MISS cuts risk of back pain, helps recovery
Published on: Tuesday, August 22, 2023
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For patients who have their spinal nerve badly compressed, the only way of being free from back pain is to do surgery. (Right) Dr Tan Wei Chean
People who fear “going under the knife” and the risk of open surgery, like getting infections, can choose this procedure to treat their back pain without any worry.
Elderly and obese patients are prone to infections and complications from open surgery, hence, they can benefit from less invasive surgery.
Here is what one can expect from MISS.
MISS consists of various approaches when it comes to treating back pain, therefore, patients should consult their doctors first regarding their specific condition.
One of the approaches is the pain management approach. This approach is designed for when the spine support elements, like disc or facet joints, are already injured but not serious enough to go for surgical intervention.
For this kind of case, regenerative medicine is the best option.
Regenerative medicine is an innovative field of medicine that utilises the body’s healing agents to restore and repair injured tissues.
Unlike steroid injections, these are naturally occurring healing agents produced in one’s own body.
The procedure uses Platelet-Rich- Plasma (PRP) Injection therapy and Dextrose-based solutions injection (Prolotherapy) to restore health to damaged tissues and joints in the body.
For chronic back pain, the intervertebral disc, facet joints and spinous ligaments are the common parts to get injured. Research has shown that PRP injection can significantly decrease chronic lower back pain and has no major adverse effects.
PRP therapy uses injections of a solution abundant in platelets isolated from a patient’s blood to achieve natural healing by stimulating growth factors in the injured tissues.
For chronic back pain, the intervertebral disc, facet joints and spinous ligaments are the common parts to get injured. This solution is injected into the affected area to promote healing.
Research has shown that PRP injection can significantly decrease chronic lower back pain and has no major adverse effects. PRP was also shown to be a more effective option over steroids in long-term follow-ups for lumbar spondylosis and sacroiliac arthropathy.
Besides that, Dextrose-based treatments – such as Prolotherapy and Perineural Injection Treatment (PIT) – involve injecting a solution consisting of biological substances (eg saline and dextrose) into the affected area to promote the healing process.
Prolotherapy is used to treat chronic musculoskeletal conditions, including joint instability, ligament laxity and chronic pain. It uses 12.5-5 per cent of hyperosmolar Dextrose as the main solution to inject into the injured tissue.
The injection acts as an irritant which may trigger the body’s inflammatory healing response and, thereby, helps to repair the injured tissues.
The purported mechanism focuses on proliferative repair. This treatment helps in strengthening and stabilising the affected structures. The goal of Prolotherapy is to alleviate pain and improve function, providing long-lasting relief for patients suffering from persistent musculoskeletal issues.
PIT is a treatment mainly targeted for nerve-related pain conditions, such as neuropathic pain or neuralgia.
This treatment uses isotonic buffered Dextrose 5 water (D5W) as the main solution to inject adjacent to peripheral nerves to reduce neuropathic pain. Istotonic dextrose may be associated with downregulated pain receptors (TRPV1).
So, the purported mechanism is associated with a sensorineural effect and possible neurodegenerative effects. Research has shown that PIT with dextrose is better than steroids in the treatment of carpal tunnel syndrome.
The effects of PIT are also like or better than steroids for treating ulnar neuropathy at the elbow and better than saline for treating caudal epidural injection when assessing long-term follow-ups.
This treatment is an effective option for those seeking pain management when conservative treatments have been unsuccessful.
For patients who have their spinal nerve badly compressed, the only way of being free from back pain is to do surgery.
However, conventional open spine surgery is typically chosen for complex spinal conditions requiring comprehensive intervention and a wider view of the affected area.
While it provides direct access to intricate surgical procedures, it involves larger incisions and lay lead to a longer recovery time, a higher possibility of getting infections, more blood loss, instability increased and more pain after surgery.
On the other hand, endoscopic spine surgery (ESS) is a minimally invasive option suited for conditions like herniated discs, spinal stenosis and nerve compression.
ESS is an ultra-minimally invasive surgical procedure that effectively relieves chronic low back and leg pain.
This state-of-the-art spine surgery utilises a HD camera attached to an endoscope inserted through an 8mm skin incision to the target pain generator in the spine.
The surgeon can observe the spine on a HD monitor and operate through the endoscope using highly specialised micro-instruments like a radiofrequency probe or graspers.
Operating instruments are inserted through the channel to remove any problematic bone spurs, herniated discs or thickened ligaments.
Patients are usually just lightly sedated during the operation which will reduce the risk of the side effects from general anesthesia. This surgery can also be performed as ambulatory (outpatient) spine surgery due to the benefit of easy recovery.
Minimal-invasive surgery stands at the forefront of modern medical advancements, revolutionising the field of surgery and transforming patient experiences.
Through its numerous benefits, including better wound cosmetic results and improved outcomes, this type of surgery has become a preferred choice for a wide range of surgical procedures.
It plays a crucial role in preventive medicine by offering less invasive techniques that can help minimise the risks and complications associated with traditional open surgeries, particularly when it comes to spinal health.
MISS offers benefits such as smaller incisions, reduced tissue damage, quicker recovery, better skin cosmetic outcome and less postoperative pain as compared to open spine surgery.
With smaller incisions and reduced body trauma, it leads to minimal risks, smoother recovery and a faster return to work. MISS can aid in preserving and enhancing spinal health, promoting overall well-being and a better quality of life for patients.
As technology continues to evolve, MISS is expected to expand its applications, further improving preventive measures and patient care.
Through its transformative impact on healthcare, MISS undoubtedly represents a promising future where patients can undergo surgical interventions with greater ease and confidence, contributing to long-lasting spinal health and a proactive approach to well-being.
- This article was contributed by Dr Tan Wei Chean who is a Consultant Neurosurgeon, Pain Management Specialist and Endoscopic Spine Surgeon at Gleneagles Hospital Kota Kinabalu.
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