In preparation for spinal fusion surgery, I watched a video at my surgeon’s office that showed how it’s done. I still don’t get how they can put a tiny tube down through a small opening and see what they are doing. Even on the video, it just looked like a lot of weird tissue and blood to me. What is it the surgeon is really seeing?

It sounds like your surgeon is planning to use the new minimally invasive technique to perform your spinal fusion. Instead of making a long open incision and cutting through all the layers of muscle, tendons, ligaments, and other soft tissues, a smaller cut is made. The long, round tube you saw is inserted through the layers of tissue down to the bone.

The tube has an expandable retractor that pushes away the soft tissues surrounding the area. This gives the surgeon a better view of the area and more room to navigate the surgical tools. At the same time, there is a magnifier on the end of the tube that gives the surgeon a bigger view of the area.

Movement of the surgical tools is further aided by a special type of real-time, 3-D X-ray called fluoroscopy. Fluoroscopy is a moving X-ray giving the surgeon details of the vertebral bones. The entire system gives the surgeon a focused view of the anatomy magnified for easier recognition of the structures.

Knowing anatomy, and practicing identification of the bones, muscles, tendons, discs, joints, and so on using these special surgical tools takes time. But using cadavers (bodies preserved after death for study) and practicing under the supervision of other trained surgeons gives the surgeon a clear idea of what is being seen.