Minimally Invasive Spine Surgery

The tools that make it possible

A tubular retractor is a slim metal tube passed between the muscle fibres after the skin cut, then widened step by step until it is just wide enough for the instruments. The muscles are pushed aside instead of being cut, and when the tube comes out they fall back into place. The operating microscope gives a bright, magnified view down the tube, so that nerve and bone can be told apart clearly. The endoscope goes further still: a thin rod with a camera and light at its tip, passed through a cut about the width of a fingertip, with the picture on a screen.

The microscope suits most discectomies and decompressions; the endoscope suits selected disc herniations where the fragment lies within its reach. The microscopic spine surgery and endoscopic spine surgery pages describe each.

What it is used for

The commonest use is the slipped disc. A microdiscectomy or an endoscopic discectomy removes the fragment pressing on the nerve through a small opening; the lumbar disc herniation surgery page covers this in full. A narrowed spinal canal at one or two levels, which causes leg heaviness on walking in older patients, can be widened through a tube from one side. Screws and rods for an unstable spine can be placed through small cuts in suitable cases. Some neck discs are treated with the microscope through a small cut at the front of the neck.

When open surgery is still the right choice

Smaller is not always better. Open surgery is still the right choice when the problem is spread over many levels, when a deformity has to be corrected, when a tumour or infection has to be cleared widely, or when an earlier operation has left scar tissue that makes a narrow approach unsafe. Some fractures need the wide exposure of an open operation to be set and held properly.

If a case is not suitable for the smaller approach, Dr. Salman Falak says so at the consultation and explains why. Converting to an open operation part-way through is sometimes necessary for safety, and it is discussed beforehand.

The downsides, honestly

The approach has real limits. The view is narrower, so the surgeon relies on the scan and on X-ray pictures taken in theatre to know exactly where the tube is, which is why these operations should be done by someone who does them regularly. Radiation from those X-ray pictures is higher than in open surgery. And because the view is narrow, a piece of disc hiding around a corner can be harder to find.

The advantages are also smaller than the advertising sometimes suggests. Less muscle damage does mean less pain in the first days and a quicker discharge, but a few months after surgery the results of a well-done open discectomy and a well-done minimally invasive one are much the same. The operation inside the spine is identical; what changes is the road in. Dr. Salman Falak wants patients to understand this before they choose a surgeon on the size of the scar.

Before surgery and what recovery looks like

Preparation is the same as for any spine operation: a recent MRI, sometimes a CT scan or bending X-rays, blood tests and an ECG, and a visit to the anaesthetist. Blood thinners are stopped in advance, and smokers are asked to stop. Most of these operations are done under general anaesthesia; a few endoscopic cases can be done under local anaesthesia with sedation.

Recovery is where the approach pays off. Most patients walk within hours and go home the same day or the next, with ordinary painkillers. The spine inside still needs the same care as after open surgery: avoid bending from the waist and heavy lifting until the surgeon clears you, and walk every day. Follow-up is a wound check and a later review, which patients from other cities can do by video.

Where it is done, and how to start

Dr. Salman Falak's main OPD is at Sharif Medical City Hospital in Jati Umra on Raiwind Road, Lahore; he also sees patients at Life Hospital in Bahria Town and at Doctor Care Hospital in Al Kabir Town, with a Friday OPD at Gujranwala Medical Complex on G.T. Road and a Tuesday OPD in Phool Nagar. The operations are carried out in Lahore. To find out whether your case suits this approach, send the MRI on WhatsApp or book a video consultation; Dr. Salman Falak will look at the scan and tell you what he would advise, and whether surgery is needed at all. The patients from across Punjab page explains how a single trip to Lahore is usually arranged.

Risks and how they are kept low

The risks are the same as for the equivalent open operation: infection, a spinal fluid leak, bleeding, nerve irritation or injury, and a repeat herniation or incomplete relief. Wound infection is somewhat less common with small cuts. A narrow view adds the risk of operating at the wrong level or missing a fragment, which is why the level is confirmed on X-ray before and during the operation. Dr. Salman Falak keeps these risks low by choosing the approach that fits the scan and by widening the exposure whenever the view is not good enough to work safely.