Undoubtedly, most patients have heard something about MIS or Less exposure spinal surgery. Many patients refer to this a “band aid” or “laser” spine surgery. The concept is simple. Surgeons use smaller incisions and specialized tools to protect the muscles and ligaments and bone support of the spine, when doing spine surgery procedures. This allows as small a surgery as possible, while removing the painful parts of the spine to alleviate pain. The next logical question of course is “What can I expect after surgery and how long will it take for me to recover?”
The answer to this question hinges on just what kind of MIS surgery will I have. MIS spine surgery is basically broken down into two types. Decompression only surgery and Decompression with fusion surgery. Decompression surgery is the smaller of the two. It involves removing the painful pathology from the spine. This usually includes the removal of discs, bone spurs, and inflamed tissues which is usually the source of buttock and leg pain, numbness, tingling, and sometimes weakness. Fusion surgery is the larger of the two surgeries. Fusion surgery usually requires decompression surgery, and the insertion of implants and screws to stabilize the spine, and lessen abnormal motion in the spine. This fusion helps with back pain symptoms mainly.
As minimally invasive spine surgeons, our goal is to perform the smallest surgery possible to address the majority of the patient’s symptoms. Generally, the more back pain a patient has, the more likely that patient will need a fusion type procedure. The more leg pain a patient has, the more likely that patient will require a decompression type procedure. The good news is, both procedures can be performed with minimally invasive (MIS) techniques. The recovery of each of these procedures is outlined below.
Decompression only surgery (Band aid surgery) is usually a faster recovery. The reason for this is simple. It is a smaller procedure. Patients must remember, the smaller the procedure, the less it does in most cases. This type of procedure is ideal in someone with 100% buttock and leg pain from compression of the nerves. A one or two level procedure like this, is generally about an hour-long procedure and us usually performed under general anesthesia. If no complications occur, this is usually an outpatient procedure. This means that patients can go home the same day. Patients are generally encouraged to begin walking and moving the day of their surgery. There is usually a restriction period of several weeks where bending and lifting are restricted. Physically therapy is sometimes recommended after surgery, but this depends on each surgeon’s preference. The incision and muscles generally heal in about 2-4 weeks’ time after surgery. The nerve healing usually will continue 6 to 9 months after surgery. Patient’s ability to return to work depends a lot on just what kind of work they do. Sitting or desk work is usually easier to return to than heavy lifting or construction work.
Decompression with fusion is a bit longer recovery with more restrictions, because it involves realigning the bones, which will then need to grow together to heal or “fuse”. Bone generally takes 6 months to fully heal. Patient’s frequently ask, ‘If I have screws in my back, why do I have to wait to heal?”. The answer is that the screws just function to hold the back in place while it heals or grows together. The screws are like an internal cast. If the bone does not heal, the screws will likely break or fail. This is because once the bone heals, the screws are not needed as much. The bone will take the stress of holding the spine together, instead of the screws. Because of this, after surgery, patients are in a “race” between the bone healing, and the screws failing. This is one reason why smoking and nicotine use is so detrimental to spine surgery. Nicotine slows down the bones ability to grow together. The longer it takes for the bone to grow together, the more likely the screws may loosen or fail, causing the surgery to be less successful.
So, for this reason, more restrictions are placed on a patient after fusion surgery, even though it is performed MIS or minimally invasive. Usually for the first one or two months, patients are restricted from lifting, bending, twisting. Many surgeons insist on wearing a brace for a month or two, to help keep patients from overdoing things. Minimally invasive fusion surgery is often much less painful than traditional techniques of spine surgery. Because patients start to feel better so quickly, they will often forget the fact that they are not fully healed. Patients can get frustrated from their surgeon’s restrictions. This is because bone will grow together at the same slow rate. As I tell many patients, “We can’t make the grass grow any faster. We just have to wait.” Usually after the first one or two months, patients are allowed to slowly increase their activities. This will depend on each surgeon, and exactly what he found in surgery and what he had to do. For example, some patients have thinner bones (osteopenia) or even worse osteoporosis. With these thinner bones, usually more caution is advised from your surgeon. Oak wood (strong bones) are sturdier than balsa wood (thin bones).
Regardless of which surgery, fusion or decompression, MIS techniques usually offer a faster recovery with less pain and less chance of repeat surgery compared to traditional open techniques of spine surgery. I tell my patient’s that I expect you to feel better after spine surgery, but not perfect. Patient’s should expect to always have some pain or numbness after surgery, but it is usually much better than before the procedure.
Patient understanding of the surgery itself, and the post op course final goals is critical to patients having a desired good outcome, and satisfaction with the MIS spine procedure performed.