Minimally Invasive Spine Surgery


Traditional spine surgery usually requires long incisions. Muscles are cut and moved away from the spine to expose the surgical area. This causes increased pain, long recovery time and impaired spinal function.

With minimally invasive (keyhole) techniques, surgery on the spine can be performed with a wound of only 2-3cm and many of these can be performed as day surgery. Prolapsed intervertebral disc, spinal stenosis and spondylolisthesis are some of the conditions that can be performed with minimally invasive surgery.


In minimally invasive surgery a tubular retractor is used to dilate the muscles and create a tunnel to expose the spine (Fig 1a,b). Using the tubular retractor, procedures to relieve pressure on the spinal cord and to remove the slipped disc can be performed.

In patients who require spinal fusion to stabilize the spine, the metal screws and rods can be inserted through small wounds (Fig. 2).


1. Smaller scars

2. Less tissue trauma

3. Less blood loss

4. Less postoperative pain

5. Shorter hospital stay

6. Faster rehabilitation

7. Quicker return to work and normal activities

Clinical example

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patient with back pain and both leg pain which is worse with walking. Patient underwent minimally invasive surgery to relieve the pressure on the spinal nerves. He had rapid recovery with a small wound.


  1. Benedict Peng. Clinical and Radiological Outcomes of Minimally Invasive versus Open Transforaminal Lumbar Interbody FusionSpine 2009 Jun 1;34(13):1385-9.

Contributing Specialist:

(Spine Surgery)

Island Orthopaedic Consultants
Gleneagles Med Ctr,#02-16,
Tel:(65) 6474 5488, 6479 8998
Mt Elizabeth Med Ctr, #06-03,
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What Can You Do To Help Your Back and/or Neck?

In our fast-paced society, we often look for “quick fix” solutions to quickly remove the pain. We need to understand that in many instances, back or neck pain become obvious as a result of years of “neglect” of the spine. Patients with back or neck pain can become sedentary, or become out of shape, gaining weight that places more strain on the low back. Our goal at the Centre for Spine and Scoliosis Surgery (CSS) is to make your back or neck stronger, more flexible, and thus reducing the chance of further injury. Many of these can be achieved by educating you on the structure and function of the spine, and the lifestyle modifications that may accompany.

While a spinal injection or surgery can help relieve symptoms, not maintaining spinal muscle strength and flexibility, or use of good body mechanics can increase your likelihood of future problems. You have to remember that as you get older,

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especially past the age of 40, the back is more prone to injury. You may need to avoid lifting heavy objects, or participating in contact sports involving twisting, bending, and jumping, because these activities can damage your back or neck.

Ergonomics is important, and it means matching the

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sure your chair molds properly to your back. If you are too short or too tall for your back to rest properly in your chair, or if your company does not offer ergonomically designed chairs, consider bringing in a rolled-up towel. Place it behind your low back to reduce the amount of stress on the back. While sitting, make sure your feet rest flat on the floor. If this is a problem, use a footstool. Proper foot and leg alignment will ease back stress. While typing on a computer, your forearms and thighs should be parallel to ensure proper shoulder alignment. If necessary, use a pad to support your wrists while typing. The monitor should be at eye-level or slightly below eye-level. Last but not least, always get up and move around every half hour, even if it is just a quick stretch by the side of your desk.

Some jobs require standing for many hours at a stretch. People rarely distribute their weight equally onto both legs while standing. They tend to shift their weight from one side to another, throwing the spine out of

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alignment, which can lead to back strain.

If you have difficulty standing without shifting weight, try standing with one leg on a footrest, periodically switching feet. It is also important to do back stretches now and

then in order to reduce stiffness of the back.

Lifting is a common activity in our daily life. When lifting, maneuver the object close to your body, and use the strength in your legs to get the object off the ground, rather than your low back. Whenever possible, your back should not bend forward when lifting something, however light it may appear.
Contributing Specialist:

Dr Hee Hwan Tak
MBBS, FRCS (Ed), FRCS (Glas), FAMS (Ortho)
Medical Director and Senior Consultant, Pinnacle Spine & Scoliosis Centre
Mobile: 65-98283132
Tel: 65-67370680
Fax: 65-67370522
Emergency: 65-97718964
3 Mount Elizabeth, Mount Elizabeth Medical Centre, #04-07, Singapore 228510
Adjunct Associate Professor, Nanyang Technological University, Singapore
Panel of Medical Experts, The Subordinate Courts of Singapore

Associate Editorial Board Member, The Spine Journal (USA)


Chronic Ankle Pain – What could be the problem?


The ankle is a very complex joint. There are actually many small joints in the region of the “ankle”. One of which is the subtalar joint

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foot. These too can cause “ankle pain”.


A proper evaluation of ankle pain requires listening to the patient’s symptoms and then performing an examination of all the joints, tendons and ligaments. Sometimes, Xrays or MRI scan may be necessary to assist in confirming a diagnosis.


Treatment of ankle pain has advanced significantly. Many conditions

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which used to be less known and underdiagnosed can now be treated by minimally invasive surgery. The ankle can now be scoped (anterior and posterior ankle arthroscopy) from the front and also from the back. The tendons around the ankle can also be scoped (tenoscopic surgery). The subtalar joint can also be scoped (subtalar arthroscopy). Mini instruments have allowed us to treat many painful ankle conditions through “keyholes”. In my personal experience, the success of such surgery in improving the function of a damaged “ankle” ranges from 85 to 95%.

Ankle arthroscopy showing a “meniscoid lesion”. This is a fibrous “scar” that appears after an ankle injury that can get trapped in the joint, causing pain. Arthroscopic removal results in excellent pain relief.

Tendon scope (tenoscopic surgery) on the ankle. My published personal results

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This topic is courtesy of:

Dr. Chong Keen Wai

The Ortho Klinic

Gleneagles Medical Centre

Suite 08-01

6 Napier Road

Singapore ( 2588499 )

Clinic Tel: +65 64738826



Low Back Pain

Low back pain, also called lumbago, is a common condition. It is safe to say that most of us have experienced back pain. Usually, the pain is triggered by physical activities such as daily work, recreation, or even sexual intercourse. Fortunately, most of the cases can go away within a few days. Others take much longer to resolve and may lead to more serious conditions.

There are 2 types of low back pain, acute and chronic. Acute low back pain lasts no longer than a few weeks. Most of them are caused by mechanical trauma such as sports, horseback riding, daily activities at home, or accident. On the other hand, chronic low back pain is very different. The pain persists for more than 2 months and it is often progressive. There is always an underlying cause behind chronic low back pain which should be corrected. Common causes of low back pain are mechanical (such as

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fractures, back injury, lifting heavy objects), inflammatory (such as arthritis, infections), malignancy or cancer, metabolic (such as osteoporosis), and psychological causes.

Symptoms of low back pain may range from a simple muscle ache to stabbing and severe pain, limited flexibility or difficulty to stand straight. Sometimes, the pain may originate from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.

Finding the causes of low back pain can be difficult.

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