Dr. Kim explains the size of the area operated on during minimally invasive spine surgery.
Most things that we treat in a spine, the problems occur in a very small area. An example is in this model where the herniated disc, for example, is shown in this red bump. Now this is actually very large compared to what we normally see in most patients. So this spot is probably no bigger than the size of a nickel, and in real life the lesions tend to be even smaller than that.
Now if you have a herniated disc like this, traditionally we may need to make an incision that may be several inches long so that not only do we have visualization of the herniated disc but all the anatomy around it so that we know exactly where we are, we know where the nerves are, so that we can do the surgery safely and not injure any other surrounding tissues.
But if we know where all these tissues are, using computer navigation and intraoperative imaging, then really the only exposure that’s necessary is over the area that’s a problem. We call that the surgical target site. So this spot can be easily exposed and localized through a small portal like this tube, this circular tube.
And I can tell you that a dime will not fit down the center of this opening, but if you put this opening directly over the surgical target site, that’s all you really need to see everything. So one of the tenets, one of the key concepts of minimally invasive surgery is expose only what you need. And if you have the right tools and the right instruments, really all you need is an opening that’s about the size of a dime because that encompasses usually the entire problematic area.
So the way we expose this lesion in minimally invasive surgery, for example, is to make a little opening, and then we put in a thin pin and over the pin we put in a slightly bigger tube and over that a slightly bigger tube after that. And we literally step-by-step dilate the incision open instead of pulling apart the incision.
We open it like we would with a pen and a straw, and then we slide this over the last dilator, and then we pull the dilator out. And now we have created this opening without having to tear apart any tissues because when you do a dilation, it tends to kind of open up the spaces that want to be opened up and stretches things out a little bit temporarily rather than having to detach things.
So one of the most important advancements in minimally invasive surgery is not exactly how the surgery is performed, in terms of what we do once we get down there, but how we get down there and how we retract the soft tissues, how we create a corridor where we can do surgery.
So instead of making a big opening with powerful retractors that crush the soft tissues, we make the smallest opening possible. We take the most direct path to the problem and we use tubes that spread apart the pressure around the entire area rather than around a small tooth or a tine.
And that type of technology takes us most of the way there in terms of performing minimally invasive surgery, and this is just one of several tools that we use routinely to do all the surgeries that we would normally do open. We can do minimally invasively with much less soft tissue trauma, much smaller incisions, much smaller amounts of bleeding.
About Dr. Kim, M.D.:
Dr. Choll Kim graduated cum laude from Harvard Medical School and completed his fellowship training in complex spine surgery at the Mayo Clinic. He is board certified by American Board of Orthopaedic Surgeons.
Dr. Kim is a nationally known expert in the modern field of computer-assisted minimally invasive spine surgery. He has trained specialists throughout the country on the safe and effective application of state-of-the-art techniques using image guidance and navigation technologies.