Minimally Invasive Spine Surgery: Risks, Benefits & Procedure

In Singapore, healthcare has moved beyond relying solely on open surgery for spinal issues. Today, doctors can perform Minimally Invasive Spine Surgery (MISS) to treat spinal conditions without extensive incisions.

This surgical approach signifies a departure from traditional open surgeries, promising reduced trauma, quicker recovery times, and potentially less postoperative pain.

What is Minimally Invasive Spine Surgery?

MISS is a surgical method performed with specialised instruments and smaller incisions. Its primary goal is to treat spinal conditions while reducing the impact on surrounding muscles and tissues.

This technique encompasses different types of procedures to treat various spinal issues, such as endoscopic spine surgery, lateral access tubular , posterior tubular and other procedures done with needle and/or scopes with typically less than 1cm incision(s).

How does Minimally Invasive Spine Surgery differ from traditional open surgery?

The key difference from traditional open surgery is the reduced impact on surrounding structures. Unlike traditional open procedures with larger incisions, MISS employs smaller incisions of typically 1-2cm. Through these smaller openings and specialised instruments, MISS achieves comparable outcomes while minimising harm to muscles, spinous process, ligaments and tissues.

Reduced incision size also brings advantages such as quicker recovery, diminished postoperative discomfort, and, in certain instances, outpatient ambulatory treatments. In contrast, traditional open surgery may cause more significant tissue damage with large incisions, extended recovery periods, and heightened postoperative pain.

Types of Minimally Invasive Spine Surgery

Minimally Invasive Endoscopic Surgery

Endoscopic procedures utilise a tiny camera called an endoscope inserted through a small incision. It allows surgeons to visualise the internal area without needing large openings.

Minimally Invasive Endoscopic Surgery is often employed for herniated discs, spinal stenosis, spondylolisthesis and facet joint problems etc.. At Achieve Spine & Orthopaedic centre, we have employed the technique of spinal endoscopy to include treatment of cervical spine, thoracic spine and lumbar fusion hence replacing 80% of our spine surgery cases which typically required open surgeries.

Minimally Invasive Lumbar Spine Surgery

Focusing on the lower back (lumbar region), this type of surgery aims to address issues like degenerative disc disease , prolapsed intervertebral discs, lumbar spinal stenosis and spondylolisthesis etc.

Common procedures within Minimally Invasive Lumbar Spine Surgery include lumbar discectomy (removal of a portion of a herniated disc) and laminotomy (removal of the lamina to ease the pressure on the spinal cord) and multiple levels decompression.

Minimally Invasive Spinal Fusion Surgery

Spinal fusion is a surgical procedure recommended for conditions that involve instability, deformity or excessive motion in the spine.

With Minimally Invasive Spinal Fusion Surgery, surgeons use specialised techniques and instruments to fuse vertebrae to stabilise the spine while causing less disruption to surrounding tissues. Common conditions for which spinal fusion may be recommended include:

Degenerative disc disease
Spondylolisthesis
Spinal stenosis
Fractures
Scoliosis
Spinal tumours

Dr. Wu Pang Hung is one of the earliest Singaporean spine surgeon to perform and also describe endoscopic fusion in the literature and have extensive experience performing fusion technique using the endoscope as an alternative to mini open techniques using the endoscope as an alternative to mini open techniques. This is an option of fusion which promises shorter hospital stay, less blood loss, less perioperative pain and issues related to hospitalization.

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Minimally Invasive Thoracic Spine Surgery

Minimally Invasive Thoracic Spine Surgery targets conditions affecting the thoracic spine, the mid-section of the spine between the cervical (neck) and lumbar regions. This type of surgery addresses herniated discs, fractures, and deformities.

Is Minimally Invasive Surgery suitable for lumbar spinal stenosis?

Yes, Minimally Invasive Lumbar Spine Surgery is particularly effective for treating lumbar spinal stenosis. This condition narrows the spinal canal and puts pressure on the nerves.

Minimally invasive techniques can decompress the affected nerves, relieving symptoms such as pain, numbness, and weakness.

What conditions can be treated with Minimally Invasive Spine Surgery?

Minimally invasive spine surgery (MISS) in Singapore is a modern approach to treating various spinal conditions with less tissue disruption and faster recovery times. The suitability of MISS depends on the severity of the condition, your overall health, and your surgeon’s expertise. Here’s how MISS can address specific spine issues:

Herniated Discs

MISS effectively removes or repositions the damaged portion of the disc to relieve pressure on nerves, reducing pain and improving mobility. This minimally invasive technique minimises scarring and speeds up recovery.

Spinal Stenosis

MISS is ideal for decompressing narrowed spinal canals, alleviating nerve pressure, and reducing symptoms like pain, numbness, or weakness. Learn more about how we address spinal conditions on our Spine and Hip page.

Degenerative Disc Disease

MISS stabilises the affected spinal segment through techniques like spinal fusion or disc replacement, offering pain relief and restoring function with minimal disruption to surrounding tissues.

Scoliosis

For mild to moderate scoliosis, MISS can correct spinal curvature with smaller incisions, preserving muscle integrity and reducing recovery time.

Spinal Fractures

MISS helps stabilise and restore alignment in fractured vertebrae through procedures like vertebroplasty or kyphoplasty, minimising downtime and postoperative pain.

Facet Joint Issues

MISS addresses painful facet joints through minimally invasive techniques such as facet joint injections or radiofrequency ablation, providing targeted relief.

Tumours in the Spine

MISS allows for precise removal of spinal tumours, preserving healthy tissues while reducing surgical risks. For complex cases, our expert surgeons evaluate and recommend the most suitable approach.

Potential risks and complications associated with Minimally Invasive Spine Surgery

While MISS offers many advantages, it has risks. Potential complications may include infection, bleeding, nerve injury, or inadequate resolution of the spinal issue. However, studies showed that minimally invasive and in particular endoscopic spinal surgery has the potential to significantly lower complication rate than traditional open surgery. We recommend that you discuss them with your surgeon.

Schedule a consultation with Dr. Wu to learn about the risks and complications involved when considering Minimally Invasive Spine Surgery for yourself or a loved one.

Who is a candidate for Minimally Invasive Spine Surgery?

Determining candidacy for MISS involves several factors your surgeon will assess. While specific criteria may vary based on your circumstances, here are common considerations:

Type of spinal condition: Your eligibility depends on your diagnosis.
The severity of the condition: The severity of your spinal issue is a key determinant. MISS is often recommended for simple to a variety of complex cases, and the decision may depend on the extent of the damage or deformity in your spine.
Overall health: Your general health is a significant factor. Candidates for MISS typically have good overall health, which contributes to a smoother recovery process. Patients who are not deemed to be fit for anesthesia are potential candidates for local anesthesia with sedation in some selected cases of spinal endoscopy
Medical history: Your medical history, including any previous operations, existing medical conditions, or medications, will be considered to evaluate potential risks and complications.
Body Mass Index (BMI): Maintaining a healthy weight is beneficial for both the success of the surgery and the recovery process. A higher BMI may increase the risk of complications. However, in our centre we generally recommend endoscopic procedures for higher BMI patients as it lowers the risk of infection and size of wound in this group of patients.
Patient preferences: Your preferences and expectations will be taken into consideration. Some patients may prefer the minimally invasive approach due to its associated benefits, while others may have specific concerns that could influence the decision.

You should have a detailed discussion with your spine surgeon to assess your situation. They will consider these factors and thoroughly examine you to determine if MISS is the most appropriate treatment for your spinal condition.

How long does a Minimally Invasive Spine Surgery typically last?

The duration of MISS depends on the complexity of the procedure and the condition being addressed. On average, MISS can last anywhere from one to three hours.

What is the cost of Minimally Invasive Spine Surgery?

The cost of MISS varies widely based on factors such as the specific procedure, the surgeon’s experience, and the location of the medical facility.

Insurance coverage may also impact the total cost. You should consult your healthcare provider to understand the financial aspects thoroughly.

Minimally Invasive Spine Surgery in Singapore

If you or your family members are considering getting an MIS, Dr Wu Pang Hung is an experienced spine specialist in Singapore who can advise and guide you through your spinal concerns.

Dr Wu believes the shift from larger incisions to precision-driven solutions is fundamental in pursuing optimal spinal health and improved quality of life. Leading Achieve Spine & Orthopaedic Centre, he specialises in MISS for spinal conditions.

Dr. Wu, the earliest Singaporean surgeon featured in the European Spine Journal, he demonstrated that ambulatory Uniportal and Biportal Endoscopic Spine Surgery is possible in Singapore, showcasing results in reputable journals. Instrumental in initiating endoscopic spinal units abroad, his contributions earned accolades, including the Patient Service Quality Service Ambassador Award in 2018 and the Service Ambassador Gold Award in 2022 at the National University Health System, Visiting Travelling Expert in Ganga Hospital, India in 2023, Visiting Professor in Henan Third Provincial Hospital in 2023.

He is the Guest Chief Editor of Medicina Journal for Endoscopic (2023) and Minimally Invasive Spinal Surgeries (2024), and an editorial board member of the Journal Of Minimally Invasive Spinal Surgeries Technique. He served as the board member of the ASEAN Minimally Invasive Spinal Surgical Technique.

Book an appointment to consult Dr Wu and learn how Minimally Invasive Spine Surgery can benefit you.

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Dr. Wu Pang Hung is an experienced orthopaedic and spine surgeon in Singapore, specialising in both uniportal and biportal endoscopic spine procedures for complex cervical, thoracic, and lumbar spinal conditions. With over 10 years in the field, he is actively involved in numerous spine societies and contributes to several international journals and textbooks. Dr. Wu has also received specialised training in spine surgery across Canada, South Korea, Japan, and Germany.

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Frequently Asked Questions (FAQs)

What are the benefits of Minimally Invasive Spine Surgery?

While individual experiences may vary, common advantages of minimally invasive spine surgery in Singapore include:

Less scarring and minimised damage to muscles and ligaments.
Reduced post-surgery pain compared to traditional open surgery.
Quicker recovery times and a faster return to regular daily activities.
Preservation of muscles and tissues from minimised disruption to adjacent muscles and tissues.
Less blood loss due to smaller incisions.
Shorter hospital stays, contributing to overall convenience and cost-effectiveness.
Lower infection rates due to smaller incisions and reduced exposure of internal tissues.

Learn more about these advantages and our approach on the About page.

Are all spine surgeries eligible for a minimally invasive approach?

The suitability of MISS depends on various factors, such as:

Type and complexity of the procedure: More complex surgeries, such as extensive spinal fusions or correction of severe deformities, may require traditional open surgery.
Spinal anatomy: Certain spinal regions or structures may be challenging to reach with small incisions.
Surgeon’s expertise in MISS: Our doctor specialises in MISS, allowing us to address complex cases effectively.
Patient factors: Your overall health, the presence of comorbidities, and your ability to tolerate minimally invasive techniques could affect eligibility.

Learn more about minimally invasive spine surgery on our blog.

What is the recovery time for minimally invasive spine surgery?

Recovery times vary depending on your condition, the type of surgery performed, and adherence to post-surgery care instructions. Generally, patients can walk within a day of MISS and may fully recover within six weeks. For guidance, consult with our team here.

Is there a difference in postoperative pain between minimally invasive and traditional spine surgery?

MISS is associated with less postoperative pain due to reduced tissue damage and smaller incisions. In contrast, open spine surgery often involves cutting through muscles and tissues, leading to more significant discomfort during healing.

How soon can patients return to regular activities after minimally invasive spine surgery?

Patients often resume normal activities sooner after minimally invasive spine surgery, though the timeline varies based on the procedure and individual recovery. A personalised consultation with our specialist team is essential for tailored recovery advice.

Are there limitations to the complexity of spine issues that can be addressed with minimally invasive techniques?

Yes, some conditions may still require open surgery, such as:

Complex spinal deformities
Multilevel spinal fusion (> 3 levels)
Severe instability
Extensive tumour resection
Certain traumatic injuries

Our experienced surgeon assesses each case carefully to recommend the most suitable approach. Learn more about our comprehensive services here.

Can minimally invasive spine surgery be used for spinal fusion procedures?

Yes, minimally invasive spinal fusion surgery is a common technique for stabilising the spine with less disruption to surrounding tissues. For detailed insights into this procedure, visit our blog.