Dr. Bidiwala’s minimally invasive instrumentation stabilizes your spine without large incisions

Stabilizing a spine affected by fracture, disease or degeneration used to require a large incision along the center of the spine and forced muscle retraction. With the affected area of the spine exposed, the physician would then place screws into the affected spinal segment and connect them to rods, creating an internal cast to maximize spinal stability.

This tradtional approach damages muscle tissue, increases the risk of postoperative infection, requires a multi-day hospital stay (as well as a lengthy post-operative recovery period) and results in significant pain and scarring along the spine.

How is minimally invasive instrumentation different from the traditional approach?

By contrast, Dr. Shaad Bidiwala’s minimally invasive approach accesses the affected area through two small incisions on either side of the spine. Once the incisions are made, he then gently moves muscle tissue aside along its natural planes, which allows rods and screws to be carefully advanced through the incision. Separating the muscles in this manner causes significantly less trauma to the surrounding tissue and promotes better postoperative healing.

What are the benefits of minimally invasive instrumentation?

A minimally invasive approach stabilizes your spine with significant benefits, including:

  • Smaller incisions (and therefore smaller scars)
  • Shorter hospital stays
  • Faster recovery periods
  • Less post-operative pain
  • Reduced risk of post-operative infection
  • Reduced risk of muscle damage

What happens during a minimally invasive instrumentation procedure?

Once the incisions are made and muscle is moved aside, screws attached to screw towers are carefully placed using advanced image guidance with live x-rays or CT scanning. This technology helps ensure each screw is precisely and correctly placed and no nerves are contacted. Once the screws are placed, bony overgrowths may be removed via corridors created between the screws. Next, rods are placed through the screw towers and attached to the screws. After placing the screws and rods, the screw towers are removed and the muscle falls back into place. Once the procedure is finished, the tough fascia, or connective tissue covering the muscles, is closed with sutures and the small skin incisions are closed with resorbable sutures and an antibacterial skin glue.

Minimally Invasive Instrumentation (Screws & Rods)

Quick Facts

Possible Symptoms

  • Leg pain, numbness, and/or weakness
  • Back pain, especially with movement
  • Bowel or bladder incontinence

Typical X-Ray Findings

  • Spondylolisthesis, or slippage of one vertebral body upon another (MRI, CT myelogram).
  • Disc and endplate changes suggesting excess “wear and tear” (MRI, CT myelogram).
  • Excess movement of one vertebral body upon another when bending forward or backward (Flexion and extension x-rays)

Average Procedure Time

  • 2-6 hours, depending on number of levels

Average Recovery Time

  • Home in 2-4 days
  • Off work 6-8 weeks, depending on duties

Postperative Limitations

  • No bending, twisting, lifting, or strenuous exercises (8 weeks)
  • No driving while on narcotics

The Procedure

Instrumentation with screws and rods is done to stabilize the spine in an area that may be unstable from degeneration or a fracture.  Instrumentation is always performed in conjunction with at least one fusion procedures such as a Posterolateral Lumbar Fusion (PLF)Anterior Lumbar Interbody Fusion (ALIF)Posterior Lumbar Interbody Fusion (PLIF), or Extreme Lateral Interbody Fusion (XLIF).

Instrumentation Slide

While instrumentation with screws and rods used to involve rather large incisions, newer technologies allow us to do this minimally invasively, through natural muscle planes.  Minimally invasive technology allows for quicker recovery times and a dramatically decreased rate of infection, since tissue disruption is minimal compared to that which is necessary with traditional approaches.

Traditional Instrumentation vs. Minimally Invasive Instrumentation

The Old Way

Pedicle Screws The Old Way

An incision is made in the midline. Muscle is burned and then peeled off of enough of the spine in order to expose the bone that will accommodate the screws. Spiked retractor blades (pink lines) hold the muscle off of the bone while screws are placed.  At the end of the procedure, even though sutures are used to sew the damaged muscle back together, a significant amount of “dead space” (shown in pink),  remains.  Fluid tends to accumulate in this space and can become infected.

The New Way

Pedicle Screws the New Way

Two  incisions measuring about 1.5 inches each are made 2 inches on each side of the midline. Muscle bundles are separated bluntly (with a gloved finger) through natural tissue planes (green lines) in order to expose the bone that will accept the screws.   Screws are advanced using xray guidance and electrical monitoring to make sure no nerves are contacted.  After the insertion of the screws and rods, the the muscle falls back into place, with minimal dead space,  and does not even need to be sutured!

The Old Way

Open Lumbar Instrumentation

A midline incision is made and muscle is retracted away from the midline using large clawed retractors for several hours while bone is removed and screws and rods are placed under direct visualization.

The New Way



Incisions are made 2 inches off of midline, and screw towers attached to screws are placed using image guidance with live xrays or CT scanning through natural tissue planes. Muscle is only minimally retracted.  Bone is removed in corridors created between the screws.  Afterwards, rods are placed through the screw towers, which are then detached from the screws.

The Old Way


The wound must be closed in multiple layers in order to eliminate the “dead space” that results from retracting the muscle during the duration of the procedure.  A lengthy midline incision is generally closed with nylon sutures.

The New Way


Upon removal of the screw towers, the muscle falls back into place, and no sutures need to be placed into them.  Only the tough fascia covering the muscles is closed.  The small skin incisions are closed with  reabsorbable sutures and tape strips.

To learn more about Dr. Bidiwala’s minimally invasive instrumentation procedure, please call 214-823-2052. You can also request an appointment using our easy online form.