain and stiffness. MISS can be used to remove the affected disc and replace it with an artificial disc.

It's important to note that not all patients with these conditions will require surgery. Even minimally invasive surgery should only be considered after other non-surgical treatments have been tried and have failed to provide relief; that is the main belief at the Vienna Medical Center, where the aim is to provide a cutting-edge minimally invasive treatment in a timely manner to prevent secondary injuries. Getting to a state-of-the-art treatment is very challenging given that it requires a thorough examination and consultation by a team of closely cooperating experienced specialists that have access to cutting-edge technology. The Vienna Medical Center provides all possible innovative treatment modalities for spinal disorders including minimally invasive spinal surgery without long delay.

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