1 Ghrelin is a fast-acting hormone that plays a vital role in meal initiation and contributes to weight gain. 2  Leptin mediates long-term regulation of energy balance and suppresses food intake, thereby inducing weight loss.  Both hormones can be controlled naturally, primarily though exercise and stress management.
Surgical retractors. A retractor is a surgical instrument with which a surgeon can either actively separate the edges of a surgical incision or wound, or can hold back underlying organs and tissues, so that body parts under the incision may be accessed. The two are each available in many shapes, sizes, and styles.
To summarize, the concept of minimal access spine surgery involves the use of dilators to split the fibers of the paraspinous musculature. This muscle splitting approach markedly reduces injury to the muscles and also limits dissection of the ligaments. A tubular-type retractor is then placed over the dilators and docked on the spine. (Figures 1 & 2) Utilizing magnification provided by an endoscope or microscope, based upon surgeon preference, decompression of the neural elements may be carried out and if necessary, grafts placed for fusion.