Implants for Less Invasive Lower Back Surgeries
It is quite evident that minimally invasive spinal surgeries are the way forward to alleviate pain and other problems in patients with a lower chance of complications during the surgery. Generally, the main goal of less or minimally invasive surgeries (MIS) is to provide stability to the vertebrae in the spinal column and relieve pressure from the nerve roots.
The pressure on the nerves due to instability of the spine, herniated discs, scoliosis, spondylolisthesis, and other factors causes the patient to feel constant pain and weakness in the legs and the affected regions of the spine on the back. Surgeries are recommended by doctors in cases where the condition is further declining, or the pain cannot be managed by non-surgical methods.
Lower back surgeries are usually of two types – open surgeries and minimally invasive surgeries. The latter is usually preferred in most cases as it leads to lower blood and tissue loss, and reduced damage to the muscles.
These factors lead to a shorter recovery time for the patient. With new emerging developments in implant technology like Premia spine medical devices (TOPS), patients can now get greater improvement than they could with previous techniques, while subsequently lowering the chances of future complications as a result of the surgery.
To understand the benefits of using implants for less-invasive lower back surgeries, let’s take a look at how minimally invasive surgeries (MIS) are done.
How Does Minimally Invasive Spine Surgery Work?
The parts of the spine that need to be worked upon rest under the muscles in the back. This makes it essential to make an incision in the muscles to gain access to the spinal nerves, vertebrae, and discs. With open surgeries, the cuts that need to be made are larger, leading to longer recovery times.
But, with MIS the spine can be accessed by making a small deep dilation in a small part of the muscle, which alleviates the problems discussed earlier. A Tubular retractor progressively dilates the tissues to insert an endoscope or microscope to aid the surgery process.
After making the required corrections or installing spinal implants, the endoscope is removed to let the tissue come back together on its own, which makes the healing process much easier. The incisions are often very small when compared to open surgeries.
How are Implants Placed on the Spine Without Removing Tissue or Bone?
When implants and instrumentation need to be placed to support the recovery of the spine, it is often done by the removal of muscle and surrounding tissues from the spine. But with minimally invasive surgeries, surgeons practice a technique called ‘Percutaneous’ placement.
Percutaneous placement is done by inserting instruments like screws, rods, and plates through very small incisions on the skin, without disturbing the muscle tissue. Visualization during the surgery is done using X-rays images, and guidewires are installed through the skin to direct the instruments to the desired location. With the recent use of robots and detailed spinal navigation, the process gets completed in a very intuitive and safe manner.
Also, in some cases, the spine is accessed through the patient’s side. This leads to even lesser damage to the muscles because of the low density of muscular tissue in this position. The tubular retractor is then attached to the patient’s side in order to access the needed parts of the spine.
Common Minimally Invasive Lower Back Surgeries
Some of the common lower back surgeries that are done through the MIS approach are as follows.
The vertebrae present in the spine have cushions between each other in order to absorb shock. These are commonly referred to as spinal discs. When this elastic cushion gets weak, it may deform and extrude outside of the vertebrae, which puts pressure on the nerve roots.
The surgical procedure used to correct this problem is to trim or remove the affected spinal disc to relieve pressure on the surrounding nerves. The discs are often approached using MIS, using an endoscope, and tubular retractors or dilators.
Laminectomy and Spinal Decompression
This surgical procedure is mainly used for spinal stenosis. In spinal stenosis, the vertebral canal shrinks and narrows, which compresses the nerves in the area. The bone and the surrounding soft tissues which put pressure on the nerves are removed by minimally invasive procedures.
Spinal fusion refers to the process of grafting a bone between the affected vertebrae after removal of the disc. This is done in order to attach the two vertebrae as one and relieve pain and weakness due to diseases like spondylolisthesis, disc degeneration, disc herniation, and more.
Different Types of Implants Used in Minimally Invasive Surgeries
Spinal implants are made biocompatible so that the body doesn’t detect them as foreign bodies. Their main job is to either replace the functionality of the affected vertebral parts or to aid the healing process of natural bone tissue.
Now, let’s take a look at the types of implants used in MIS for a variety of spinal problems that require surgery.
These types of implants are generally installed to combine with the bone graft and provide it the required stability to heal correctly. This includes hardware like screws, rods, plates, connectors, and others.
Any installed implants other than the ones used along with bone grafts fall under the category of Non-fusion implants. These include growth sparing devices in children, artificial disks, premia spine medical devices, Vertical Expandable Prosthetic Titanium Rib (VEPTR), and a few others.
The implants are made of either titanium or one of its alloys to mainly allow MRIs to be possible after the surgery and to have the best biocompatibility. One of the latest innovations in spine surgery that has recently been approved by FDA in the USA is the ‘TOPS’ spinal implant. It is a part of the premia spine medical devices and has been tested on several individuals since 2013.
TOPS is intended to be a spinal fusion surgery alternative. The process involves replacing the problematic vertebra with an entirely artificial replacement, instead of just joining the adjacent vertebra as it is done with fusion surgery. This promises more mobility for patients and does not put pressure on the connected vertebrae. It has also been proven to last longer than traditional fusion methods.
New spinal implants are being researched at a steady rate, and several breakthroughs have been made over the years which have in turn provided relief to a huge number of patients. Along with better and smaller implants, surgeons are also focusing on faster recovery times, and lesser invasive methods for spinal surgeries.