Minimally Invasive Spine Surgery
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.
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?
MISS can address a wide range of conditions, including:
- Herniated discs
- Spinal stenosis
- Degenerative disc disease
- Scoliosis
- Spinal fractures
- Facet joint issues
- Tumours in the spine
The suitability of MISS for a specific condition depends on its severity, your overall health and the surgeon’s assessment.
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 haspotentialsignificantly 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.
Frequently Asked Questions (FAQs)
While individual experiences may vary, common advantages of Minimally Invasive Spine Surgery 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.
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: Surgeons who specialise in MISS are often better equipped to navigate complexities and perform a broader range of minimally invasive procedures.
- Patient factors: Your overall health, the presence of comorbidities, and the ability to tolerate minimally invasive techniques could affect eligibility.
Recovery times vary and will depend on your condition, what type of surgery was performed, and how well you adhered to post-surgery care instructions. Generally, one can walk within a day of MISS surgery while recovery to normal daily from MISS may take up to six weeks.
MISS is associated with less postoperative pain due to reduced tissue damage and smaller incisions. Open spine surgery often requires cutting through or dissecting muscles and tissues to access the spine. This can result in significant pain as the body heals from the muscle trauma.
Patients often resume normal activities sooner after Minimally Invasive Spine Surgery, but the timeline depends on the specific procedure and individual healing factors. Consultation with the surgeon is crucial for personalised recovery guidance.
While MISS has advanced significantly and is applicable to a wide range of spinal conditions, there are certain limitations to its application, such as:
- Complex spinal deformities
- Multilevel (> 3 levels) spinal fusion
- Severe instability
- Extensive tumour resection
- Certain traumatic injuries
These cases may require open spine surgery, based on a thorough assessment by the surgeon.
Yes, Minimally Invasive Spinal Fusion Surgery is a common technique employed to stabilise the spine, causing less disruption to surrounding tissues.