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I'm very excited that when I have the disc removed in my low back next week, there will be the tiniest scar. I can even have the area tattooed to cover it up. The surgeon was very clear that this is a better way to do things. Why isn't everyone doing surgery this way?

There's no doubt that smaller incisions during spine surgery (called minimally invasive spine surgery or MISS) has many advantages. Besides the tiny scar left behind, patients experience less tissue trauma. There is faster recovery of muscle strength when muscles don't have to be cut away and reattached at the end of the operation. Some studies show less blood loss with MISS, shorter hospital stays, and lower costs as a result. With fluoroscopy for viewing the spine, accuracy is improved when placing tiny screws in the vertebrae through these small incisions. Why isn't it done more often? There are several reasons. Not every hospital can afford to invest in the surgical tools necessary for this type of procedure. With each specialty area, new technology is available but very expensive. There are laser tools for cancer surgeries, computer-based CT and MRI scans, fluoroscopes (real-time X-rays) for orthopedic surgeries, and so on. From a business point-of-view, they purchase the equipment that will be used the most. Surgeons must take the time to get trained in these newer techniques. Of course, each surgeon will have his or her own transition time learning how to do surgery with minimally invasive methods. Patient safety and good results are always on the surgeon's mind. It does take time and practice to learn any new skill or surgical technique. If there isn't a large number of people in the area who will need the particular minimally invasive surgery needed, then the surgeon is less likely to seek out that training.

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