Minimally Invasive Spine Surgery Bangkok | Dr. Chaidej Sasomboon

What is Minimally Invasive Spine Surgery (MISS)?

Minimally invasive spine surgery achieves the same goals as open surgery — decompressing nerves, removing disc herniations, stabilising unstable segments — through much smaller incisions using endoscopes, microscopes, and specialised instruments. MISS avoids the wide muscle stripping of traditional open surgery, resulting in less blood loss, less post-operative pain, shorter hospital stays, and faster recovery.

MISS vs Open Surgery — Key Differences

• Incision size: 8-25 mm (MISS) vs 5-15 cm (open)
• Muscle damage: Minimal — muscles dilated not cut (MISS) vs extensive stripping (open)
• Blood loss: Under 50 ml (MISS) vs 200-500 ml (open)
• Hospital stay: Day surgery or 1-2 nights (MISS) vs 3-7 nights (open)
• Return to desk work: 1-2 weeks (MISS) vs 4-8 weeks (open)
• Infection risk: Lower — smaller wound with less exposed tissue

MISS Procedures Performed by Dr. Chaidej at Bangkok International Hospital

1. Endoscopic Discectomy

The most minimally invasive surgical option for disc herniation. An 8 mm working channel endoscope provides direct high-definition visualisation of the herniated fragment and compressed nerve root. Fragment removed through precision instruments under continuous saline irrigation. Day surgery or 1 overnight stay. Return to desk work 1-2 weeks. Available in transforaminal and interlaminar approaches.

2. Microscopic Discectomy (Microdiscectomy)

Established gold-standard through a 2-3 cm incision with surgical microscope magnification. Preferred for complex, recurrent, or anatomically challenging cases. Hospital stay 1-2 nights. Office work in 2-4 weeks.

3. MIS-TLIF and OLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion)

Spinal fusion through two 2-3 cm incisions without midline muscle stripping. Titanium cage fills the disc space; percutaneous pedicle screws placed under fluoroscopic or robotic guidance provide posterior stability. Used for spondylolisthesis, instability, and recurrent disc herniation. Hospital stay 3-5 nights. Full recovery 3-4 months.

4. Percutaneous Pedicle Screw Fixation

Screws placed through stab incisions under fluoroscopic or robotic guidance — no muscle stripping. Provides posterior stabilisation combined with interbody fusion or as standalone fixation for select fractures.

5. Vertebroplasty and Kyphoplasty

For osteoporotic vertebral compression fractures. Medical-grade bone cement injected into the collapsed vertebra (vertebroplasty) or space first created by balloon inflation (kyphoplasty). Day surgery under local anaesthesia. Dramatic pain relief within 24-48 hours.

6. Robotic-Assisted Spine Surgery

Robotic guidance integrated with O-arm 3D intraoperative imaging achieves screw placement accuracy under 1.5 mm — compared to 5-15% malposition rate with freehand technique. Particularly valuable for complex deformity correction, high-grade spondylolisthesis, and multi-level fusion in challenging anatomy.

7. Endoscopic Cervical Surgery

Posterior cervical endoscopic foraminotomy (PCEF) removes bone and soft tissue causing cervical nerve root compression through a 10 mm endoscope — an alternative to ACDF for lateral soft disc herniations with predominantly arm pain.

Conditions Treated with MISS

• Lumbar disc herniation (endoscopic or microscopic discectomy)
• Spinal stenosis (endoscopic UBE decompression, microscopic laminectomy)
• Spondylolisthesis (MIS-TLIF and OLIF)
• Sciatica from disc or foraminal stenosis
• Osteoporotic vertebral fractures (vertebroplasty or kyphoplasty)
• Cervical disc herniation (endoscopic foraminotomy or ACDF)
• Degenerative disc disease with instability (MIS-TLIF and OLIF)

Technology at Bangkok International Hospital

• Full-endoscopic spine system with HD visualisation
• Surgical microscope for microdiscectomy
• O-arm intraoperative 3D imaging for real-time verification
• Robotic spine surgery guidance system for percutaneous screw placement
• Intraoperative neuromonitoring (IONM) for all major procedures

Dr. Chaidej Sasomboon — MISS Specialist, Bangkok

• Fellowship: Minimally Invasive Spine Surgery, UCSF Medical Center, San Francisco (2019)
• Fellowship: Complex Spine Surgery, Columbia University Medical Center, New York (2020)
• Residency: Ramathibodi Hospital, Mahidol University
• Member: NASS, RCST, Thai Medical Council

Dr. Chaidej is one of Thailand’s foremost minimally invasive spine surgeons. His training at two leading US academic spine centres brings international-standard MISS techniques to patients in Bangkok.

Recovery After MISS

• Day of surgery: Walk within hours. Oral pain medication only.
• Week 1-2: Return to desk work (endoscopic procedures). Daily walking encouraged.
• Week 2-4: Physiotherapy begins. Light activities increasing.
• Month 1-2: Gym and non-contact sports (decompression procedures).
• Month 3-6: Full return to physical activities after fusion procedures.