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The Value of Minimally Invasive Spine Surgery

The value of Minimally Invasive Spine Surgery (MISS) is more than surgeon assumption or a marketing whim. That sounds very poetic, but what does it mean exactly? The author answers that question in this review article on the topic of minimally invasive spine surgery.

What is MISS? In the simplest terms, it means the surgeon makes a very small incision and there is as little disruption of the underlying soft tissues as possible. Special surgical instruments developed just for MISS are used such as intraoperative microscopes and fluoroscopes (real-time X-rays).

But experts in the field say that defining what is and is not a minimally invasive surgical procedure is more difficult than just saying it's a small incision. For one thing, how small is small? Is it a certain number of inches -- or just smaller than an open incision for the same operation? If a small incision is made but the surgeon still cuts through muscles, is it still minimally invasive?

Some researchers have used blood markers of inflammation to gauge how much soft-tissue damage has occurred. In this way they can determine whether a procedure has been minimally invasive or not. Those studies have provided some interesting information to consider. Open procedures do tend to have higher levels of inflammatory substances. When the final patient outcomes are the same, perhaps this one difference could be enough to support the benefit of minimally invasive over open procedures.

Can any type of procedure fall under the category of MISS? Sometimes the surgeon is injecting a substance into an area. In other cases, there is resection (removal of tissue) or instrumentation. Instrumentation refers to the use of metal parts to help hold an area together until healing takes place. This could include cages, plates, screws, nails, or rods.

All this sounds good but no one wants to be the first patient a surgeon treats with some new-fangled idea. But patients can be rest assured; minimally invasive spine surgery is well-researched with over 850 articles already published since the year 2000.

Of course, each surgeon will have his or her own transition time learning how to do these techniques. It does take time to learn any new skill or surgical technique. But the basic skills required don't change from procedure to procedure. Patient safety and good results are always on the surgeon's mind. Studies so far don't show a high complication rate for surgeons developing this new set of surgical skills.

One of the latest developments in MISS is the tube-based procedure. The original MISS operations started with needle-like instruments such as the endoscope used for vertebroplasty, kyphoplasty, discectomy, or destroying tumors with radiofrequency. Larger portals openings into the body with the same small incision are possible with tube-shaped surgical tools.

The tube allows the surgeon to access a larger area underneath the incision, take photos inside the body at the operative site, and even allow for more extensive surgeries that would have needed an open incision before tubular retractors were developed. Retractors help hold the skin and underlying soft tissues open to give the surgeon access to the intended surgical area.

Minimally invasive spine surgery is not the norm yet. Surgeons would say it's not the community standard. But as more and more studies are published supporting its use, surgeons are being trained in using this technique. The methods used are compared to constructing a ship in a bottle. More highly technical skills are needed but they can be done with the newer microsurgical tools now available.

To repeat with greater understanding now, recall what the authors first said: The value of Minimally Invasive Spine Surgery (MISS) is more than surgeon assumption or a marketing whim. Here are some practical examples of just what that means. 1) Patients experience less tissue trauma. 2) There is faster recovery of muscle strength when muscles don't have to be cut away and reattached at the end of the operation. 3) Some studies show less blood loss with MISS, shorter hospital stays, and lower costs as a result. 4) With fluoroscopy for viewing the spine, accuracy is improved when placing tiny screws in the vertebrae through these small incisions.

In the future, it is likely that more types of spinal surgeries will move from an open approach to a minimally invasive method. This expansion has already been observed in some places. Surgeons will specialize in MISS. Surgical instruments will continue to improve as technology moves forward. And the reported records of patient (good) results will bear out this treatment method as safe and more effective with fewer complications.


Reginald Q. Knight. Minimally Invasive Spine Surgery. In Current Orthopaedic Practice. May/June 2009. Vol. 20. No. 3. Pp. 227-231.

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*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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