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Minimally Invasive Spine Surgery


Our Spinal Specialists at Virginia Spine Institute are at the forefront of minimally invasive procedures. Because we live in a world where health care is constantly evolving and progressing, as a patient it is hard to keep up with the latest procedures and treatment options. Minimally invasive techniques mean different things to different people. It is not about the instruments used, but rather about surgery that protects healthy tissue and the normal supporting structures of the spine. Minimally invasive surgery is performed with the least tissue manipulation necessary, while still accomplishing the goals of the surgery.


In recent years, minimally invasive techniques have changed the face of spine surgery and ultimately surgical recovery. Minimally invasive spine surgery offers the same post-surgical benefits as traditional spine surgery, but with much less trauma. If spaces in-between muscles and tissues can be separated as opposed to being cut, there is less healing required.  If smaller incisions can be made, while still seeing what needs to be seen and doing what needs to be done, then the body can heal faster. A smaller incision is not the only advantage. To perform minimally invasive surgery, surgeons may use various tools, tubes, x-ray/fluoroscopy, lasers, robots, endoscopes, microscopes, and cameras. These minimize damage of spinal muscles and supporting structures. Patients also require much less anesthesia during minimally invasive procedures. In addition, hospital stays are dramatically shorter, enabling many patients to go home the same day after minimally invasive spine surgery.

Pioneers in Innovation

As Spinal Specialists at Virginia Spine Institute, it is part of our philosophy and mission to constantly seek better ways to improve our patients’ lives. Our surgeons are active participants in clinical trials and pioneer of artificial disc and other minimally-invasive procedures. We believe the complexity of the case doesn’t necessarily mean that minimally invasive techniques are ruled out. The advances our specialists make provide our patients with the safest and most effective results while performing the least invasive surgery possible. Innovative techniques allow our surgeons to perform less invasive surgical procedures with smaller incisions, less operative bleeding, faster recovery time and shorter hospital stays. These procedures are performed with less radiation exposure to patients and health care providers. 

Robot Guidance

Our doctors at Virginia Spine Institute are leaders in modern spinal health care. Dr. Thomas Schuler and Dr. Christopher Good, two of our Spinal Specialists, made a breakthrough in spinal surgery in July 2012 by performing the first robot-guided surgery in the Mid-Atlantic Region at HCA Reston Hospital Center. Robot-guided technology allows our surgeons to operate very accurately through a small incision while also decreasing the need for radiation during a surgical procedure. This new technique provides our surgical patients with smaller incisions for faster recovery time, less exposure to radiation, and improved surgical accuracy. This decreases overall risk during surgery. We will continue to use this new technique to perform both minimally invasive spine surgeries and complex spinal reconstructive surgeries. All of our Spinal Specialists at Virginia Spine Institute are trained in the Renaissance™ Robotic system and are double board certified in their chosen specialty of orthopedic surgery or neurosurgery, as well as spinal surgery.


Minimally invasive surgery uses smaller incisions which usually cause less damage to surrounding healthy tissue, less post-operative pain, and a faster recovery. Traditionally, spine surgery requires “open” surgery with incisions large enough to expose the entire area being treated. Open surgical techniques are beneficial and necessary for many conditions; however, in some cases minimally invasive surgery can be safely used for a similar result. One common technique the spine surgeons at the Virginia Spine Institute use to correct spinal conditions is spinal fusion. The purpose of a spinal fusion is to fuse, or join together, two separate segments of the spine to correct misalignment or instability.

Minimally invasive surgery often relies on more x-rays in the operating room since the surgeon can’t directly see the spine. The increased radiation exposure from more x-rays during surgery increases the risk of cancer for the patient as well as the health care team.


Surgical treatment of scoliosis requires a high degree of planning and precision. Surgery for scoliosis involves the use of spinal instrumentation such as screws, rods, hooks, and wires which are placed along the spine to corrects an abnormal curvature and prevent further progression of the disease. Each specific curve pattern is unique, and many patients have abnormally shaped vertebrae making surgery more challenging. Robot-guided scoliosis surgery increases correctness of where surgical instrumentation is placed. This increases the safety of the surgery and allows our scoliosis specialist, Dr. Christopher R. Good, the ability to customize an ideal surgery for each patient.


Case Report

Effectiveness of a Minimally Invasive Surgical Approach in the Treatment of a Lumbar Disc Herniation

A 43-year-old patient presented to Virginia Spine Institute with pain that began in the left buttock and radiated down her left leg and calf to the top of her foot. She was initially seen by her primary care physician, who told her that she probably had a muscular strain and prescribed a muscle relaxant. The muscle relaxant was ineffective and she began noticing tingling and numbness along the top of her foot associated with pain. She felt that her symptoms were clearly worse when she was standing and walking. She found some relief lying down with a pillow under her knees.

At her primary care follow up, her symptoms had not improved over the course of approximately one month and an MRI scan was ordered and obtained. The MRI scan demonstrated evidence of degeneration of the discs at L4/L5. The disc space was darker indicating loss of water content, or desiccation. Desiccation is one of the first signs of disc deterioration. Also associated with this disc degeneration was a disc herniation clearly originating from the L4/L5 disc protruding toward the left side of the spinal canal.

When the patient was seen, several possible options were discussed. She was given oral steroids and cortisone epidural injections in an attempt to alleviate her symptoms. She also participated in physical therapy and was prescribed medications for pain relief. All these options failed to improve her symptoms. She had severe pain with numbness and tingling in the left leg and felt disabled by the pain.  Her lifestyle was affected as she was having difficulty working, sleeping and taking care of her family. After exhausting non-operative treatments without improvement, the patient considered surgical intervention. Traditionally, the surgery for this problem entails an open incision which strips the muscle from the spine and allows the surgeon to remove a window of bone, removing the disc herniation directly. The patient was offered the possibility of a minimally invasive approach using a tubular retractor which does not cause any damage to the muscle. This technique lets a microscope visualize the critical structures of the spine and allows a laser to vaporize the disc herniation, thereby minimizing damage to the degenerative disc. The patient decided to pursue a minimally invasive approach.

The patient was taken to the operating room under general anesthesia. Fluoroscopic guidance was used to identify the L4/L5 level. A one-half inch incision was made approximately one inch from the midline. Through that incision a series of tubular dilators were used to displace the muscles without causing any damage and identify the area of disc herniation. Using a microscope to visualize these structures the nerve roots were gently mobilized. The disc herniation was identified and vaporized using a microsurgical laser. The nerve roots were carefully returned to the normal position. Absorbable sutures were placed to cover the incision and a band-aid covered the wound. The patient woke from anesthesia and was taken to the recovery room. She was discharged home approximately one hour later without feeling any pain in her left leg.


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