Minimally invasive spine surgery

1

What is minimally invasive spine surgery?

Minimally invasive spine (MIS) surgery is a surgical approach or technique intended to provide equivalent or superior outcomes compared with conventional open spine surgery as a result of limiting approach-related surgical morbidity. In spine surgery, as with most other invasive procedures, less is more as long as surgical goals are fully met. Principles shared by MIS procedures include:

• Small surgical incisions

• Minimal disruption of musculature compared with standard open approaches

• Requirement for specialized equipment, retractor systems, and implants

• Use of intraoperative neurophysiologic monitoring and intraoperative imaging modalities, including fluoroscopy and computerized navigation technologies

2

Have MIS procedures been proven safer or more effective than traditional open spine procedures?

Despite the fact that MIS procedures are performed through smaller skin incisions, the potential for serious and life-threatening complications is not completely eliminated. All spine procedures are considered maximally invasive because neural, visceral, and vascular structures remain at risk for serious injury. Current literature supports that MIS procedures have decreased certain complications such as excessive blood loss and infection compared to traditional open spine procedures. Other complications, such as pseudarthrosis, adjacent level disease, or proximal junctional kyphosis do not seem different between procedure types. However, this may change in the future depending on technological advances, surgeon education, and changes in practice patterns.

3

Are the goals of MIS procedures different from standard open procedures?

No. The surgeon must be able to achieve the same surgical goals with MIS techniques as with standard open surgical procedures:

• Adequate neural decompression

• Stabilization and arthrodesis

• Balanced correction of spinal deformity

• Relief of axial and/or radicular pain

4

What are reasonable steps for a surgeon to take in order to overcome the learning curve and maximize patient safety when learning MIS techniques?

• Attend technique-specific surgical courses

• Study the anatomy, indications, and potential complications of MIS surgery

• Rehearse surgical techniques through practice in animal and cadaver laboratory models

• Visit or train with experienced surgeons currently performing these procedures

• Perform initial cases in conjunction with an experienced surgeon

• Develop a game plan for addressing intraoperative problems

• Maintain competence in MIS techniques through adequate surgical case volume

• Perform a critical analysis of personal surgical outcomes

5

List common applications of MIS techniques for cervical spine pathology.

• Posterior-Based Approaches

  • Tubular laminoforaminotomy

  • Posterior screw-rod fixation and fusion

• Anterior-Based Approaches

  • Endoscopic approaches to the upper cervical spine and craniovertebral junction

  • Anterior cervical foraminotomy

6

List common applications of MIS techniques for thoracic spine pathology.

• Posterior-Based Approaches

  • Tubular microdiscectomy

  • Percutaneous pedicle screw-rod placement and thoracic posterior fusion via MIS approach

• Anterior-Based Approaches

  • Thoracoscopic discectomy and corpectomy

  • Mini-open thoracoscopic-assisted discectomy and corpectomy

  • Anterior instrumentation and fusion for spinal instabilities

  • Video-assisted spinal instrumentation and fusion for idiopathic scoliosis