The goal of minimally invasive spine surgery (MIS) is to stabilize the vertebral bones and spine joints and/or relieve pressure being applied to the spinal nerves – often a result of conditions such as a spinal instability, bone spurs, herniated discs, scoliosis or spinal tumors.


As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. There is reduced trauma to the muscles and soft tissues – and the potential benefits to the patient are:


  • Smaller skin incisions
  • Less blood loss from surgery
  • Reduced risk of muscle damage
  • Reduced risk of infection and postoperative pain
  • Faster recovery and less rehabilitation
  • Less pain medications necessary after surgery


Some conditions treated using MIS procedures are:


  • Degenerated disc disease
  • Herniated disc
  • Lumbar spinal stenosis
  • Spinal deformities such as scoliosis
  • Spinal infections
  • Spinal instability
  • Vertebral compression fractures
  • Spinal tumors


The spinal nerves, vertebrae and discs are located deep inside the body and any approach to gain access to the spinal areas require moving the muscle tissue out of the way. Minimally invasive spine surgery utilizes small incision (s) and guidance instruments and/or microscopic video cameras through these incisions – all to minimize damage to the surrounding muscles and soft tissue.

Back surgery requires the surgical skill of a neurosurgeon and the patient’s commitment to proper rehabilitation. The one category of back surgery called “complex spine surgery” is the most difficult to perform. Complex spine surgeries may involve many vertebrae in the spine and require extensive surgery time.


Complex spine surgeries encompass the more severe spinal deformities such as major curvatures of the spine like scoliosis or any congenital abnormalities, kyphosis or spondyloisthesis, spine tumors, revisions of previously unsuccessful operations, degenerative disc disease, disc herniation, vascular malformation or axial skeleton pain or patients who have experienced severe spinal trauma from an infection or injury.


Many spinal surgery procedures are performed using advanced, minimally invasive approaches – leading to a faster recovery, shorter hospital stays and reduced postoperative pain – all geared towards better patient outcomes.


The surgical procedure of spine reconstruction can be divided into two methods: spinal fusion surgery and replacement operation for diseased disc or vertebra.


Types of reconstructive complex spine surgery may involve placement of hardware such as titanium rods, bolts and screws to secure the vertebrae together to straighten and strengthen the spine; placement of bone grafts between the vertebrae acting as an internal cast to stimulate bone growth and support the disc space; or artificial disc device replacements can be implanted into the spine to replicate the functions of a normal disc.

The cervical spine is made up of the seven bones, called cervical vertebrae, stacked on top of each other in your neck area. The cervical discs are the cushions that lie between the cervical vertebrae and act as shock absorbers to allow your neck to move freely.


Artificial cervical disc replacement surgery involves removing a diseased cervical disc and replacing it with an artificial disc. This procedure allows more movement and creates less stress on the remaining vertebrae than traditional cervical disk surgery. It is done when the space between your vertebrae has become too narrow and part of your vertebrae or your cervical disc is pressing on the spinal cord or spinal nerves, causing pain, numbness or weakness. When these symptoms don’t respond to nonsurgical types of treatment, disc surgery may be required.


Loss of space between the cervical vertebrae from cervical disc degeneration, or wear and tear, is common. The cervical discs begin to collapse and bulge with age; but some people have more symptoms from cervical disc degeneration than others.


Symptoms may include:


  • Neck pain
  • Neck stiffness
  • Headache
  • Pain that radiates down into the shoulder or into the arms
  • Weakness of the shoulders, arms, hands or legs
  • A feeling of “pins and needles” or numbness in your arms

Kyphoplasty is a minimally invasive procedure to treat spine fractures caused by osteoporosis or cancer-damaged vertebrae. In most cases, a weakening of the bones has caused the vertebrae to compress or collapse, causing pain or a hunched posture.


With x-ray guidance, the physician inserts a needle through the skin and back muscles into the bone, then, inflates a balloon to help the vertebra regain its normal shape. The surgeon will then inject a special type of cement into the vertebra’s space that was created by the balloon-like device. The needle is removed, with no stitches needed. This minimally invasive procedure will probably take an hour or less, depending if any additional vertebrae are treated it may last longer.


This procedure helps to straighten the spine, restore a damaged vertebra’s height and may also relieve pain.

Brain tumors, a mass of abnormal cells in the brain, are difficult diseases that may become debilitating – causing physical problems such as severe headaches, nausea, seizures, or behavioral changes such as confusion and impulsiveness.


Brain tumors are divided into two categories: primary tumors and metastatic tumors. Primary tumors begin in the brain cells, the brain’s immediate surroundings and membranes, the pituitary or pineal glands or in the cranial nerves. These primary tumors can be noncancerous (benign) or cancerous (malignant). Both types of these tumors can cause serious problems. Metastatic tumors originally form in another part of the body – often in the breast or lungs, then spread to the brain. These secondary tumors are cancerous and commonly strike adults.


A spine tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells can grow and multiply uncontrollably. Symptoms can include numbness or muscle weakness in the legs, arms or chest, difficulty walking, excessive pain, loss of bowel or bladder function, paralysis, or scoliosis.


Spinal tumors can be benign or malignant. The primary tumors originate in the spine or spinal cord, while secondary or metastatic tumors result from cancer spreading from another location of the body to the spine. Spine tumors may be referred to the basic regions of the spine such as cervical, thoracic, lumbar and sacrum.


Brain and spine tumors can be treated with chemotherapy, radiation or surgery. The treatment options depend on the type, location and size of the tumor along with the age, size and condition of the patient.

The pituitary is a small gland attached to the base of the brain (behind the nose) and is often call the “master gland” because it controls the secretion of most of the hormones in the body. The pituitary is responsible for controlling and coordinating growth and development, organ function (kidneys, breasts and uterus), and gland function (thyroid, gonads and adrenal glands).


Endoscopic pituitary surgery, a minimally-invasive approach to remove a pituitary tumor, usually does not require a large incision. This procedure, using a thin-lighted tube and camera called an endoscope, is designed to reduce risk to injuring the brain by creating a small keyhole opening inside the nose in order to access the tumor. The neurosurgeon works jointly with a team of ENT/head and neck (ear, nose and throat) surgeons, plastic surgeons, neuro-oncologists and radiologists.

All of the body's nerves – those which are not part of the central nervous system (the brain and spinal cord) are known as peripheral nerves. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain and the rest of the body. There are many types of peripheral nerve conditions, often brought on by diabetes, genetic predispositions, exposures to toxic chemicals, malnutrition, inflammation (infectious or autoimmune diseases) and injuries to name a few.


Compressed or damaged peripheral nerves will cause pain, burning or tingling, numbness, loss of feeling and muscle strength, and in most cases – will require medical attention.


Peripheral nerve surgery is designed to open the area surrounding the nerve by dividing a fibrous band that crosses the nerve. This permits more room for the nerve and better blood flow. The nerve will then glide freely with movements of surrounding joints and muscles.

Carpal Tunnel Syndrome (CTS) is a common problem affecting hand function, caused by compression of the median nerve at the wrist. It most often occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements, such as typing on a computer keyboard, talking on the phone (holding phone to the ear), texting or playing the piano. It also affects professional artists (sculptors, printmakers, violinists) or any job requiring long-term repetitive motion of the wrist (jackhammer use, certain factory positions).


Only a small percentage of patients require surgery. Factors leading to surgery include the presence of persistent neurological symptoms and lack of response to conservative measures. If the patient experiences severe pain that cannot be relieved through rest, rehabilitation or nonsurgical management, he or she may be a candidate for one of several surgical procedures that can be performed to relieve pressure on the median nerve. The most common procedure is called carpal tunnel release, which can be performed using an open incision or endoscopic techniques.


The open incision procedure involves the surgeon opening the wrist and cutting the ligament at the bottom of the wrist to relieve pressure. The endoscopic procedure involves smaller incision(s), using a miniaturized camera to assist in viewing the carpal tunnel. The possibility of nerve injury is slightly higher with endoscopic surgery, but the patient’s recovery and return to work may be quicker.

Most cubital tunnel release surgeries are performed on an outpatient basis. You may be under general anesthesia and asleep during surgery. Or, you may be given local anesthesia, which numbs just your arm and hand, plus a light sedative to keep you relaxed during surgery. The surgery will take less than one hour.


There are two surgical techniques your surgeon may use – a traditional open surgery or a minimally invasive endoscopic variation. The goal of both is to increase the size of the cubital tunnel and relieve pressure on the ulnar nerve.


Open Ulnar Nerve Release

During open cubital tunnel release surgery, the surgeon makes a 3- to 4-inch incision on the inside edge of the elbow, allowing the cubital tunnel below to be viewed and accessed. The surgeon then divides the overlying ligament, known as Osborne’s ligament, increasing the size of the tunnel and reducing pressure on the ulnar nerve.


Endoscopic Ulnar Nerve Release

In endoscopic cubital tunnel release surgery, the surgeon makes one or two smaller skin incisions and inserts a thin instrument equipped with a miniature camera – called an endoscope. Viewing the surgery site on the monitor, your surgeon uses a small, specialized knife to divide the ligament covering the cubital tunnel and create more space for the ulnar nerve. This minimally invasive option can reduce the impact of the surgery for faster healing.