What is a Minuteman Procedure?
The Minuteman Procedure refers to the minimally invasive treatment of spinal stenosis (Nunley et al., 2017). This process uses a minimally invasive, interspinous fusion device to stabilize and fix the spine (thoracic, lumbar, and sacral) for bony fusion. This technique helps to make a small incision at the side of the lower back to treat stenosis. To produce a percutaneous fusion at the treatment level, physicians use the device in combination with hydroxyapatite (bone cement). This procedure brings significant relief immediately and requires a short recovery time.
Through its bilateral locking plates, the Minuteman device connects to the posterior non-cervical spine at the spinous processes. This device immobilizes and stabilizes the spinal segments. A wide variety of sizes and a core threaded post allow for optimal positioning and anatomical fit. Manufacturers deliver this Minuteman device in sterile and individually packed condition. Neurosurgeons treat essentially all grade 1 spondylolisthesis and most Grade 2 spondylolisthesis with this Minuteman device (Vaishnav, Othman, Virk, Gang, & Qureshi, 2019). Also, this device helps to stabilize any considerable movement of the spine. For degenerative disc disease (DDD), this device works well. Spinal specialists also use this to stabilize metastatic cancer in lumbar vertebrae.
Conditions for Minuteman Procedure
The Minuteman Fusion Plate refers to a non-pedicle supplementary fixation device for the non-cervical spine that uses at a single level between the first thoracic vertebrae to the first sacral vertebrae (T1-S1). Basic conditions for minuteman procedure include (Licina, Silvers, Laughlin, Russell, & Wan, 2021):
- Physical trauma such as spinal fracture or dislocation
- Degenerative disc disease (DDD): This refers to a discogenic back pain condition characterized by disc degeneration as evidenced by history and radiological investigations.
A minimally invasive lateral approach, known as the minuteman procedure, requires implanting the Minuteman device into the spinal column along with bone graft material.
Risks of Minuteman Procedure
Complications may occur during any surgical operation. Potential complications of Minuteman Procedure include infection at the operation site, delayed healing, excessive blood loss, injured blood vessel or nerves, formation of hematoma or blood clot, etc. Neurosurgeons found a higher risk of complications among the older group of people with obesity, poor nutrition, etc.
How should a patient prepare for a Minuteman Procedure?
Neurosurgeons need to trim the hair of the patient above the surgical site and clean the surgical region with antiseptics before the Minuteman procedure. Furthermore, prior to surgery, the surgical team will take a nose swab sample from the patient to monitor and assess any dangerous germs. Patients must refrain from drinking or eating for at least 12 hours prior to surgery (Park et al., 2020). Patients should talk to their surgeons about any drugs they’re taking, and neurosurgeons may advise them to cease taking certain medications, such as blood thinners, before surgery.
How does a Spinal Surgeon perform Minuteman Procedure?
Minuteman’s procedure requires an expert surgical team led by an expert neurosurgeon, with an anesthesiologist and nurses, to perform successfully. The entire operation may require less than one hour to complete. The basic steps include (Baranidharan, 2019):
- Patients will lie in the lateral decubitus position on the operating table.
- Anesthesiologists need to inject general anesthesia to the patient to fall asleep to avoid any pain or sensation.
- Nurses will prepare the incision site and monitor the vital signs of the patient’s body, such as heart rate, respiration, etc.
- Using manual palpation and AP fluoroscopy, neurosurgeons will identify the midline of the spinous processes at the level to implant instrument and insert a spinal needle.
- Later, neurosurgeons will introduce the guide wire through the incision into the device until it reaches the first stop. Neurosurgeons need to verify the position of the guide wire with fluoroscopy and lateral views.
- Under fluoroscopy, neurosurgeons will prepare the implant site by inserting a 3 mm dilator through the skin incision while holding the guide wire in place. Later, surgeons will insert the graduated tap over the extended guide wire.
- After that, neurosurgeons will remove the guide wire while leaving the sleeve in place against the lateral surface of the spinous processes and attach the Minuteman to the insert by measuring their sizes.
- Finally, the neurosurgeon will insert the Minuteman and fix the spinous process.
- Later, neurosurgeons can remove the implant through a conventional posterior open surgical approach using the Minuteman G3 Posterior Instrument Set.
- Finally, surgeons will return structures like muscles and tissues to their natural places and suture the skin together.
What does recovery from Minuteman Procedure look like?
Patients undergoing a Minuteman Procedure generally leave the hospital the same day as the operation. Physicians suggest taking advice from the physical therapists before going home. Usually, physical therapists instruct patients regarding the proper way of getting in and out of bed and walking safely. Neurosurgeons instruct patients to avoid weight lifting and twisting their back to prevent strain injuries for 4-6 weeks. Please contact us for any information.
Baranidharan, G. (2019). Interspinous Distraction Devices, has this Lost its Place in Treatment Algorithm? Biomedical Journal of Scientific & Technical Research, 13(1), 9720–9721. https://doi.org/10.26717/bjstr.2019.13.002346
Licina, A., Silvers, A., Laughlin, H., Russell, J., & Wan, C. (2021). Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components. BMC Anesthesiology, 21(1), 1–21. https://doi.org/10.1186/s12871-021-01281-1
Nunley, P. D., Patel, V. V., Gorndorff, D., Lavelle, W. F., Block, J. E., & Geisler, F. H. (2017). Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis. Clinical Interventions in Aging, 12, 1409–1417. https://doi.org/10.2147/CIA.S143503
Park, J., Ham, D. W., Kwon, B. T., Park, S. M., Kim, H. J., & Yeom, J. S. (2020). Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications. Asian Spine Journal, 14(5), 694–701. https://doi.org/10.31616/asj.2020.0384
Vaishnav, A. S., Othman, Y. A., Virk, S. S., Gang, C. H., & Qureshi, S. A. (2019). Current state of minimally invasive spine surgery. Journal of Spine Surgery, 5(S1), S2–S10. https://doi.org/10.21037/jss.2019.05.02