Types of Minimally Invasive Spine Surgery

Minimally invasive spinal surgery involves the use of smaller incisions that minimize damage to the surrounding muscles and ligaments of the spine. These less invasive surgeries allow for the following benefits when compared to traditional surgeries, including:

At MedStar Georgetown, our fellowship-trained spine surgeons offer the most advanced techniques and minimally invasive treatments available, including:

Discectomy

A discectomy is the surgical removal of material that is pressing on a nerve root or the spinal cord due to a herniated or bulging disc. A discectomy is used to treat a pinched nerve (nerve root compression), bone spur, sciatica, or radiating pain through the limbs called radiculopathy.

In a minimally invasive discectomy, surgeons use special retractors and a microscope or endoscope to perform the removal of the herniated disc. This allows our surgeons to make smaller incisions that lead to a faster recovery. These surgeries are completed under general anesthesia, typically take less than an hour, and patients are able to go home several hours later.

Anterior cervical discectomy and fusion

Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure where the disc is removed through the front of the neck (anterior approach) in order to relieve pressure from the spine (decompress) and relieve pain. This procedure is combined with a fusion surgery in order to stabilize the neck.

ACDF is used to treat herniated disc and degenerative disc disease.

Foraminotomy

A foraminotomy is a procedure that widens the tunnel (foramen) in your back where nerve roots leave your spinal canal. It is used to relieve the symptoms of nerve root compression, also known as a “pinched nerve” or “radiculopathy.” These symptoms may include pain, numbness, tingling, or muscle weakness. The procedure can also be performed using a minimally invasive approach that requires no hospitalization.

A foraminotomy of the spine is used to treat the following conditions:

Laminectomy

In a laminectomy, the surgeon removes the lamina (the back part of the vertebra that covers and protects your spinal canal). The procedure takes pressure off the spinal cord or a spinal nerve in cases such as a lumbar stenosis, a herniated disc or bone spur.

A laminectomy can be performed at any level of the spine and using minimally invasive techniques. Patients with single-level or two-level stenosis of the lumbar spine are usually sent home on the day of surgery. A laminectomy can be used to treat spinal stenosis, degenerative disc disease, or a herniated disc.

Spinal fusion

Spinal fusion is a surgery performed to permanently join together two or more bones in the spine so there is no movement between them. To fuse the bones together, the surgeon uses a graft.

There are several different types of graft material. An autograft is composed of strips of bone obtained from the area of surgery or another part of your body, such as your pelvic bone. An allograft is cadaver bone obtained from a bone bank. Grafts can also be made from synthetic material.

Fusion surgery of the spine can be approached from the front, the side, or the back. A number of recent technological advances have allowed fusion surgery to be performed using minimally invasive techniques in select cases.

Our surgeons routinely perform minimally invasive fusion of the lumbar spine from the side (XLIF or DLIF surgery) as well as from the back (TLIF or PLIF surgery). These less invasive techniques can reduce infection rates and blood loss and lead to a faster recovery.

To promote proper bony fusion, the surgeon often fixes the vertebrae together with rods, screws, plates, or cages to keep the bones from moving until the grafts fully heal. This is called spinal instrumentation.

While fusion surgery takes away some spinal flexibility, most spinal fusions involve only small segments of the spine and do not limit motion very much.

Spinal fusion may relieve symptoms of many back conditions, including the following:

Spinal instrumentation

Spinal instrumentation is a method of keeping segments of the spine immobile after spinal fusion surgery. During this procedure, the surgeon inserts screws and rods to the spine to keep the bones in alignment while the bone graft heals, and they fuse together.

Two types of minimally invasive spinal instrumentation procedures are available at MedStar Georgetown University Hospital:

These minimally invasive methods of screw insertion when used with other fusion techniques allows the surgeon to stabilize your spine while disrupting as little healthy tissue as possible.

Corpectomy

A corpectomy is the surgical removal of part or all of a vertebra for the purpose of taking pressure off the spinal cord and nerves. Corpectomy is often used to relieve pressure caused by stenosis, bone spurs, fractures, a spinal tumor, or infection in the cervical (neck), thoracic (mid-back), or lumbar (lower back) spine.

The discs above and below the affected vertebra are removed, along with the middle portion of the bone. A bone graft or metal prosthesis is typically inserted to keep the spine stable after the damaged structures have been removed.

Resection of synovial cyst

During this procedure, a surgeon removes the synovial cyst and any structures compressing the nerves. Our surgeons perform these surgeries on an outpatient basis with minimally invasive techniques avoiding the need for fusion surgery in select cases.

Spinal cord stimulator implantation

A spinal cord stimulator implantation is a procedure where a small pulse generator is implanted into the back in order to send an electrical current to the spinal cord and relive chronic pain. The low voltage stimulation to the spinal nerves causes tingling sensation to the back and blocks pain.

This procedure is used to treat the following conditions:

Kyphoplasty

Kyphoplasty is an outpatient procedure used to treat compression fractures in the spine. A compression fracture is when all or part of a vertebra collapses due to problems like osteoporosis (thinning of the bones), cancer, or injury.

In this minimally invasive procedure, the patient is put under local or general anesthesia. The surgeon places a needle through the skin into your vertebra. The surgeon then inserts a special balloon through the needle, into the bone, and inflates it. The balloon can help to restore the vertebra to its original shape. Bone cement is injected into the space to impart stability and make sure it does not collapse again.

Tumor resection

Tumor resection is the surgical removal of tumors from the spine whether benign or malignant.

CyberKnife® radiosurgery

Though it sounds like a surgical procedure, CyberKnife is actually a painless and non-invasive form of radiation that offers accurate, effective treatment for tumors anywhere in the body — even in places previously considered unreachable. CyberKnife uses a combination of computers, image-guided cameras, and robotic technology to concentrate radiation directly at tumor cells, while limiting radiation exposure to surrounding healthy tissue.

CyberKnife is one of the most advanced and effective stereotactic radiosurgery technologies, which is a method of controlling or destroying tumors by aiming beams of radiation at them from multiple directions. Multiple X-ray cameras and powerful software pinpoint the exact location of a tumor. A robotic arm then points a linear accelerator directly at the tumor from more than 1,400 different angles, aiming high-powered radiation beams at it. Because the robotic arm has unparalleled flexibility, the beams of radiation can be directed even at difficult-to-reach areas of the body. And, because the beams are so precise, they focus only on the tumor, not on any surrounding healthy tissue.

Learn more about CyberKnife and other oncology treatments available at MedStar Georgetown.

Lumbar disc arthroplasty

Lumbar disc arthroplasty is a minimally invasive surgical procedure that uses the activL® Artificial Disc made of cobalt-chromium with a plastic core of polyethylene. A superior alternative to a fusion, it preserves motion and helps prevent significant progressive degeneration of segments above and below the impaired disc. This surgical approach also decreases the need for secondary surgeries because it only requires one small incision between the lower abdominal muscles to access the spine, rather than entry through the back that involves cutting through muscle and tissue.

The patient typically spends two to three days in the hospital, is limited to light activities for four to six weeks, and is cleared for more rigorous physical activities after three months, when the replacement disc is bonded to bone.