If the elastic ring becomes weakened, the soft tissue inside can extrude - or herniate - outside of the elastic ring. Though the field continues to develop, the list below highlights some of the most common options.ĭiscectomy: Spinal discs are essentially elastic rings with soft material inside that serve as cushions between the vertebral bones. However, thoracoscopic access relies on multiple small incisions, through which working ports and cameras can be inserted to facilitate surgery.Ī number of specific techniques have been deployed for MIS surgery. Traditional access approaches often involve opening the chest through large incisions that may also require removal of one or more ribs. Then, a tubular retractor docks on the side of the spine to enable access to the spine’s discs and bones.ĭepending on the patient's condition, it may be necessary to access the front portions of the thoracic spine, located in the chest and surrounded by the heart and lungs. This approach is typically performed with the patient on his or her side. In some cases, especially those involving the lumbar spine, approaching the spine from the side of the body results in reduced pain, due to the limited amount of muscle tissue blocking the way. With the use of spinal navigation and robots, spinal instrumentation is being placed more safely and accurately. These screws have temporary extenders that extend outside of the skin and are subsequently removed after helping to guide passage of rods to connect and secure the screws. Then, screws are placed over the guidewires and follow the path of the wires. With the aid of x-ray images, guidewires are placed through the skin and into the spinal vertebrae along the desired paths for the screws. However, percutaneous (meaning “through the skin”) placement typically involves inserting rods and screws through relatively small skin incisions without cutting or dissecting the underlying muscle. Traditional approaches for placement of screws requires extensive removal of muscle and other tissues from the surface of the spine. Percutaneous Placement of Screws and Rodsĭepending on the condition of the patient, it may be necessary to place instrumentation, such as rods and screws, to stabilize the spine or to immobilize the spine to facilitate fusion of the spinal bones. Depending on the extent and type of surgery necessary, incisions can often be small. Once the procedure is complete, the tubular retractor can be removed, allowing the dilated tissues to come back together. Sometimes, the surgeon will also utilize an endoscope or microscope focused down the tube to assist with performing the surgery through a minimal access strategy. By using tubes to keep the muscles out of the way, the surgeon works through the incision without having to expose the area widely. This technique involves progressive dilation of the soft tissues, as opposed to cutting directly through the muscles.
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