It is also called Minimally Invasive Spine Surgery.
Our society has many myths about spine surgery.
Decision of spine surgery should be based on advice of experts in Spine surgery and not on opinion shared by non medical people.
Key hole surgery is performed through a serial dilator system which splits the muscle on one side rather than cutting the muscle. One inch is the size of the cut on the skin through which dilator system is used to reach the bone . Small hole is made in the bone with a drill to reach the disc space.
With the aid of endoscope or microscope prolapsed disc material is removed preserving the nerve root. Magnification due to endoscope or microscope aids in safe surgery.
Not all patients for spine surgery will benefit with Key hole surgery. Key hole surgery just reduces the external size of the wound , the actual success of surgery depends on the nerve root decompression and adequate disc or bony removal.
Key hole spine surgery can only be performed for following indications:
- Lateral or Far lateral one sided disc prolapse
- Vertebral Body fracture with instability without pressure on the nerves
- Vertebral body collapse which can be expanded with cement (vertebroplasty or kyphoplasty)
- Single level spine tumor
Key Hole surgery offers following advantages:
- Same day mobilization
- Next day discharge
- Muscle tissue is pushed aside rather than disrupted
- Very less surgery site pain
- Less blood loss
- One inch incision
- Stitch less surgery
- No need for bed rest
- Can climb stairs the next day
- One can place multiple spine fixation screws through few small holes
- Can be done under local anaesthesiae (not always)
Traditional open spine surgery requires a large muscle-tearing incision, longer hospital stay and a long recovery period.
Advances in technology in the form of equipments and endoscope and microscope and surgical microtools, spine surgery has been simple with excellent results.
Most often the spine surgery results are bad due to wrong patient selection , delay in surgery by the patient due to fear of spine surgery and wrong approach . If there is indication of open spine surgery and for patient wanting key hole surgery if wrong approach is selected the results will be compromised.
Although most patients are provided a brace, this is for comfort only. The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as an internal brace, allows one to avoid having to wear a brace. Most patients find that the brace improves their pain for about 1-2 weeks, and thereafter it is only worn occasionally.
After a Key Hole disc surgery patient can go home in the evening or next day morning. In spine fusion surgery , open procedure will need 5-7 days of stay whereas Key hole surgery will 2-3 days of stay.
Physiotherapy helps in rapid recovery. After 1 week of surgery muscle strengthening exercises are started . It is advisable to continue these exercises at home as a part of routine to prevent recurrent episodes of low back pain.