Advanced Spine Institute
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Spine Surgeon K. Rad Payman, MD

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Minimally Invasive Surgery


Minimally invasive surgery is a technique of performing surgeries through the tiny incisions and is an alternative to the open surgery. Moreover minimally invasive surgery offers certain advantages over open surgery.

Minimally invasive surgeries are done by using various techniques and the Minimal Exposure Tubular Retractor (METRx) system is a more evolved technology than micro endoscopic discectomy system. Using the METRx system, surgery is done in a fashion similar to open surgical techniques using a tubular retractor which provides the surgeon with the operative corridor. The anatomical details can be visualized using either the endoscope or a microscope. Since the muscles and soft tissues of the spine are not cut to approach the spinal bone therefore it is a minimally invasive surgical procedure. It is proven to be clinically effective and complication rates are comparable to traditional procedures. Moreover it is cost effective with high patient satisfaction. Surgeons are using METRx system to treat various spinal conditions including herniated discs, lumbar and cervical stenosis, synovial cysts, lumbar instability, trauma, and even some intraspinal tumors.

For the surgery first a spinal needle is inserted into the muscles next to the spine and is directed towards the spinal bone, the position of which is confirmed by lateral fluoroscopy. The spinal needle is then removed and an incision is made at the puncture site. The length of the incision made is same as the diameter of the tubular retractor required to be placed for surgery. A guidewire is then passed through the incision and positioning of wire is confirmed by lateral fluoroscopy. The cannulated soft tissue dilator is then placed over the guidewire and is directed towards the spinal bone by a twisting motion. A series of dilators are placed one on the other slowly increasing their diameter to retract the soft tissue to the desired diameter as required to insert the selected retractor. The markings on the dilator suggest the length of the tubular retractor required. This varies depending on the patient's anatomy and is equivalent to the depth required to reach the desired anatomical spinal site for the surgical procedure. The selected retractor is then placed over the sequential dilators and is passed through the incision. Once it is fixed steadily on the spinal bone a flexible arm is attached to it. All the sequential dilators are then taken out establishing an operative corridor through which the spinal surgery can be done.

The procedure is minimally invasive and thus offers the advantages of: