Understanding Minimally Invasive, or MIS, Spinal Fusion

Back Pain ReliefMIS fusion

Minimally invasive spinal fusion surgery, also called MIS fusion, offers great results without a big and long surgical procedure and benefits people with chronic back pain to quickly get back to their daily and recreational activities, according to Endoscopic Spine Surgeon Kaixuan Liu, MD, PhD and founder of Atlantic Spine Center.

Unlike traditional "open" spinal fusion in which long incisions are used to access spinal structures, MIS fusion requires much smaller cuts. This allows the surgeon to realize equal results with much less pain and a much faster and easier recovery.

"We find that many of our patients are unclear or confused about MIS fusion including how it works and why it's better in some cases than traditional open spinal fusion. Dr. Liu offers the following 5 top things to know about MIS fusion in an attempt to clear up any misunderstandings.

Performed since the 1990s, MIS fusion fixes problems with the vertebrae, the small bones of the spine, by fusing together vertebrae that are causing pain so that they heal into a single, solid bone. The benefit is that this alleviates the vertebral bones from "grinding" together, which can cause bone spurs, arthritis, and other pain-producing problems.

Who's an ideal contender for MIS fusion?

MIS Fusion is commonly advised for patients suffering from persistent back pain from a variety of causes such as, recurrent lumbar disc herniations, which occurs when the jelly-like center of a disc bulges between the vertebrae and pushes on nerves; lumbar degenerative disease, which causes radiating pain from damaged discs in the spine; spondylolisthesis, in which one vertebrae slides forward over another below it and squeezes the nerves; or foraminal stenosis requiring disc height restoration, a situation where there is a narrowing of spine openings resulting in nerve compression.

How is MIS fusion surgery performed?

MIS fusion surgery is performed with specific tools called tubular retractors. These tools are inserted into a small incision and through soft tissues to the specified location on the spine causing pain. The retractor holds the muscles open while a surgeon can remove any problematic tissue. The surgeon then sets screws or rods in place that will fuse the vertebrae together. The surgeon gains access to the spine through the patient's back or side. This "point of entry" defines the exact procedure and its specific name (common MIS fusion names include XLIF, TLIF and OLLIF).

What's to be expected when recovering from MIS fusion surgery?

Unlike traditional open spine fusion surgery, MIS fusion is an out-patient procedure and doesn't require a stay at the hospital. Since the blood loss in MIS fusion is minimal, most patients are up and walking around the same day as the procedure, adds Dr. Liu. While some traditional open spine fusion surgery involves a recovery of 6 months or longer, most MIS fusion patients return to routine activities in 4 to 6 weeks. MIS Fusion patients can start driving once post-operative pain has been reduced to mild which usually happens in 7 to 14 days. In most cases after the initial recover, physical therapy sessions are recommended to help strengthen the back muscles and improve mobility and flexibility.

What are the pluses of MIS fusion?

There are many pluses of MIS fusion including less blood loss during surgery and a reduced need for blood transfusions using the minimally invasive technique. In most cases patients require less pain medication following MIS fusion adds Dr. Liu. "However, the biggest benefit of MIS fusion is that it stops the aberrant movement between the spinal vertebrae with a technique that causes much less damage to the adjacent tissues than in an open surgery," he adds. "MIS fusion more gently spreads muscles, as opposed to cutting and moving muscles, allowing quick access to the spine. This procedure is much less traumatic and painful for the patient, and it doesn't require as long for muscles to heal."