In this practice, minimally invasive surgery means reaching the spine through a narrow tube that separates the muscle along its fibers, without stripping it off the bone. This page explains how that works, and when an open approach is the better choice.
What affects your recovery most is what happens to the muscle underneath the incision.
In a traditional open approach, the muscles running alongside the spine are detached from the bone and held back with retractors for the length of the operation. This wide exposure is sometimes necessary. These muscles help hold you upright, though, and stripping them and then compressing them under a retractor for two hours injures them. Much of the pain and stiffness people associate with back surgery comes from that muscle injury.
Tubular technique avoids the stripping. A series of progressively larger dilators is passed down to the spine, parting the muscle along its natural fiber planes. A tube is then slid over the final dilator and locked in place. The muscle sits around the outside of that tube, undisturbed, for the whole operation.
Live X-ray confirms the exact level before any incision is made. A small corridor leaves little room to adjust, so the entry point has to be right the first time.
Roughly 15–20 mm, placed slightly to one side of the midline.
Dilators of increasing diameter are passed one over the next, each spreading the muscle a little further. The fibers separate without tearing, as the figure below shows.
The working tube passes over the final dilator and is secured to a table-mounted arm, holding the corridor open without anyone needing to hold a retractor.
Working through the tube under a microscope or endoscope, the surgeon removes bone to decompress the nerve, takes out disc fragments and places hardware if the level is being fused.
The tube is withdrawn and the muscle falls back into place on its own, because it was never detached. Closure is typically a deep suture and skin adhesive.
Tubular retractor in position
Illustration to come: a cross-section through the lumbar spine with the tubular retractor docked on the lamina and the muscle parted around the tube.
The operating microscope
Photograph to come: the microscope over the operating field, angled down the tube.
The view down the tube
Photograph to come: the surgeon's view down the working tube, with the lamina at the bottom.
The two approaches differ in how the spine is reached. The operation done at the spine is the same, but the amount of muscle disturbed on the way in is different. Dr. Zaidi performs both.
Figures are general ranges from the surgical literature and vary considerably by procedure, number of levels, and individual health. Comparative studies of tubular versus open decompression generally report less blood loss, less early post-operative pain, and shorter hospital stays with tubular technique, with decompression quality and longer-term outcomes broadly similar. The advantage is concentrated in the first weeks of recovery.
A decompression done through a tube is the same decompression done open. The nerve is freed to the same extent, the same disc material comes out and the same amount of bone is removed. The difference is how much tissue is disturbed on the way in.
No laser is used, and nothing is dissolved or “vaporized”. The instruments used through a tube are the same ones used in an open decompression.
A tube gives a narrow corridor, and a narrow corridor is a disadvantage when the problem is broad. Deformity correction across many levels, revision surgery through scar tissue and reconstructions that need wide access are all better done through an open exposure.
Smaller problems are the opposite case. A single-level discectomy or a one-level fusion in a patient with suitable anatomy gains very little from a 5-inch incision, which costs muscle stripped off the spine and weeks of extra recovery.
Where the anatomy is distorted enough that direct visualization is safer, an open approach is the more conservative decision, and it is the one Dr. Zaidi will recommend.
Most patients seen in this clinic never need surgery, and it is what patients mention most often in their reviews.
Very personable. Very matter of fact. Not aggressive with treatment plan; starts slow in order to try all options to avoid surgery.Kaye M. · Google review
As someone who has undergone back surgery before, I was in a panic. Dr. Zaidi worked with me to assuage my fears, prescribed physical therapy and a round of medicine, which worked wonders.Matt T. · Google review
Seeing Dr Zaidi for a couple of years now for a neck problem. He’s been very knowledgeable, has presented my options clearly, and has been supportive of conservative care.Chris C. · Google review
These are general ranges from the surgical literature and cannot be guaranteed for any one person. Recovery varies with the procedure performed, the number of levels, your overall health, and how closely post-operative guidance is followed. Nerve symptoms present for a long time before surgery can take months to settle regardless of the approach used.
Dr. Zaidi performed my microdiscectomy on my far lateral herniation. He is very skilled and was so kind before, during, and after my surgery. Three months post op and I am back to my old self.Tiffany B. · Google review
I had the lower back microdiscectomy surgery. After so much pain I had because of herniated disc leading to sciatica in my leg, he did a magic. Thank you doctor.Aizirek Z. · Google review
Quick recovery and minimal scar on back surgery, also very polite and easy to explain and understand.Verified patient · Google review
Verbatim from public Google reviews, shown with first name and last initial. Each review describes one patient's experience and does not guarantee any outcome. More patient reviews →