Minimally invasive spine surgery (MISS) can help treat several types of back pain-related ailments. Compared to traditional open back surgeries, it requires fewer incisions, is less damaging, has fewer risks, and is often cheaper.
Your spine, spinal nerves, disks, and vertebrae are situated under layers of muscle and tissue. Accessing these parts requires extensive maneuvering and sometimes more complicated cutting procedures.
Minimally invasive spine surgery (MISS) is a surgical approach that requires smaller incisions and causes less damage to muscles and tissue compared to traditional procedures.
MISS allows surgeons to stabilize your:
- spine
- disks
- joints
- nerves
These are the same goals as traditional open back surgery. However, the benefits of MISS compared to traditional open back surgery include:
- less trauma or risk of muscle damage
- faster surgery
- shorter recovery time
- less damage to your skin from small incisions
- less blood loss
- lower risk of infection
- less rehab or physical therapy is needed
- reduced need for pain medications
MISS incisions typically range from 1 to 2 inches (2.5 to 5 centimeters [cm]) long, though they can be smaller. In contrast, open back surgery often requires incisions that are 5 to 6 inches (12.7 to 15.2 cm) or more in length.
There are several types of MISS:
Spinal fusion
This uses X-ray images and guide wires to help the surgeon place screws and rods in your spine, which will help stabilize certain areas of it.
Once the screws or rods are in place, the surgeon will remove the guide wires and close the incisions.
Discectomy
Spinal disks are soft tissue between your vertebrae that cushion your spine during movement. Sometimes, the disks expand and push out, causing a hernia.
Hernias can press on nearby nerves and cause pain. During a discectomy, a surgeon can remove or trim the herniated disk.
Spinal decompression
Spinal stenosis is a common cause of:
- pain
- numbness
- tingling
It happens if the space in and around your spine narrows too much. A decompression procedure can remove bone or soft tissue to make more space and ease symptoms.
Transforaminal lumbar interbody fusion (TLIF)
During TLIF, a surgeon places several screws in your vertebrae and removes the damaged disk and bone.
The surgeon then adds bone material and fuses it to the existing bone, creating a new, stronger, more stabilized spine section.
MISS can help treat several common back conditions:
- degenerative disk disease
- spinal deformities such as scoliosis or sagittal imbalance
- back fractures
- bone spurs
- herniated disks
- spinal stenosis
- spinal infections
- spinal instabilities such as spondylolisthesis
Not all back conditions qualify for MISS. Speak with your doctor to review your back pain treatment options. MISS may or may not be one of many treatments available to you.
A surgeon will discuss what to expect prior to your procedure. Most will take 1 to 2 hours.
Depending on your condition, the procedure may vary slightly. This is the typical process:
- You’re prepped for surgery. This may mean changing into a hospital gown, confirming the procedure with your healthcare team, and receiving an IV or pre-surgery medications.
- You receive an anesthetic in most cases. The type depends on your surgery. You may receive a local anesthetic (numbs a small part of the body) or a general anesthetic, which puts you to sleep.
- Surgery begins. The surgeon starts with one or more small incisions in your back or side.
- The surgeon inserts instruments or tubes. These help move tissue and muscle aside so they can access the part of your spine that will be operated on.
- Depending on the procedure, the surgeon may use additional instruments to correct, remove, or replace the necessary parts of your spine.
- The surgeon removes all instruments and closes any incisions.
MISS is considered a safer alternative to open back surgery. But there are still some risks associated with it, including:
- blood clots
- a reaction to an anesthetic
- infections at the incision sites
- injury to tissue or nerves
- spinal fluid leak
In some cases, the initial MISS can’t be completed. The surgeon may convert it to open surgery during that same procedure. A second surgery, which could be MISS or open surgery, may be necessary.
MISS is increasingly popular because it’s considered safer than open back surgeries and is still highly effective.
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Because the success rates are similar and the potential risks are fewer, MISS microdiscectomy may be preferred to the open version.
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They may also have shorter operation times and may be able to return to work sooner than those who have open back surgery.
Back surgery of any kind requires recovery time. But people treated with MISS often have a shorter recovery window, around 1 month.
A doctor will discuss post-operation limitations and restrictions with you. These may include avoiding:
- showers for one or two days
- baths for 1 month
- lifting heavy objects for 1 month or more
- strenuous work for 1 month or more
MISS reduces tissue damage during surgery, making recovery easier. However, risks may delay recovery, so your individual timeline will differ.
You may need to work with a physical therapist after surgery. These professionals advise you on movement and activity restrictions and limitations.
Your doctor may also prescribe some mild pain relievers to take in the days immediately after surgery. Swelling and inflammation can occur. Rarely, doctors may prescribe narcotic pain relievers.
MISS can be costly. Total costs can vary based on:
- your location
- the medical venue
- recovery expenses
- follow-up procedures
However, MISS is often cheaper than open surgery because the hospital stay is typically shorter than for open surgeries.
The table below shows the cost variance between MISS and an open surgery for different back surgeries based on a 2020 research review:
| MISS | Open surgery | Variance | |
|---|---|---|---|
| Posterior 1-level fusion | $9,824 | $40,486 | -$30,662 |
| Posterior multilevel fusion | $6,849 | $39,347 | -$32,498 |
| Discetomy | $8,327 | $22,441 | -$14,114 |
If you have health insurance or Medicare, your provider may cover some of the cost. You may have to pay deductibles and copays, which may make the out-of-pocket cost higher.
How can I find a minimally invasive spine surgeon near me?
If you’re looking for treatment for back pain or related issues, your doctor may already have a relationship with a back surgeon experienced in MISS.
Other methods of finding a surgeon include using health professional search tools, such as this one from the American College of Surgeons, and filtering for those with a specialty in the spine.
MISS is an increasingly popular alternative to open back surgery, largely because it minimizes damage to tissue and muscles while achieving equivalent results.
Many people who undergo a type of MISS often recover faster and have fewer risks compared to other open back surgeries.
Speak with your doctor about their recommendations for which type of MISS is right for you and potential surgeons.