Minimally Invasive Spine Surgery (MISS) is spine surgery done through an incision that is usually less than 1 inch in size using tubular retractors and microscope. Today spinal stenosis, disk herniation, spondylolithesis and instability can be treated with MISS.
This technique involves the progressive dilation of soft tissues by the placement of series of tubular retractors, each one larger then the last, until the surgeon has an opening large enough to work through. The incision and dilators (usually 18 to 22 mm) are much larger then used in endoscopic surgery (8 mm). A microscope is focused down the tube for visualization to resect bone (laminotomy). This makes an opening into the spine to remove spinal stenosis or herniated disks pinching nerves. Once the procedure is completed, the tubular retractor can be removed, allowing the dilated tissues to come back together. The advantages of MISS include small skin incision (usually less then 1 inch), minimal muscle damage (muscles dilated rather then retracted) and little blood loss compared to traditional surgery.
Lumbar fusion can also be performed through tubular retractors. Transforaminal Lumbar Interbody Fusion (TLIF) can be done through small tube to decompress the nerves, remove disk and put cage, rods and screws in place to fuse and stabilize the spine bones.