The objectives of minimally invasive or keyhole spine surgery are similar to traditional open spine surgeries. They are to stabilize spinal segments and reduce compression on the spinal nerves. The pathologies causing nerve compression include spinal instability, bone spurs, and prolapsed discs.

As compared to open spine surgery, minimally invasive spine surgery is associated with lower complication rates and faster recovery time. There is less damage to the surrounding muscles and soft tissues when performing minimally invasive spine surgery.

Advantages of Minimally Invasive (Keyhole) Spine Surgery

The advantages are:

Better cosmesis from smaller skin incisions

Less blood loss, reducing the need for blood transfusion

Less muscle damage due to reduced muscle cutting

Lower risk of infection due to smaller incisions

Less postoperative pain, reducing the need for strong pain medications (e.g. opioids)

Faster recovery from surgery, allowing earlier return to work

Conditions Treated with Minimally Invasive (Keyhole) Spine Surgery

Various spinal conditions can be managed via minimally invasive or keyhole spine surgery. They include:

prolapsed disc

spinal stenosis

Degenerative scoliosis

Spinal instability (Figure 1)

Spinal tumours

Osteoporotic compression fractures

Figure 1

Minimally Invasive (Keyhole) Spine Surgery Procedure and Techniques

A commonly used keyhole spine surgery technique is the use of a tubular retractor. This technique involves progressive dilation of the soft tissues (Figure 2), as opposed to cutting directly through the muscles.

By using tubes to gently retract the muscles, surgery can be performed through small incisions without the need for a long incision. In our practice, we may also combine a tubular retractor with a microscope focused down the tube to assist with performing the surgery. The microscope provides illumination and magnification so that the surgery can be performed effectively and safely.

Figure 2

Sometimes, keyhole spine surgery may involve placing rods and screws to stabilize the spine (Figure 3).

This usually involves inserting rods and screws through small skin incisions without cutting or dissecting the underlying muscles.

keyhole spine surgery with rods and screws

Figure 3

Common Minimally Invasive (Keyhole) Spine Surgery Procedures

The three most commonly performed spinal operations using minimally invasive or keyhole spine surgery are:

Lumbar discectomy (removal of prolapsed disc)

Lumbar discectomy can now be performed using a tubular retractor and a microscope via a small skin incision.

Lumbar spine decompression

Lumbar spine decompression is usually performed for spinal stenosis. It is now possible to relieve nerve compression through a keyhole approach using a tubular retractor and a microscope.

Lumbar spinal fusion

Lumbar spinal fusion can be performed via keyhole methods for various spinal conditions, such as spondylolisthesis and recurrent disc herniation. Using several small incisions, screws and rods are placed between two or more vertebrae. The intervertebral disc is removed and replaced with a cage filled with bone to allow bony fusion (healing) to occur between two spinal segments (Figure 4).

Figure 4

Risks and Considerations

Not every patient is suitable for minimally invasive surgery. During the counselling process prior to surgery, the doctor will discuss the pros and cons of the procedure based on the patient’s condition. In some cases, there may be a small chance where keyhole spine surgery cannot be completed, requiring conversion to open surgery.

As with any surgery, there are potential risks associated with minimally invasive spine surgery, including anaesthetic risks, deep vein thrombosis, lung infection, wound infection, and nerve injuries. The doctor will explain the associated risks to the patient prior to surgery.

When to Consult a Spine Specialist

Minimally invasive spine surgery may be considered for patients with persistent back or leg symptoms that do not improve with conservative treatment. A consultation with a spine specialist helps determine whether keyhole techniques are suitable based on the specific spinal condition and overall health.

	Dr Hee Hwan Tak Orthopaedic Surgeon & Spine Specialist MBBS (Singapore) \| FRCS (Edinburgh) \| FRCS (Glasgow) \| FAMS (Ortho)
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