If a doctor has recommended spinal surgery to address your neck or back pain, you may be worried about the procedure, including about how much time you will have to take off to heal. Historically, spinal surgery has been a challenge: In order to access the affected area, a surgeon had to make a large incision and then move aside the muscles surrounding the spine.

But in the last decade, minimally invasive spinal procedures—requiring smaller incisions and causing less damage to the surrounding tissue—have allowed surgeons to navigate the spine and isolate a patient’s spinal problems with better results and less recovery time. “A minimally invasive spine surgery allows for less surgical stress on the patient, including minimal blood loss during surgery, decreased pain after the procedure, and a shorter hospital stay,” says Yale Medicine neurosurgeon Pedro Coutinho, MD, who specializes in spine surgery. 

Yale Medicine uses cutting-edge technology to perform these procedures so that patients can get back on their feet quickly. Our surgeons routinely perform spine surgeries using intraoperative CT scans, neuro-navigational tools, and robotic arms, Dr. Coutinho says. 

Common spine problems that compel patients to seek minimally invasive surgical treatment include:

• Degenerative instability, which happens when joints become so arthritic that patients begin to experience slipped vertebrae.
• Spondylolisthesis, a condition that often affects the lower spine and happens when one vertebra slips over the vertebra beneath it.
• Disk herniations with sciatica, in which a patient may experience extreme pain from a pinched nerve that runs down the leg.
• Myelopathy, which is spinal-cord compression that results in stiffness and weakness in the neck that can also begin to affect the arms and legs.
• Spinal stenosis, which occurs when the spinal canal has stiffened ligaments and bone spurs. Those abnormalities can begin to compress the nerves that go to the legs, causing pain and difficulty walking.
• Spinal tumors, which can either be primary tumors that originally developed in the spine or metastatic tumors, which are related to the spread of other cancers.

Minimally invasive spinal surgery refers to any procedure in which a surgeon accomplishes the goal of the conventional surgery while sparing the soft tissues and musculature around the spine. 

The procedure usually involves a small incision, and doctors use a variety of tools to access the spine including:

Endoscopic cameras: These thin, fiber-optic cameras can be inserted into the spine through a small incision, giving the surgeon a better understanding of what is happening in the spine and of the type of intervention necessary.

Tubular retractors: These specialized tools are inserted through the skin and soft tissues all the way through to the spinal column. These small retractors effectively create a tunnel space around the area when the surgeon is operating, leaving the rest of the spinal structure untouched.

O-arm imaging: This tool provides intraoperative CT scanning that allows surgeons to see imaging results while the surgery is ongoing. 

These tools have led to fewer infections, have lessened the need for interventions such as blood transfusions, and have led to quicker recovery times. 

At Yale Medicine, our spinal surgeons are on a constant quest to pioneer advanced, minimally invasive methods that minimize patient trauma. 

Our doctors are passionate about helping patients return to normal functioning as quickly as possible and work with other specialists to ensure this happens. “We collaborate with other neurosurgeons, orthopedic surgeons, pain management doctors, physiatrists, and physical therapists to find better ways to treat our patients,” Dr. Coutinho says.