All types of spinal surgery have never been simple procedures, but there have been many advancements made in this field. At one time, spinal surgery could only be accomplished through a major, invasive operation that required extensive pre- and post-op preparation. In the early 1990's, most of the minimally invasive spinal surgery techniques were only used for biopsies, for temporary relief, or for lessening pressure on the spine. Today, there are new methods available for minimally invasive spinal surgery through a surgical instrument called the endoscope. Basically, it is a camera that is mounted on a long cable connecting it to a TV screen. It has proven to be invaluable in some types of minimally invasive spinal surgery, also known as keyhole surgery," that includes spinal fusion, deformity corrections from scoliosis, and repair of herniated discs. The orthopedic surgeon uses the instrument to view the spinal column through a small scope that magnifies and illuminates the potential operating area. Using an endoscope enables the physician to make smaller incisions and perform minimally invasive spinal surgery by pinpointing the exact problem area, and the portion of the herniated disc, for example, can then be removed with a laser. Of course, the surgeon must first determine if the required minimally invasive spinal surgery can indeed be performed. Secondly, he or she must ensure the proper instruments are available, since this type of surgery requires much longer instruments to fit through much smaller incisions, usually around one-half inch in size. In addition, the operating field is further away from the surgeon's hands and considerably reduced in size, and the surgeon must insert portals or tubes through these incisions. These portals are open and sealed, the open ones to let air into the operating area, and the sealed to limit the loss of air or gas from the body. Implants such as bone grafts must be placed through these small incisions, as well, requiring the utmost skill and focus. After the surgery has been performed, the incisions are sutured and covered with surgical tape. Although the endoscope has made surgical techniques much simpler, minimally invasive spinal surgery is still not practiced to any great extent. It does ensure faster recovery time and return to work or other activities, less pain and scarring from major incisions, less blood loss, and minimal muscle disruption that often occurs with more extensive invasive surgery.
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